The method of abortion to be used
is dependant on the gestational age (how far along the pregnancy
is) and the woman's physical condition. More than 90 percent
of all abortions are performed in the first trimester of pregnancy
(the first 14 weeks after a woman's last menstrual period).
medical abortion, chemical abortion, instrument free abortion- (ru486-mifiprex-mifipristone-abortion pill-early option pill, french pill, methotrexate, tamoxifen, cytotec, misoprostol)
(to 9 weeks LMP, 7 weeks conception).
“About 2 to 5 percent of abortions by this method fail and a vacuum aspiration must be performed to remove the embryo. The patient may have sex whenever she wants to.
(3 to 6 weeks LMP, 1 to 4 weeks conception)
Patient can undergo a surgical abortion procedure prior to missing her menses. Minimal pain and discomfort. No IV sedation necessary. May return to normal activities the same day. May have sex 24 hours after the surgery.
Local anesthetic (numbing medicine) is injected into or near
the cervix. Intravenous medication may be administered to
ease discomfort. The opening of the cervix is gradually stretched,
and a tube attached to a suction machine is inserted into
the uterus. The uterus is emptied by suction. After the suction
tube is removed, a curette ( a spoon-like instrument) is used
to gently scrape the walls of the uterus to be certain it
has been completely emptied of the fetus and other products
of conception. The procedure takes about 2 to 3 minutes.
(17 to 24 weeks LMP, 15.5 to 22 weeks conception)
Laminaria/Dilapan (small, tapered segments of absorbent material
which expand as they become moist and slowly open the cervix)
may be placed into the cervix for several hours or overnight.
Intravenous medication may be given to ease discomfort and
prevent infection. A local anesthetic is injected into or
near the cervix. If expansion is incomplete, the cervix is
carefully opened with a succession of dilators. The fetus
and other products of conception are removed from the uterus
with instruments and suction curettage. The procedure takes
about 10-30 minutes.
(17 weeks and beyond LMP, 15 weeks and beyond conception)
The cervix is softened and becomes dilated over a period of
hours with the use of Misoprostol and Laminaria. Fetal demise
is accomplished with an injection of medication into the fetal
heart. Drugs are administered which help the uterus to contract
and expel the fetus. The time from the beginning of the procedure
to delivery varies greatly. At Orlando Women's Center most
women complete the procedure on average of 20 hours (range:
4 to 36 hours). Following delivery and removal of the placenta,
the patient is observed in the recovery room to make certain
the uterus is well contracted and bleeding has been controlled.
In rare cases where the induction method fails or cannot be
used, an extraction procedure (similar to an abortion by D&E
or a hysterotomy is performed to remove the fetus. A hysterotomy
is similar to a caesarean section delivery and carries the
same risks.
Psychological impacts associated with abortion
Studies on the psychological impacts of abortion do not provide conclusions
which allow doctors and others to make statements or predictions about
psychological problems associated with abortion. While many women are relieved
after their abortion, some experience anger, regret, guilt, or sadness. In a
review of 250 such studies, former Surgeon General C. Everett Koop reports that
factors which may make the decision about abortion more difficult for some women
than others include: Strongly held personal values, feelings about abortion,
pressure from others, ending an originally desired conception, a decision made
late in the pregnancy, or the lack of support by a partner or family members.
Effects of abortion on fertility or future pregnancies
Most studies show no impact of first trimester abortion on fertility or subsequent
pregnancies. The effects of multiple second trimester abortions are undetermined.
There are three ways a pregnancy can end: a woman can give birth, have a miscarriage, or she
can choose to have an abortion. If you make an informed decision to have an abortion, you and your doctor will need
to consider how long you have been pregnant before deciding which method to use. Based on data from the Centers for
Disease Control and Prevention (CDC), the risk of dying as a direct result of a legally induced abortion is less than
one per 100,000. The risk of dying from a full term vaginal delivery is 8 to 11 per 100,000 and from a C-Section is
28 per 100,000.
From 4-14 weeks (after the first day of the last normal menstrual period)
Abortion Methods: Early non-surgical abortion or Vacuum Aspiration
Early non-surgical abortion
A drug is given to stop the development of the pregnancy.
A second drug is given by mouth or placed in the vagina, causing the uterus to contract and expel the fetus and
placenta.
Vacuum Aspiration
Local anesthetic is applied or injected into or near the cervix to prevent discomfort. The cervix is gradually opened.
This is done by the insertion of a series of dilators, each one thicker than the previous. The thickest dilator used
is about the width of a fountain pen. After the opening is stretched, a clear plastic tube is inserted into the uterus
and attached to a suction system. The fetus and placenta are then removed.
After the tube has been removed, a spoon-like instrument, called a curette may be used to
gently scrape the walls of the uterus to make certain it has been completely emptied of the pregnancy.
Medical Risks
Immediate medical risks include the following: Blood clots in the uterus, heavy bleeding, lacerated or torn cervix, perforation of
the wall of the uterus, pelvic infection, incomplete abortion, and anesthesia-related complications.
15-24 WEEKS (after the first day of the last normal menstrual period)
Abortion Methods: Dilatation and Evacuation (D&E) or Labor Induction
Dilatation and Evacuation (D&E)
Laminaria (sponge-like tapered pieces of absorbent material) are placed into the cervix. This material becomes moist and slowly
opens the cervix. The sponge-like material will remain in place for several hours or overnight. A second or third application of
the material may be necessary. Intravenous medications may be given to ease pain and prevent infection. After a local or general
anesthetic is given, the fetus and placenta are removed from the uterus with medical instruments such as forceps and suction
curettage. Occasionally for removal, it will be necessary to dismember the fetus.
Medical Risks
Immediate medical risks may include the following: blood clots in the uterus, heavy bleeding, cut or torn cervix, a
perforation of the wall of the uterus, pelvic infection, incomplete abortion, anesthesia-related complications. Possible
long-term medical risks.
Labor Induction
Labor induction is started by administering medications in one of three ways: medicine is placed in the cervix,
directly into the woman's vein or by inserting a needle through the mother's abdomen and into the amniotic sac
(bag of waters).
Labor will usually begin within 2 to 4 hours.
If the afterbirth (placenta) is not completely removed during labor induction, the doctor
must open the cervix and use suction curettage.
Medical Risks
Labor induction abortion carries the highest risk for problems, such as infection and excessive bleeding.
When medicines are used to initiate labor, there is a risk of rupture of the uterus.
Other immediate medical risks may include the following: blood clots in the uterus, heavy bleeding, lacerated or
torn cervix, a perforation of the wall of the uterus, pelvic infection, incomplete abortion, anesthesia-related
complications.
Possible Long-term Medical Risks
If the labor induction method is used, there is a small chance that a baby could live for a short period of time.
(See “What if the fetus is determined to be viable”)
From 24 To 40 Weeks (after the first day of the last normal menstrual period)
No person will perform or induce an abortion when the fetus is viable unless such person
is a physician and has a document referral from another physician who has determined that continuing the pregnancy is
a threat to the mother's life or a risk to her health.
Abortion Methods: Labor Induction or Hysterotomy
Labor induction is started by giving medications in one of three ways: medicine is placed in the cervix, directly
into the woman's vein or by inserting a needle through the mother's abdomen and into the amniotic sac (bag of waters).
Labor will usually begin in 2 to 4 hours.
If the afterbirth (placenta) is not completely removed during labor induction, the doctor must
open the cervix and use suction curettage.
Labor and delivery of the fetus during this period are similar to childbirth.
The duration of labor depends on the size of the baby and the readiness of the uterus.
Medical Risks With Labor Induction
As with childbirth, possible complications of labor induction include infection and excessive bleeding.
When medicines are used to initiate labor, there is a risk of rupture to the uterus.
Other immediate medical risks may include the following: blood clots in the uterus, heavy bleeding,
lacerated or torn cervix, a perforation of the wall of the uterus, pelvic infection, incomplete abortion, anesthesia-related
complications.
Hysterotomy (similar to a Caesarean Section)
This method requires that the woman be admitted into the hospital.
A hysterotomy may be performed if labor cannot be started by induction, or if the woman or
the fetus are too ill to undergo labor.
A hysterotomy is the removal of the fetus by surgically incising the abdomen and uterus.
Anesthesia medication, given intravenously or into the woman's spine, or by breathing the anesthetic, is administered
so the woman will not feel the pain of the surgery.
Medical Risks Associated With Hysterotomy
Complications are similar to those seen with other abdominal surgeries and the administration of anesthesia, such as
severe infection (sepsis); blood clots to the heart and brain (emboli); stomach contents breathed into the lungs
(aspiration pneumonia); severe bleeding, pelvic infection, retention of pieces of the placenta, anesthesia-related
complications.
WHAT IF THE FETUS IS DETERMINED TO BE VIABLE?
The chance of the fetus living outside the uterus (viability) improves as the gestational
age increases. The doctor must tell you the probable gestational age of the fetus at the time the abortion would be
performed.
If an abortion is to be performed after the doctor has determined the fetus is viable, the
following steps must be taken:
- A physician referral that has determined continuing the pregnancy is a threat to the mother's life or a risk to her health.
- If the child is born alive, the attending physicians have the legal obligation to take all reasonable steps necessary to
maintain the life and health of the child.
Medical Emergencies
When a medical emergency requires an abortion be performed, the physician will inform the woman before the abortion if possible, of
the medical indications supporting the physician's judgment that an abortion is necessary to prevent substantial and permanent damage
to any of the woman's major bodily functions.
In the case of a medical emergency, a physician also is not required to comply with any condition listed
above if in the physician's medical judgment, he or she is prevented from satisfying because of the medical emergency.
The risk of complications for the woman increases with advancing gestational age.
The following is a description of the risks cited in the previous pages:
Pelvic infection(sepsis): Bacteria (germs) from the vagina or cervix may enter the uterus
and cause an infection. Antibiotics may be used to treat such an infection. In rare cases, resuctioning, hospitalization or
surgery may be needed. Infection rates are less than 1% for suction curettage, 1.5% for D&E, and 5% for labor induction.
Incomplete abortion: Fetal parts or other products of pregnancy may not be completely emptied
from the uterus and require further medical procedures. Incomplete abortion may result in infection and bleeding. The reported
rate of such complications is less than 1% after a D&E; whereas, following a labor induction procedure, the rate may be as high
as 36%.
Blood clots in the uterus: Blood clots which may cause severe cramping occurs in about 1%
of all abortions. The clots are usually removed by a repeat suction curettage.
Excessive bleeding (hemorrhage): Some amount of bleeding is common following an abortion. Heavy
bleeding (hemorrhaging) is not common and may be treated by repeat suction, medication or rarely, surgery. You will be informed
about heavy bleeding and instructed what to do if it occurs.
Lacerated or torn cervix: The opening to the uterus (cervix) may be torn while it is being
dilated to allow medical instruments to pass through to the uterus. This happens in less than 1% of first trimester abortions.
Perforation of the uterine wall: A medical instrument may puncture the wall of the uterus.
The reported rate is 1 out of every 500 abortions. Depending on the severity, perforation can lead to infection, heavy bleeding
or both. Surgery may be required to repair the uterine tissue, and in the most severe cases hysterectomy may be required.
Anesthesia-related complications: As with other surgical procedures, anesthesia increases the
risk of complications associated with abortion. The reported risks of anesthesia-related complications are approximately one per
5,000 abortions.
Rh Immune Globulin Therapy: Protein material found on the surface of red blood cells is known
as the Rh Factor. If a woman and her fetus have different Rh factors, she must receive medication to prevent the development of
antibodies that would endanger future pregnancies.
LONG TERM MEDICAL RISKS
Future childbearing: Early abortions that are not complicated by infection do not cause infertility
or make it more difficult to carry a later pregnancy to term. Complications associated with an abortion may make it difficult to
become pregnant in the future or carry a pregnancy to term.
Cancer of the breast: Several studies have found no overall increase in the risk of developing
breast cancer after an induced abortion; however, there are other studies which do indicate increased risk. The consensus is that
this issue needs further study. Women who have a strong family history of breast cancer or who have clinical findings of breast
disease should seek medical advice from their physician irrespective of their decision to become pregnant or have an abortion.
EMOTIONAL REACTIONS
Because every person is different, one woman's emotional reaction to an abortion may be different from
another's. After an abortion, a woman may have both positive and negative feelings, even at the same time. One woman may feel relief,
both that the procedure is over and that she is no longer pregnant.
A woman may feel sad that she was in a position where all of her choices were hard ones. She may feel
sad about ending the pregnancy. For a period of time after the abortion, she also may feel a sense of emptiness or guilt,
wondering whether or not her decision was right.
Some women who describe these feelings find they go away with time. Others find them more difficult to overcome.
Certain factors can increase the chance that a woman may have a difficult adjustment to an abortion. One
of these is not having any counseling before consenting to an abortion. When help and support from family and friends are not
available, a woman's adjustment to the decisions may be more difficult.
Other reasons why a woman's long-term response to an abortion might be perplexing may be related to past
events in her life. For example, negative feelings could last longer if she has not had experience with making major life decisions,
or already has serious emotional problems.
Talking with a counselor or physician may help a woman to consider her decision fully before she takes any
action.
We offer our sincerest condolences. We realize this is an extremely difficult decision and that it may take
time and a tremendous amount of soul searching to arrive at a choice that is right for you and your family. Once the decision is made
to have a premature delivery, we will make your stay at Orlando Women's Center as supportive and as comforting as possible.
We believe that you will find the atmosphere of our center to be filled with warmth and compassion. The members of our staff
are highly dedicated individuals who are fully devoted to providing you with kindness, respect, and the utmost quality of care.
Women who are more likely to experience problems during and after a pregnancy are those
who did not obtain prenatal care early in the pregnancy and/or did not continue with that care, and those with
generally poor health and life styles, e.g., smoking, alcohol and drug use. Continuing a pregnancy and delivering
a baby is usually a safe, healthy process. Based on data from the CDC, the risk of the woman dying as a direct
result of pregnancy and childbirth is less than 10 in 100,000 live births. Continuing a pregnancy also includes
a risk of experiencing complications that are not always life-threatening.
Caesarean section (C/S) delivery: Occurs in 20 out of every 100 births
Infection: Approximately 4 out of every 100 women experience an infection after childbirth
and are treated with antibiotics. Lack of treatment may lead to infertility or more serious infections.
Bleeding: Heavy bleeding may occur as a result of clotting problems, tears in the placenta
prior to delivery, or if pieces of the placenta remain in the uterus after delivery.
Need for Rh Immune Globulin: As part of prenatal care, the woman will have a blood test to
find out her blood type. If the pregnant woman is Rh negative and the father is Rh positive, she can make antibodies
(sensitization) that can attack the red blood cells of the fetus if the fetus is Rh positive. This sensitization can occur
any time fetal blood mixes with the mother's blood; during pregnancy or after an abortion, miscarriage, ectopic pregnancy, or
amniocentesis.
To prevent the development of the antibodies the woman can receive injections (immunizations) of Rh
immune globulin (rhIg), one at 28 weeks of pregnancy and the other following a miscarriage or delivery of a baby. The only known
side effect of the immunizations for the woman is soreness from the shot or a slight fever. There is no risk of infection with
human immunodeficiency virus (HIV) with the globulin.
If the woman who is Rh negative does not receive the Rh immune globulin, the fetus' red blood cells
may be damaged, leading to anemia, serious illness or death of the fetus or newborn.
CAUSES OF COMPLICATIONS WITH PREGNANCY
Severe bleeding
Blood clots in the lungs
High blood pressure
Seizures or strokes
Severe infection
Abnormal functioning of the heart
Anesthesia-related complications and death
Together, these causes account for 80% of all deaths relating to pregnancy.
Unknown or uncommon causes account for the remaining 20% of deaths relating to pregnancy. Women who have chronic
severe diseases are at greater risk of death than are healthy women.
PREGNANCY, CHILDBIRTH, AND NEWBORN CARE
You may or may not qualify for financial help for prenatal (pregnancy), childbirth and
neonatal (newborn) care, depending on your income. If you qualify, programs such as the state's medical assistance
program, called Medicaid, will pay or help pay the cost of doctor, clinic, hospital and other related medical expenses
to help you with prenatal care, childbirth delivery services, and care for your newborn baby.
A listing of agencies that are available to provide or assist you to access financial
assistance or medical care is available.
What About Adoption?
Women or couples facing an untimely pregnancy who choose not to take on the full responsibilities of parenthood have
the option of adoption.
Making a plan for adoption is rarely an easy decision. Counseling and support services
are a key part of adoption and are available from a variety of adoption agencies and parent support groups across the
state. A list of adoption agencies is available.
There are several ways to make a plan for adoption, including through a child placement
agency or through a private attorney. Although fully anonymous adoptions are available, some degree of openness
in adoption is more common, such as permitting the birth mother to choose the adoptive parents.
The Father's Responsibility
The father of a child has a legal responsibility to provide for the support, educational, medical and other needs
of that child. In Florida, this responsibility includes child support payments to the child's mother or legal
guardian. A child has rights of inheritance from their father and may be eligible for benefits such as life
insurance, Social Security, pension, veteran's or disability benefits of the father. Further, the child benefits
from knowing the father's medical history and any potential health problems that can be passed genetically.
Paternity can be established in Florida by two methods:
- The father and mother, at the time of birth, can sign forms provided by the hospital acknowledging paternity
and the father's name is added to the birth certificate.
- A legal action can be brought to a court of law to determine paternity and establish a child support order.
Issues of paternity effect your legal rights and the rights of the child. More information
concerning paternity establishment and child support may be obtained from any regional office of the Florida Division
of Child Support Enforcement.
Information Directory
The decision to have an abortion, have a baby or make an adoption plan, must be carefully considered. There are
lists of state, county and local health and social service agencies and organizations available to assist you.
You are encouraged to contact these groups if you need more information for making an informed decision.
Our Facility
Thousands of patients throughout the world have received quality reproductive health care services at our clinic.
Facilitated support groups are offered to patients and their significant others. Professional individual
counseling is available.
Our Fees
Fees include all costs associated with the procedure with the exception of prescriptions. Payment includes
sonogram(s), laboratory tests, anesthesia, surgery, follow-up examinations(s) and one month's birth control
(as appropriate to the patient's personal medical history). Our telephone counselors will take a brief medical
history and quote fees according to the duration of the pregnancy and medical considerations. Fees may be paid
with cash, Master Card, Visa, American Express, Discover, money orders, traveler's checks, or cashier's checks.
We regret that personal checks can not be accepted.
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