Abortion Procedures and the Risks

Making an Informed Decision

This section will tell you about the different kinds of abortions. It will also tell you about the medical risks for abortion, pregnancy, and childbirth.

Abortion is ending the pregnancy by using medicine or a surgical procedure. In Texas, the legal definition of an abortion is the use of any means to terminate the pregnancy of a female known by the attending physician to be pregnant with the intention that the termination of the pregnancy by those means will with reasonable likelihood result in the death of the fetus. Some women consider an abortion because their pregnancy might threaten the woman's life or her health or her baby may have severe birth defects. Other women choose to end their pregnancy without any known problems with their health or with their unborn child.

Spontaneous abortion (often called miscarriage) can occur when problems with a pregnancy cause the woman to lose that pregnancy naturally.

A doctor should evaluate you if you are thinking about having an abortion. Only a doctor can perform an abortion. Discuss your situation with your doctor. Ask about any risks you might face. You can expect the following things to happen:

• If you are a minor, a parent must be notified or you will have to ask a judge to waive that notification.
• You will be asked about your medical history.
• You will get a physical exam.
• Some lab tests will be done.
• You will find out for sure if you're pregnant and how long you've been pregnant. Your doctor will do a pelvic exam and may do an ultrasound.
• You will get counseling.
• You will talk about your feelings about abortion.
• You will find out about the risks of having an abortion.
• You will find out the risks of having a baby.
• Your questions will be discussed and answered.
• You will get some information about abortion. You will have at least a full day to read this information before the appointment for your abortion.
• You will sign a consent form for your abortion.

Remember, it is your right and the doctor's responsibility to inform you fully prior to the procedure. Ask all of your questions and make sure you understand the answers. You have a right to view your medical records, including your ultrasound, at any time.

Abortion Risks

The risks are fewer when an abortion is done in the early weeks of pregnancy. The further along in the pregnancy, the greater the chance of serious complications and the greater the risk of dying from the abortion procedure. For example:

• One death per every 530,000 abortions if you are at eight weeks or less.
• One death per 17,000 abortions for pregnancies at 16–20 weeks.
• One death per 6,000 abortions at 21 weeks and more.

Other factors that affect the possibility of complications include:

• The skill and training of the doctor.
• The kind of anesthesia used.
• Your overall health.
• Abortion procedure used.

Medical (Nonsurgical) Abortion

Medical abortion is a way to end a pregnancy with medicines without a surgical procedure. The protocol approved by the Food and Drug Administration allows this type of abortion up to 49 days after the last menstrual period. Only a physician can perform a medical abortion. A medical abortion can only be used in early pregnancy, usually up to seven weeks, but sometimes up to nine weeks from your last menstrual period. The gestational age must be determined before getting any of these medicines.

Who should not have a medical abortion?

Some women should not be given the medicines used for a medical abortion, such as women who are too far along in their pregnancy or are allergic to certain medications, women with confirmed or suspected ectopic pregnancy, or women with an IUD in place. You should discuss with your doctor whether you have any medical condition that would make a medical abortion unsafe for you. To have a medical abortion, you must:

• have access to an emergency room.
• have access to a telephone.
• be able to attend all the visits; several visits may be required.
• be able to follow the doctor's instructions and understand what may occur with the procedure.

Mifepristone (RU 486) and methotrexate are two of the medicines used for a medical abortion. Mifepristone is given to a woman by mouth, or vaginally. Methotrexate is usually given by injection, but may also be given by mouth. Methotrexate can cause serious birth defects if your pregnancy doesn't end.

After receiving mifepristone or methotrexate, you may bleed and pass clots, tissue, and the unborn child within hours to days. The bleeding can last up to three weeks or more. Your doctor will tell you when you need to return to be checked. If you are still pregnant at that visit, you will be given a second drug (misoprostol), either by mouth or vaginally. Approximately two weeks later, you will return for an important follow-up visit. Your doctor will determine whether your pregnancy has completely ended. If you are still pregnant, a surgical procedure will be necessary.

Possible side effects and risks

• Cramping of the uterus or pelvic pain.
• Nausea or vomiting.
• Diarrhea.
• Warmth or chills.
• Headache.
• Dizziness.
• Fatigue.
• Inability to get pregnant due to infection or complication of an operation.
• Allergic reaction to the medicines.
• Hemorrhage (heavy bleeding) possibly requiring treatment with an operation, a blood transfusion, or both.
• Incomplete removal of the unborn child, placenta, or contents of the uterus, requiring an operation.
• Rarely, death.

Dilatation and Curettage (D&C) with Vacuum Aspiration

This is a surgical procedure generally used in the first 12 weeks of a pregnancy. Unless there are unusual problems, this procedure may be done in a doctor's office or a clinic.

The doctor first opens (dilates) the cervix and then empties the uterus with suction. After suctioning, the doctor may scrape the walls of the uterus to make sure the unborn child, placenta, and contents of the uterus have been completely removed.

Possible side effects and risks

• Cramping of the uterus or pelvic pain.
• A hole in the uterus (uterine perforation) or other damage to the uterus.
• Injury to the bowel or the bladder.
• A cut or torn cervix (cervical laceration).
• Incomplete removal of the unborn child, placenta, or contents of the uterus requiring an additional operation.
• Infection.
• Complications from anesthesia such as respiratory problems, nausea and vomiting, headaches, or drug reactions.
• Inability to get pregnant due to infection or complication from an operation.
• A possible hysterectomy as a result of complication or injury during the procedure.
• Hemorrhage (heavy bleeding).
• Emergency treatment for any of the above problems, including possible need to treat with an operation, medicines, or a blood transfusion.
• Rarely, death.

Dilatation and Evacuation (D&E)

This procedure is generally used after 12 weeks of pregnancy. The procedure will generally be done in a doctor's office or clinic, but may sometimes be done in a hospital. The doctor will often use ultrasound to determine how far along you are in your pregnancy.

To prepare for the procedure, the doctor will open (dilate) the cervix. Most women experience some pain, so the doctor may give you a painkiller — either locally by shots in the area of the cervix or by a general anesthetic — or a sedative (which will leave you conscious). The uterus will be scraped and the unborn child and placenta are removed. After 16 weeks, the unborn child and placenta are removed, piece-by-piece, using forceps or other instruments. This procedure will take less than an hour.

Possible side effects and risks

• A hole in the uterus (uterine perforation) or other damage to the uterus.
• Injury to the bowel or bladder.
• A cut or torn cervix (cervical laceration).
• Incomplete removal of the unborn child, placenta, or contents of the uterus requiring an additional operation.
• Infection.
• Complications from anesthesia, such as respiratory problems, nausea and vomiting, headaches, or drug reactions.
• Inability to get pregnant due to infection or complication from an operation.
• A possible hysterectomy as a result of complication or injury during the procedure.
• Hemorrhage (heavy bleeding).
• Emergency treatment for any of the above problems, including the possible need to treat with an operation, medicines, or a blood transfusion.
• Rarely, death.

Abortion by Labor Induction (Medical Induction)

This procedure is generally used after 16 weeks of a pregnancy. The procedure will generally require a hospital stay of one or more days.

Medicines will be used to start labor. These medicines can be put in the vagina, injected in the uterus (womb) or given into the vein (intravenously or by IV). The medicines used cause the uterus to contract and labor to begin. Sometimes more than one medicine will be used. This procedure may take from several hours to several days.

Your doctor may use instruments to scrape the uterus and make sure that the unborn child, placenta, and other contents of the uterus have been completely removed.

Possible side effects and risks

• Nausea or vomiting.
• Diarrhea.
• Fever.
• Infection.
• Complications from anesthesia such as respiratory problems, nausea and vomiting, headaches, or drug reactions.
• Inability to get pregnant due to infection or complication from an operation.
• A possible hysterectomy as a result of complication or injury during the procedure.
• Damage or rupture of the uterus (womb).
• The possibility of a live-born baby. *
• Incomplete removal of the unborn child, placenta, or contents of the uterus requiring an operation.
• Hemorrhage (heavy bleeding).
• Water intoxication.
• Emergency treatment for any of the above problems, including the possible need to treat with an operation, medicines, or a blood transfusion.
• Rarely, death.

Who should not have an abortion by medical induction?

Some women should not have a medical induction, such as a woman who has had previous surgery to the uterus or a woman with placenta previa. You should discuss with your doctor if you are one of these women.

*If the unborn child is born alive, the attending physician has the legal obligation to take all reasonable steps necessary to maintain the life and health of the child.

Dilatation and Extraction (D&X)

This type of abortion is one of the procedures that can be done after 16 weeks gestation. It may be done in the clinic or in the hospital for more advanced pregnancies.

The doctor will dilate (open) the cervix. The doctor will grasp the unborn child's foot with an instrument and deliver the child except for the head. While the head is kept in the birth canal, scissors are used to make a hole in the back of the head, a tube is inserted, and suction is applied. The contents of the unborn child's skull are suctioned out, the bones of the head collapse, and the child is delivered dead.

Possible side effects and risks

• A hole in the uterus (uterine perforation) or other damage to the uterus.
• Injury to the bowel or bladder.
• A cut or torn cervix (cervical laceration).
• Incomplete removal of the unborn child, placenta, or contents of the uterus, requiring an additional operation.
• Infection.
• Complications from anesthesia such as respiratory problems, nausea and vomiting, headaches, or drug reactions.
• Inability to get pregnant due to infection or complication from an operation.
• A possible hysterectomy as a result of complication or injury during the procedure.
• Hemorrhage (heavy bleeding).
• Emergency treatment for any of the above problems, including the possible need to treat with an operation, medicines, or a blood transfusion.
• Rarely, death.

NOTE: Former Surgeon General C. Everett Koop and the Physician's Ad Hoc Coalition for Truth stated in 1996 that this type of procedure "... is never medically necessary to protect a mother's health or her future fertility. On the contrary, this procedure can pose a significant threat to both."

After an Abortion

What you may expect

After an abortion, you will need to stay at the doctor's office, clinic, or hospital where the procedure was performed, so you can be checked for problems or complications. How long you will be watched will depend on the type of procedure performed and the anesthesia used during that procedure.

After you have been watched and before you go home, you may be given an antibiotic to prevent infection, and another medication to contract your uterus to reduce bleeding. Your doctor will give you instructions. Your doctor will tell you how long you must wait before having intercourse again and may discuss birth-control methods with you. You may receive a prescription for pain medication. After having an abortion, you should not drive yourself home.

It is normal for you to have some cramping and a small amount of bleeding after having any type of abortion. Your uterus contracting back to its normal size causes the cramping.

GO TO THE EMERGENCY ROOM, OR CALL THE CLINIC OR DOCTOR THAT PERFORMED THE ABORTION IF:

• heavy bleeding occurs (2 or more pads/hour).
• pain is severe or not controlled by pain medication.
• you have fever.
• you have difficulty breathing or shortness of breath.
• you have chest pain.
• you are disoriented.

Most women can return to their daily activities within a day or so after a procedure. It is important that you return to your doctor for a checkup two to three weeks after an abortion.

Information on this page is reprinted with permission by the Texas Department of State Health Services, from the "A Woman's Right to Know" booklet, copyright 2003 Texas Department of Health. All rights reserved.