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California State University, Long Beach
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Choosing Abortion

Making Your Choice

When making the decision to either have an abortion or continue a pregnancy, it is important to take the time you need to make the choice that is best for you.

Talking with your partner, a trusted family member or friend may be helpful when making this decision. Pregnancy options counselors should provide you with information in order for you to make the best decision. They should not tell you what to do, but listen and provide factual information only.

Women choose abortion for many reasons and this decision might vary depending on the circumstances in their current situation. For example, at 16 a woman may not be ready physically, emotionally, or financially but at 30 she may be prepared for the responsibilities of having a child. Another example could be that a married couple who already has children cannot take on the burden of another child financially or emotionally. These are just a few examples but each woman will have to make these choices on her own.

Abortion is truly an individual choice and when the choice is not your own, the emotional effects may have an impact. For example, if the pregnancy was unwanted and a woman was forced to give birth, the child may be treated poorly or neglected. The opposite situation could occur as well when a woman wants to continue the pregnancy but is forced to abort, she may have lasting effects. The majority of women who choose abortion are satisfied with their decision and have no negative emotional effects.

Different Abortion Procedures

Each year, about 1.3 million women in the United States have an abortion. Abortion is legal in every state in the United States and every province in Canada, but every state has its own laws about abortion (1). It is a procedure that is low risk when done in the proper setting. If you decide to have an abortion, it is safer to do it earlier rather than later (2). An abortion can be done in several ways, and the type of abortion you have is based on your choice, your health, and how long you have been pregnant (2).

Medical Abortion

A medical abortion uses two types of medicine to end a pregnancy without surgery. The first medication will either be an injection of methotrexate, or a tablet form of mifepristone (also known as RU-486). They both affect the body differently, so your doctor will help you decide which medication will be better for you. Methotexate stops the ongoing process of implantation of an early pregnancy. Mifepristone blocks the hormone progesterone, which causes the lining of the uterus to break down and end the pregnancy (2). A second medication, misoprostol is taken in tablet form and will cause the uterus to contract and drain. A follow up visit is needed to ensure the abortion is complete. Medical abortions are only an option during the first trimester of pregnancy (2).

Bleeding may occur after taking the first drug, and this bleeding may be light or it can be similar to a heavy period. The misoprostol usually causes cramping and bleeding within a few hours of taking it. The cramps will last for several hours, and many women will pass blood clots as they are aborting. Misoprostol causes the most common side effects, which include: headache, nausea, vomiting, diarrhea, fever, chills, or fatigue (1). Cramps will usually decrease after the embryonic tissue has been passed, but bleeding may last for one to two weeks after the abortion.

Surgical Abortion

Surgical abortion is considered a safe medical procedure. The three most common methods of surgical abortion are manual vacuum aspiration, dilation and suction curettage, and dilation and evacuation. The method that will be used depends on how long you have been pregnant, or the number of days since the first day of your last period (2).

The manual vacuum aspiration, or MVA, can be done as soon as you know you are pregnant and up to week 10 of pregnancy. The abortion provider will insert an instrument, called a speculum into your vagina to hold the vaginal walls apart. The provider will usually numb the cervix (the opening to the uterus) with a local anesthetic before gradually widening (dilating) it. When the cervix is about as big around as a drinking straw, the provider inserts a small tube attached to a suction apparatus (similar to the one dentists use the clear the mouth of saliva). The machine will gently suction out the contents of the uterus through the tube (1). This procedure takes about ten minutes (2).

The dilation and suction curettage method has the same procedure as the MVA; however, the provider will then check the walls of the uterus with a small, narrow metal loop called a curette. The curette is used to clean the walls to be sure no tissue remains (2). This method is performed six to fourteen weeks after your last period and will take about ten minutes.

The dilation and evacuation method is a two-part procedure that can be done up to week 24 of pregnancy. The doctor will slowly open the cervix, and will then use medical instruments, suction, and curettage to complete the procedure (2). Abortions are not usually performed after 24 weeks unless there is a serious health reason.

During the procedure, and for a short time afterward, women may have strong cramping. Spotting or bleeding similar to a period may last for a few days or even weeks. Complications are very rare, but they can include infection, excessive bleeding, a tear in the cervix or uterus, incomplete abortion, or a continuing pregnancy (1).

Finding a Provider

Abortions are performed in a variety of settings: clinics, surgi-centers, private offices, and in certain cases, hospitals. In general, doctors and some advanced practice clinicians (including physician assistants, nurse practitioners, and nurse midwives) who are licensed by the state can provide abortions. In case of emergency, the abortion provider should have immediate access to a nearby hospital (1).

If you think you are pregnant and want to talk about your options, call the National Abortion Federation hotline operators at 1-800-772-9100. They can tell you the names of qualified abortion providers near you or you can visit their website at www.prochoice.org

Planned Parenthood is another good resource to contact if you have any questions or concerns. The number is 1-800-230-PLAN, or you can look on their website at www.plannedparenthood.org

If you are 18 or younger

Some states allow teenagers (minors) to make their own decision about abortion; however, some require you to notify one or both parents ("parental notification") or require you to obtain your parents' permission ("parental consent") (1).

It is a good idea for teens to talk with their parents or a trusted adult friend about their decision, but if you have important reasons not to involve your parents, and you live in a state that requires parental consent, you may be able to go to court and ask a judge to give you permission instead (1).

How Much Will it Cost?

Fees

The cost of an abortion can vary, depending on many factors such as how far along the pregnancy is, the kind of facility you use (clinic, physician's office, or hospital), and the kind of procedure done (1).

Hospitals generally cost more than health centers. At health centers, such as Planned Parenthood, the fee ranges from about $225 to $575 for an abortion in the first trimester (2). Abortions that are done later in the pregnancy are more expensive.

If you have insurance

Read your policy carefully. Some policies don't cover abortion services.

If you receive Medicaid

Call the National Abortion Federation hotline at (800) 772-9100 to find out whether Medicaid covers abortion in your state. If it does, the hotline operator can give you the names of facilities that accept Medicaid payment.

If you don't have enough money

Some facilities have funds to help cover abortions for women who can't pay. Also, the National Abortion Federation hotline operators at (800) 772-9100 can sometimes help find funding sources.

What Will It Be Like?

You may have to visit the clinic several times before the entire procedure is completed. The first visit may be a confirmation pregnancy test, physical examination, determination of which type of abortion you will have, figuring out payment options, and scheduling the actual termination procedure date.

The second visit you should plan to be at the medical facility for several hours, especially if you having a surgical procedure. If you are having a medical abortion, then you may be there for a shorter period of time. Most of that time will be spent waiting, so you may want to bring a friend or a book.

A third visit may be required to follow up with a clinical provider. This may include confirmation that the abortion was successful or just a medical check up.

Tests and Counseling

Before performing the abortion, the medical provider should:

  • Confirm your pregnancy with a pregnancy test, an ultrasound or an internal examination, even if that has been done elsewhere.
  • Test your blood for Rh factor.
  • Inform you about any other tests you may need.

A trained professional (nurse, doctor or counselor) should review your pregnancy options and talk with you about your decision. This session should include:

  • Explain the abortion procedure and what to expect
  • Make sure you understand any risks or possible complications in the procedure you will be having
  • Answer all of your questions

In the United States, there are more than six million women who become pregnant every year, and half of those pregnancies are unintended. In addition, 1.31 million of those unintended pregnancies will end in abortion (2).

Making the decision to end a pregnancy can be one of the most difficult decisions of your life. Just remember you are not alone. There are counselors and hotlines you can call for information or any questions that you have. They can help explain your options so you can decide what is best for you. The CSULB Student Health Services offers pregnancy options counseling and free pregnancy testing.

References

  1. National Abortion Federation.(2010). Abortion facts. Retrieved from http://www.prochoice.org/about_abortion/facts/index.html .
  2. Planned Parenthood. (2012). Abortion. Retrieved from http://www.plannedparenthood.org/health-topics/abortion-4260.as

Last Updated 08/2012