Abortion

Abortion is a divisive subject, widely considered unsuitable for polite dinner conversation, which makes it a difficult one to address on a site whose purpose is to provide simple, factual medical information. Nonetheless, we will attempt here to provide such information while steering clear of the political and ethical debates surrounding this hot-button topic.

What is Abortion?

Abortion is the termination of a pregnancy before it has reached viability; that is, before the fetus has reached a sufficiently advanced stage of development to survive outside the womb. The broadest use of the term also covers instances in which it occurs spontaneously—i.e., miscarriages. When most people use the word abortion, however, they are talking about the deliberate medical termination of a pregnancy.

Is Abortion Safe?

When legally performed by a qualified practitioner in an appropriate, safe, and sanitary setting, abortion is one of the safest medical procedures available. Unfortunately, unsafe abortions occur by the millions each year; nearly half of the estimated 44 million abortions that take place annually around the world are unsafe, and over 47,000 women die each year from unsafe abortions. Under normal circumstances, however, the risk of this routine procedure—nearly 30 percent of American women have one before the age of 45—is minimal.

Medical Abortion—the “Abortion Pill”

Before performing an abortion, a physician will usually perform an ultrasound to determine how advanced the pregnancy is. If an abortion is performed before the ninth week of pregnancy, it can be accomplished chemically, with pharmaceutical products such as mifepristone combined with misoprostol (Cytotec) or gemeprost. This is known as a medical abortion. This method has a 97 percent success rate, although it can cause birth defects in the event of failure, in which case a surgical abortion will be necessary.

Other risks are rare, but include allergic reaction to the pills, infection, uterine blood clots, heavy bleeding, and ectopic pregnancy. Following a medical abortion, call your doctor immediately if you experience any of these symptoms:

• Heavy bleeding (using up two or more pads in an hour) that lasts for two hours or more
• Clots larger than a lime more than two hours after the abortion
• Fever 100° F or higher
• Severe abdominal pain
• Nausea or diarrhea lasting longer than 24 hours
• Foul smelling vaginal discharge

Surgical Abortion Procedure

If abortion is being considered early enough, a medical abortion is possible. More often, however (at least in the United States), a surgical abortion will be necessary. Prior to 13 weeks (i.e., during the first trimester), the most commonly used method is vacuum aspiration, which involves removing the fetus by suction, either with a manual syringe or with an electric pump. This is usually referred to as a suction D&C (D&C stands for dilatation and curettage) or suction curettage. Suction D&C might also be used for treatment of a miscarriage if there is pregnancy tissue still inside the uterus. Abortions can generally be performed during the first trimester with only local anesthesia and some type of sedation.

Pregnancies that are 13 weeks or farther along require different surgical methods. One such method is dilation and evacuation (D&E), which involves a combination of suction and surgical instruments. For very late abortion (after 20 weeks), there are rare instances in which a hysterotomy abortion is required. This is similar to a cesarean section delivery in that an incision is made in the abdomen so that the fetus can be removed. These types of abortion procedures require general anesthesia and highly trained ob/gyn surgeons.

Abortion Risks

Although abortion is generally a safe procedure, there are still risks involved. As previously noted, an unsuccessful attempt to end the pregnancy with the “abortion pill” can result in various birth defects if the pregnancy is subsequently allowed to go to term. Risks that may accompany a surgical abortion include:

• Damage to the cervix or to the womb
• Accidental perforation of the uterus
• Excessive bleeding
• Uterine scarring
• Uterine infection
• Incomplete removal of fetus and pregnancy-related tissue, necessitating a second surgical procedure

What to Expect After an Abortion

If you have a surgical abortion, you will remain in a recovery area for a few hours after the procedure is finished. You will have cramps for a day or two, but you can expect to recover physically soon after that, although you may experience vaginal bleeding for a week or two. Your next period will usually arrive about a month or so later. It is possible for you to become pregnant again during this time, so you will need to be careful about further sexual activity until you get your first normal period.

Abortion can be an emotionally traumatic procedure, even when it is medically necessary or when the mother is certain she does not want the baby. While it has not been established that abortion causes long-term mental health problems, you may experience some short-term mental trauma. Most women feel relieved, but many also feel sad. You may have moments of regret, or even feelings of guilt. Hormonal changes will exacerbate any emotional trauma you experience. Lean on friends and family for emotional support, and be patient—these feelings will pass.

Questions to Ask Your Doctor About Abortion

• Does my pregnancy carry any risks that might make it necessary for me to consider an abortion?
• In light of how far my pregnancy has advanced, is it possible for me to take a mifepristone abortion pill, or will a surgical procedure be necessary?
• How likely is it that the pharmaceutical abortion will fail and that I will have to get a surgical abortion?
• If a surgical abortion is necessary, will I be under local or general anesthesia?
• Can anything be done about the psychological trauma caused by my abortion? Is there a mental health specialist I could see if I need to?