Our Bodies, Ourselves (70 page)

Prepare for variable temperatures in the clinic rooms by dressing in layers. You can bring music, and you may even be able to listen to it during the procedure. Be sure you have documentation that the clinic requires, such as identification and your insurance card or some other means of paying for the abortion.

Even when abortion feels like the right decision, it may still be difficult. You may feel a wide range of feelings, from sadness and grief to anticipation and relief. It can be confusing when even though you have decided that having an abortion is best for you, you still feel bad. Journal writing can be helpful, as can talking with a friend, acknowledging your feelings, honoring your decision, and having self-compassion. See
“Resources for Support,”
, for recommended hotlines and websites.

Think about whether you would like someone to accompany you to the abortion procedure. Some clinics will allow a companion to stay in the room with you during the abortion, and some will not. If having someone with you is important to you, ask the clinic beforehand if it is allowed and seek out a clinic where it is.

Though some private doctors' offices and clinics do not attract protesters, at other clinics there are regular “sidewalk counselors” and demonstrators. If you are concerned, call ahead and ask what you might encounter. Abortion providers are usually well prepared—there may be escorts who will meet you outside and accompany you into the clinic. If you live nearby, you may want to drive by or go to the clinic ahead of time to get familiar with the area. You will want to avoid direct contact with the protesters, even when they get close to you and say things that are mean and hurtful.

Once inside the clinic, you will fill out a medical history form. A health worker will check your vital signs (blood pressure, pulse, and temperature), repeat a urine pregnancy test, and draw blood to check for anemia and the Rh factor.
*
You may have an ultrasound exam to
confirm how many weeks pregnant you are. The length of a pregnancy is usually counted from the first day of the last normal menstrual period (LMP) and not from the day of conception (fertilization).
*

A health worker or clinician will talk to you about your decision to have an abortion and tell you what to expect during and after the procedure. In most clinics, if you are less than nine weeks pregnant, you will be given the choice of an aspiration (surgical) abortion or a medication abortion (see “Abortion Methods,” below). The educational session is a time for you to ask questions and express any concerns. The clinic may also offer informational videos or group counseling sessions where you can talk with other women who are having abortions. In some states, staff/health care workers are required to give you materials or information that will try to discourage you from having an abortion. This is not because they want to do so but because certain states require it—a result of antiabortion politics. Once you have the information you need and your questions have been answered, you will be asked to sign consent forms. The next steps in your visit depend on the type of abortion you are having.

Many abortion providers now ask their patients if they would like to see the ultrasound image of their pregnancy during their appointment. Some women find the viewing helpful to their decision-making process. Others do not want to view the image. Either way, you should think about what you want and be sure to let the staff member performing your abortion know what you want.

Most women who have abortions in the United States are highly satisfied with their care.
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When you call to make an appointment (and, of course, while you are at your appointment), ask about anything that concerns you. Trust your feelings about the way you are treated on the phone as well as in person. You should not have to defend yourself to anyone; you should feel supported in your decision and how you want your care to be provided.

A staff member at a clinic describes how it can and should be:

At our clinic, counselors are trained to help each woman sort out her feelings. We do not invade anyone's privacy if she tells us that her decision is clear and not coerced, and that she does not want to discuss her reasons or feelings. At the same time, if she needs to talk through what she's feeling, we spend time working through those emotions with her. Women talk with each other, not just with the counselor. We provide very detailed and accurate information about the abortion procedure. A woman can have a friend stay with her during the abortion. When there is a decision to be made, the woman herself is an active participant
.

In the United States, most abortions (88 percent) are performed during the first trimester, meaning through the twelfth week of pregnancy.
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First-trimester abortions are performed using one of two methods: vacuum aspiration (also called surgical abortion) or medication abortion (also called medical abortion or abortion with pills). In vacuum aspiration, suction is used to remove the pregnancy; in a medication abortion, the pregnancy is interrupted and expelled over the course of a few days using medicines.

In the United States, most second-trimester abortions are done by dilation and evacuation (D&E), which involves dilation of the cervix and
the use of instruments and suction. Alternatively, women who are more than twenty weeks pregnant may have the option for an induction abortion using medications that cause the pregnancy to be expelled.

Which abortion method is used will depend on how pregnant you are; your medical history, including any medical conditions or drug allergies; the training of the person performing the abortion; the equipment and supplies available; the approaches favored by the local medical community; and your own preferences.

A medication abortion, also called medical abortion or abortion with pills, consists of a two-drug regimen that ends a pregnancy within the first nine weeks of pregnancy. A medication abortion is different from using emergency contraceptive pills (EC, otherwise known as morning-after pills) such as Plan B, which can be taken up to three days after unprotected intercourse to prevent conception, or ella, which can be taken up to five days after unprotected intercourse. (For more information, see
“Emergency Contraception.”
)

In the United States, the most common kind of medication abortion involves the drugs mifepristone (also known as Mifeprex, RU-486, or the “abortion pill”) and misoprostol. The mifepristone is taken orally at the doctor's office or clinic, and the misoprostol is used later, usually at home. In a few clinics, Methotrexate (an injection) plus misoprostol is used for medication abortion.
*
Methotrexate is more common in Canada, where women do not yet have access to mifepristone.

Medication abortion with mifepristone/misoprostol is very safe and about 95 to 98 percent effective. In 2 to 5 percent of cases, women will need a vacuum aspiration to complete the abortion. This may be because the drugs didn't work and the pregnancy continues (about 1 percent of the time) or because of heavy or prolonged bleeding. Since September 2000, when the U.S. Food and Drug Administration approved mifepristone, more than a million women in the United States have safely used mifepristone/misoprostol,
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and millions more worldwide have used it since it first became available in France in the late 1980s.

Mifepristone works by blocking progesterone, a hormone that is needed to sustain a pregnancy. Without progesterone, the embryo detaches from the uterine lining. Misoprostol, a prostaglandin that is either inserted into the vagina or allowed to dissolve inside your mouth (between your cheeks and gums or under your tongue), causes the cervix to become soft and the uterus to cramp. The embryo is then expelled in what seems like a heavy period.

After taking the mifepristone at the doctor's office or clinic, you may experience bleeding, nausea, or fatigue. Even if you have bleeding, it is very important to take the misoprostol as instructed. Most clinics recommend that you use the misoprostol twenty-four to forty-eight hours after the mifepristone. The waiting time is important and increases the likelihood that the medications will work.

Most women use the misoprostol at home. Cramping and bleeding, possibly heavier than your normal period, will usually begin within a few hours. You can take over-the-counter pain relievers such as aspirin, Tylenol, or ibuprofen for the pain, and many women find that a heating pad or hot water bottle helps relieve the cramping. Other common side effects include nausea, vomiting, diarrhea, fever, chills, or fatigue.

It is normal to have more bleeding than a normal menstrual period and pass blood clots. You may also see light pink or whitish wispy tissue, which is the gestational sac. The embryo is less than half a centimeter long at this stage and is often embedded in a blood clot. Severe lower abdominal cramps typically mean that pregnancy tissue is passing out of the uterus. The cramping may occur in waves (see
“Controlling Pain and Anxiety,”
, for coping techniques). Generally, cramping will subside after the tissue passes (about four hours, but each woman's body is different). The bleeding will gradually decrease over the next few days, and light spotting often continues for one to three weeks.