Our Bodies, Ourselves (71 page)
Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
Though complications are rare, if you have heavy bleeding (enough to soak through two or more thick full-size sanitary pads per hour for two consecutive hours), have sharp abdominal
pain or pain in your lower back, or have a fever of 100.4°F or higher that lasts for more than four hours, call your provider or the clinic. (For more information, see “Symptoms to Watch for
After an Abortion.”
)
EXPERIENCES OF WOMEN WHO HAVE HAD A MEDICATION ABORTION
In the United States, the percentage of women who choose the method varies quite a bit from region to region and clinic to clinic. In 2005, 22 percent of women who were less than nine weeks pregnant chose a medication abortion.
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Nationally it is estimated that medication abortion is used in 10 percent of all abortions.
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Some of the reasons include a desire to avoid an invasive, surgical procedure; a perception that it is better, easier, or more “natural” (“like a miscarriage”); and a feeling that it is more private. Most important, studies show that the overwhelming majority of women surveyed are satisfied with whatever method they choose.
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This was a very personal and private procedure, which enabled me to have some control over this difficult situation. This procedure is not for every woman. The bleeding and cramping last longer [than an aspiration abortion] and are somewhat unpredictable. The hardest thing is the waiting between taking the medication and finishing the abortion. Aspiration would have been faster. However, for me it was better because I'm more private. I was comfortable being in my own home. Even though I did have side effects, this was [an] easier procedure, both emotionally and physically.
Most clinics require a follow-up visit to confirm that the abortion is complete. The clinician will do a physical examination, ultrasound, or blood pregnancy test. Sometimes these services can be managed by phone without having to return to the clinic. If the pregnancy is continuing, you will need to have a vacuum aspiration abortion. If the embryo has stopped growing but some pregnancy tissue still remains in the uterus (sometimes called an incomplete abortion), the clinician may give you more misoprostol, empty the uterus with suction, or simply ask you to return for another visit.
You will likely get your next period within about four to six weeks after using the misoprostol. Some women find that this first period after a medication abortion is heavier or has more clots than normal. A small percentage of women have an episode of extra heavy bleeding about three to five weeks after the misoprostol. (See
“Aftercare,”
and “Symptoms to Watch for
After an Abortion,”
for general abortion aftercare information and other symptoms that may warrant a call to your provider.)
Although the number of women in the United States choosing medication abortion (abortion with pills) is increasing each year, vacuum aspiration (also called suction abortion or surgical abortion) is the currently the most common method used for first-trimester abortions. In vacuum aspiration abortion, the uterine contents are removed by suction (aspiration), which is applied through a cannula, a thin tube that is inserted into the uterus and connected to a source of suction, either an electric pump or a handheld syringe. (If no electric pump is used, the abortion is a manual vacuum aspiration, or MVA.)
MEDICATION ABORTION THROUGHOUT THE WORLD
Medication abortion using misoprostol alone holds much promise to make abortion safer and more accessible in places where vacuum aspiration is not widely available and where abortion is illegal or severely restricted. Since misoprostol is approved for other medical uses, it is widely available and inexpensive at pharmacies in many countries, and it is possible for women to take misoprostol alone, without mifepristone, to induce an abortion.
If used correctly, misoprostol alone is 80 to 85 percent effective in ending a pregnancy that is less than nine weeks. The symptoms and experience are similar to those of an abortion with combined mifepristone/misoprostol, although the cramps can be more intense and the abortion can take longer. The use of misoprostol may result in an incomplete abortion (some tissue or blood remains in the uterus), especially if it is not used correctly. However, once a woman starts bleeding, she can go to a doctor and say she is having a miscarriage; the symptoms of and treatment for miscarriage and incomplete abortion are identical.
The use of misoprostol to self-induce abortion is widespread, notably in Latin America and the Philippines, where abortion is legally restricted and safe services are not widely available. Some women in the United States have also obtained misoprostol from friends and families in other countries and have used it successfully. Misoprostol is far safer than the use of instruments, herbs, or other methods that women may use to try to end an unwanted pregnancy when there are no safe providers. Because of its potential to offer a safe abortion option for millions of women who would otherwise be at risk of injury or death from unsafe abortion methods, some activists are working to spread information about the safe use of misoprostol through hotlines and the Internet. To find out more, visit Women on Waves, womenonwaves.org.
Vacuum aspiration abortion is a safe medical procedure. About 1 in 300 women who have a vacuum abortion in the first twelve weeks of pregnancy experience a complication that requires hospitalization.
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The risk of death from abortion is always lower than the risk of death involved in carrying a pregnancy to term. However, gestational ageâhow far along the pregnancy isâis the most important risk factor in death from abortion. For abortions at under eight weeks, the risk of death is less than one in one million, compared with 9 in 100,000 at twenty-one weeks.
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This is one reason why it is important to obtain an abortion as early as possible.
Before starting the procedure, the clinician will perform a pelvic exam to check the size and position of your uterus. In some clinics, ultrasound may be used either before the procedure, to confirm how far along you are in the pregnancy, or during or after, to ensure that the uterus has been emptied. Be sure to tell your provider if this is your first pelvic exam, and feel free to ask questions. Taking deep, slow breaths and staying as relaxed as possible may make the exam more comfortable.
© Casserine Toussaint
Vacuum aspiration
Next, the clinician will insert a speculum into your vagina to separate the vaginal walls and bring your cervix into view. Although you may feel pressure, this should not hurt. Ask the clinician to adjust the speculum if it pinches.
After washing the cervix with antiseptic solution, the clinician will place a tenaculum (a long-handled, slender instrument) on the cervix. This instrument allows the clinician to hold the cervix in the proper position during the abortion; you may feel a pinch or a cramp when it is applied. Next, the local anesthetic solution is injected
around the cervix in two or more places. Although many women are apprehensive about this step, injections into the cervix are usually less painful than injections in other parts of the body. You may feel pressure, a pinch, or nothing at all. You may also feel a slight burning sensation as the medicine is injected into the cervix and brief cramping and nausea. Some women also experience ringing in the ears and tingling in the lips or tongue.
CONTROLLING PAIN AND ANXIETY
Although it's natural to feel scared or anxious about experiencing pain during any abortion procedure, most women find the cramping tolerable. If you are having a medication abortion at home, you'll want to be somewhere comfortable where you can lie down and be close to a toilet. Use pillows for support, and try to find a comfortable position. A heating pad or hot water bottle may help relieve the cramps, and deep rhythmic breathing, which you can do on your own or with a support person, may help reduce pain and anxiety. Your provider may offer a prescription for pain medication or suggest over-the-counter pain relievers.
Ibuprofen is the generally the most effective painkiller for cramps. You can also use other nonsteroidal anti-inflammatory drugs such as naproxen (Aleve) and diclofenac. Acetaminophen (Tylenol) or aspirin also help, though aspirin may increase the bleeding. Do
not
use mefenamic acid (Dolfenal) or other antispasmodics; misoprostol makes your uterus contract in order to push out the pregnancy, and mefenamic acid or antispasmodics can interfere with the abortion process.
For vacuum aspiration, local anesthesia injected into the cervix helps relieve pain that may occur during dilation (opening) of the cervix. In addition, the clinic may offer medications either orally or through an IV that will help you relax and feel less discomfort and anxiety. These medications, sometimes called moderate intravenous sedation or conscious sedation, are different from general anesthesia and will not cause you to lose consciousness.
Some facilities offer general anesthesia for women who want to be asleep during the abortion. However, because general anesthesia can, in rare cases, cause complications such as breathing problems, uterine atony (failure of the uterine muscles to contract normally), and bleeding, it is usually not used for abortion.
Because each of us experiences and copes with pain in our own way, it's important to talk with your provider about what the clinic offers, the difference in cost, and what will work best for you.
Once the cervix is numb, the provider will gradually stretch the opening of the cervix by inserting and removing dilators (tapered rods) of increasing size. You will probably feel pressure and perhaps some cramps on and off. Dilating typically takes less than two minutes.
Next, the cannulaâa sterile strawlike tubeâis inserted through the cervix into the uterus. The size of the cannula depends on how pregnant you are; it may range from the size of a
small drinking straw to that of a large pen (half an inch). The clinician connects the cannula to a handheld vacuum device (manual vacuum aspiration) or an electric vacuum device and then moves the cannula back and forth to draw out the pregnancy tissue. If the clinician uses a vacuum machine (electric vacuum aspiration), you may hear the humming of the machine and a whooshing noise when the cannula is removed. The aspiration by handheld or electric vacuum usually takes only a few minutes.
You'll likely feel some cramping as the uterus contracts and empties. The contractions are important, because they squeeze shut the blood vessels of the uterus. The cramps may range from mild to intense, but they usually lessen immediately after the cannula is removed or within the next several minutes.
After wiping out your vagina and checking for bleeding, the practitioner will remove the speculum. She or he will examine the tissue to be sure the pregnancy has been fully removed. Sometimes women ask to see the pregnancy tissue. If you would like to, let the provider know.
A staff person will make sure you are feeling okay. Then you can move into a more comfortable room to sit or lie down for a while.
I was really nervous about being awake during the abortion, especially because I'm afraid of needles. But the numbing part felt more like pressure than pain, and the cramps were bad for only a few minutes. I held my partner's hand, did some deep breathing, and I couldn't believe how fast it was over
.
I experienced some pain with the procedure, but mostly, it was just a series of new sensations. I had never been so aware of my uterus. I spent an hour lying down to recover. I remember being elatedâit was over! The only way to describe it was
relief!
In the United States, about 12 percent of all abortions take place after the first trimester, at thirteen weeks of pregnancy or later, and about 1.4 percent of all abortions take place after twenty-one weeks of pregnancy.
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Women have later abortions for a number of reasons: not knowing of a pregnancy or how far along it is; difficulty raising money for an early abortion; indecision about how to handle an unplanned pregnancy; health problems that develop or worsen during pregnancy; or because serious impairments in the fetus are detected.
*
In one study, 58 percent of women who had a later abortion would have liked to have had the abortion earlier. Nearly 60 percent of women who experienced a delay in obtaining an abortion cite the time it took to make arrangements and raise money.
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