Abortion
Therapeutic abortion is the intentional ending of a pregnancy before the fetus can live independently. Abortion has been legal in the United States since 1973. Women have abortions because continuing a pregnancy would cause hardship, endanger their life or health, or because the fetus has severe abnormalities. Pre-abortion counseling is important to resolve any questions about having the procedure.
A doctor must know the stage of a woman's pregnancy before performing an abortion. The doctor asks questions about the woman's menstrual cycle and does a physical examination. This may be done at an office visit before the abortion or on the day of the abortion. Some states require a waiting period before an abortion can be performed. Others require parental or court consent for a child under age 18 to receive an abortion.
The first trimester of pregnancy includes the first 13 weeks after the last menstrual period. In the United States, about 90% of abortions are performed during this period. It is the safest time in which to have an abortion. Although an abortion during the first trimester is safer, some second trimester abortions are unavoidable. The results of genetic testing are often unavailable before 16 weeks. Also, some women, especially teens, may not recognize a pregnancy or come to terms with it soon enough to have an earlier abortion. Abortions performed between 13-24 weeks have a higher rate of complications. Abortions after 24 weeks are extremely rare and are usually limited to the mother's life being in danger.
Serious complications resulting from abortions performed before 13 weeks are rare. Of the 90% of women who have abortions in this time period, 2.5% have minor complications that can be handled without hospitalization. Less than 0.5% have complications that require a hospital stay. The rate of complications increases as the pregnancy progresses.
Very early abortions cost $200-$400. Later abortions cost more because they involve more risk, more services, anesthesia, and sometimes a hospital stay. Insurance carriers and HMOs may or may not cover the procedure. Federal law prohibits federal funds, including Medicaid funds, from being used for an elective abortion.
Early in pregnancy, most women can have abortions at clinics or outpatient facilities. Between five and seven weeks, a pregnancy can be ended by menstrual extraction, sometimes called menstrual regulation, mini-suction, or preemptive abortion. The contents of the uterus are suctioned out through a thin (3-4 mm) plastic tube inserted through the undilated cervix. Suction is applied by a bulb syringe or a small pump. Menstrual extraction is safe, but because the amount of fetal material is so small, it is easy to miss. An incomplete abortion means the pregnancy continues.
Another type of abortion, medical abortion, involves taking medications. There are two methods. In the first, a woman receives an injection of methotrexate at her doctor's office. Methotrexate stops the fetal cells from dividing. About a week later, she is given misoprostol (Cytotec), which stimulates contractions of the uterus. Within two weeks, the woman expels the contents of her uterus. This method is 90-96% effective. A follow-up visit to the doctor is necessary.
In the other method, a woman is given Mifepristone (RU-486). This drug blocks the action of progesterone, a hormone needed to continue a pregnancy. On the first doctor's visit, a woman takes a mifepristone pill. Two days later, she returns to take two misoprostol pills. Ninety percent of women complete the abortion within four days; 95-97% of women, within 14 days. A follow-up visit to the doctor is necessary. If the procedure is incomplete, a surgical abortion is performed.
First trimester surgical abortions are performed using vacuum aspiration, also called dilation and evacuation (D & E), suction dilation, vacuum curettage, or suction curettage. During a vacuum aspiration, the woman's cervix is gradually dilated by expanding rods inserted into the cervix. Once dilated, a tube is inserted and the contents of the uterus are suctioned out. The procedure is 97-99% effective. The amount of discomfort involved varies considerably. Local anesthesia is often given to numb the cervix, but it does not mask uterine cramping. The woman may return home after a few hours.
Some second trimester abortions are performed as a D & E. The procedures are similar to those in a first trimester, but the risk is higher. For some women, it is not safe. An alternative is an abortion by induced labor. Induced labor may require an overnight hospital stay. The day before, the woman visits her doctor for tests and has rods inserted in her cervix to dilate it or receives medication to speed up labor. On the day of the abortion, drugs to induce contractions and a salt water solution are injected into the uterus. Within 8-72 hours, the fetus is delivered.
Regardless of the abortion method, a woman is observed for a period of time to make sure her blood pressure is stable and that bleeding is controlled. The doctor may prescribe antibiotics to reduce chance of infection. Women who are Rh negative (lacking genetically determined proteins in their red blood cells that produce immune responses) are given a human RH immune globulin (RhoGAM) after the procedure if the father of the fetus is Rh positive.
Bleeding continues for about five days after a surgical abortion and longer after a medical abortion. To decrease the risk of infection, a woman should avoid intercourse and not use tampons and douches for two weeks after the abortion. A follow-up visit is a necessary part of the woman's aftercare. Contraception will be offered to women who wish to avoid future pregnancies, because menstrual periods normally resume within a few weeks.
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