Last Updated January 10th, 2022
What is termination of pregnancy or abortion?
Termination of pregnancy or “abortion” is a medical process done to end the pregnancy to prevent the birth of the baby. Pregnancies can be terminated up to the 24th week of pregnancy. However, some patients due to medical emergencies, can have later termination as well that can be done after 24 weeks.
Abortion can be done with medicines or through a surgical procedure. Depending on the weeks of pregnancy, the doctor will decide whether the abortion can be done medically or needs surgical intervention.
Does abortion reduce the chances of pregnancy?
Contrary to popular beliefs, abortion does not necessarily reduce the chances of pregnancy in the future. Women who have undergone a termination of pregnancy in the past can give birth to healthy babies when the time is right for them.
At what age can a woman have an abortion?
A woman who is 18 years old or older can get an abortion and does not need parental consent.
Young girls who are below 18 years and are mentally ill need the permission of their parents as well as written consent. They must visit the doctor’s clinic to seek counseling and understand the consequences of abortion.
In countries like the UK, girls below the age of 16 who are responsible for themselves can make their own decision and seek an abortion without the consent or knowledge of their parents. The doctor will however examine whether the patient is of sound health and is capable to take the decision. For patients who are not mentally or physically fit, parental consent is required.
Treatment for termination of pregnancy depends on the stage of pregnancy. When you visit the clinic, your doctor will check your general health and see how far is your pregnancy.
Once the patient is certain that she wants termination of the pregnancy, she must immediately consult a doctor. The more you delay, the fewer choices you have, and the complications of abortion increase.
Termination of pregnancy is done in two ways:
- Medical termination is where the doctor uses abortion pills and other medicines to abort the pregnancy. This is usually done in the early stages of pregnancy.
- Surgical termination where the unborn fetus is surgically removed from the womb.
Preparation for abortion
Before considering medical abortion:
- The doctor will evaluate the overall health of the patient.
- Get details about the medical history.
- Perform normal blood and urine tests.
- An ultrasound will be performed to determine the weeks of pregnancy and also to rule out other medical conditions like ectopic pregnancy (fertilized egg attaches outside the uterus) or a molar pregnancy (abnormal growth and formation of tumor in the uterus).
- The doctor will explain the abortion process, outcome, risks, and complications.
- A counselor will also talk about the legal requirements of the procedure.
- Family members and partners are advised to accompany the patients during the counselling process.
Who cannot undergo a medical abortion
- Patients who have gone too far in their pregnancy. Medical abortion is normally not done after 9 weeks.
- If the patient has an IUD (intrauterine device) implanted in the vagina.
- Individuals with medical disorders like ectopic pregnancy, abnormal bleeding disorder, heart problems, liver or kidney problems, etc., are not good candidates for medical abortions.
- Allergic to abortion pills.
- Patients who are taking blood thinners.
Preparing for surgical abortion:
- Visit the OB/GYN to learn about the abortion procedure and aftercare.
- The doctor will check your overall health and take details about your medical history.
- The doctor will perform blood tests, urine tests, and an ultrasound.
- You will be prohibited to eat, drink, or smoke for at least 6 hours before the surgery.
- Patients will be advised not to take alcohol for 48 hours before the operation.
- The doctor will ask you to stop taking certain medications like blood thinners before the procedure.
- You will be asked to reach the hospital or clinic at least one to two hours before the surgery to complete the pre-surgery formalities.
- A family member, partner, or friend must accompany you during the surgery.
Procedures for abortion
Medical abortion is a non-surgical procedure to terminate a pregnancy. It is usually done on women who are 9 weeks pregnant from their last menstrual period. It is a safe and non-invasive procedure and uses certain medications called abortion pills to abort the pregnancy. The procedure does not need any anesthesia and can be done safely at home or at the doctor’s clinic or hospital.
During the procedure:
In medical termination, two medications called mifepristone and misoprostol are used.
- On the first day, the patient will come to the doctor’s clinic. The doctor will counsel and explain the termination procedure. The patient will be given one tablet (200 milligrams) of mifepristone alternatively called “RU-486” or “Mifeprex”. The patient will take this medicine orally. It blocks the normal production of the progesterone hormone. As a result, the uterus lining resumes its normal shedding and the fetus fails to remain attached to the womb. After taking the medicine, the patient can go home.
- After two or three days, the patient will be given four tablets (800 milligrams each) of misoprostol that has to be placed inside the vagina, or under the tongue, or in the middle of the gum and the cheek.
- Misoprostol is usually taken at home. After four or six hours, the normal abortion process will start. The uterus lining will start shedding. Vaginal bleeding will start accompanied by intense pain, and abdominal cramps. Blood clots and tissues will come out from the vagina. The menstrual bleeding will be more than the normal bleeding that you have during your monthly periods. The entire process may last three to five hours, and the pregnancy will be terminated.
The patient must come for a follow-up visit. The doctor will examine the overall health of the patient, the size of the uterus, vaginal bleeding, and the possibility of any infections. If the doctor suspects that the abortion is incomplete, the patient will be sent for an ultrasound, and a surgical abortion will be needed.
After the procedure:
- The doctor will prescribe certain pain medications like ibuprofen, acetaminophen for pain management.
- The heavy bleeding will last for a few hours. Patients may continue to have vaginal bleeding for 4 weeks and have to use sanitary napkins.
- Doctors will ask the patient to refrain from vaginal intercourse for at least a week after having a medical abortion.
- A medical care provider will advise the patient about the use of contraception and when to resume normal sexual activity.
- Some patients may experience fever and chills that may last 24 hours.
- Other short-term complications like vomiting, nausea, strong cramps, back pain, diarrhea, headaches, etc. can occur.
If the pregnancy is more than 10 weeks, a woman has to undergo a surgical abortion. There are two types of surgical abortions:
- Vacuum aspiration abortion
- Dilation and evacuation (D&E) abortion
Surgical termination of pregnancy is more effective than medical abortions and is done in clinics or hospitals.
A surgical abortion can be done under different types of anesthesia such as:
- General anesthesia – Patients here are completely unconscious and are not aware of the surroundings in the operating room.
- Local anesthesia – Here, the doctor or the anesthetist injects an anesthetic to the cervix to make it numb. The process is known as a paracervical block. The patient will be completely awake during the procedure but would not feel any pain or have any sensation.
- Nitrous oxide gas – When a nitrous oxide gas is given to the patient, she will be in a ‘twilight sleep’ state.
- Local anesthesia administered with intravenous sedation – This happens when local anesthesia is injected in the cervix while the patient is put under intravenous (IV) sedation that is injected in the vein.
Surgical method one – vacuum aspiration abortion
A woman who is less than 15 weeks pregnant can have a vacuum aspiration abortion. The procedure is simple and is the most common type of surgical termination of pregnancies.
During this procedure, the patient will be given pain medications. Local anesthesia will be injected to numb the cervix. IV sedation is also used to put the patient in a relaxed state.
The doctor will use dilators to stretch the cervix. A speculum will be inserted to examine the uterus. After that, the doctor will insert a tube with a suction device into the cervix. The suction device will be used to empty the uterus.
After the procedure, the doctor will check whether the cervix is empty or not. The suction procedure may take 5 to 10 minutes. However, the entire procedure from dilation to examination may take more time. After completion of the procedure, antibiotics are prescribed to prevent infection.
Surgical method two – dilation and evacuation (D&E) abortion
A D&E procedure is done in advanced pregnancy where the patient is 15 weeks pregnant or more. The doctor will use hormone-blocking medications that will help to soften the cervix. The tablets can be taken orally or placed inside the vagina. The medications generally start affecting within two hours.
The procedure is very similar to vacuum aspiration. The patient will be given some pain medications. General anesthesia is administered.
The cervix will be dilated, suction will be used to clean the cervix. Apart from the suction, the doctor will use a small tool called a curette, a loop-shaped metal tool to clean any tissue that is left behind in the cervix.
The total procedure may take 10 to 20 minutes or even more.
After a surgical procedure, the patient has to stay in the recovery room for a few hours before she is allowed to go home.
Patients may experience certain common side effects such as:
- Abdominal cramps
- Vaginal bleeding
- Blood clots
After the nurse or the medical provider inspects the patient and declares her to be fit, she can go home. Some women may also experience breast engorgement or fullness after an abortion. Your nurse or doctor will prescribe pain medications and heating pads to relieve the discomfort.
When can you go in for an abortion?
The decision to terminate the pregnancy can be very tough for a woman. Many young women are stigmatized or judged for having a termination of pregnancy. However, having an abortion is a personal choice and there are several reasons why a woman may choose to terminate her pregnancy.
- Lack of financial support – Research shows that over 40% of women choose to terminate their pregnancy because they are not financially prepared to raise a child.
- Unplanned pregnancies – Pregnancies that are not planned can lead to abortions. Both the partners may not be financially viable or mature enough to start a family.
- Accidental pregnancies – Young adults and teenagers may get accidentally pregnant due to unprotected sex with their partners. In such cases, the girl is so young, that she is not mentally or physically capable to be a parent.
- Unhealthy relationships – Many women who are in an abusive relationship or have been assaulted or traumatized by their partners may seek an abortion. They are not mentally fit or financially independent to take responsibility for the baby.
- Wrong timing – Both the partners are focusing on their studies or career and do not want to be a parent. Women who do not want children, have passed the childbearing age, or already have children can ask for an abortion.
- Health issues of the mother – Women suffering from health problems like cancer, placental abruption, advanced preeclampsia, etc. can abort the baby for medical reasons. Doctors may also recommend abortions to women who are at risk of death during pregnancy or childbirth.
- Fetal abnormalities – If the fetal screening and diagnostic tests reveal that the unborn child has high risks of chromosomal abnormalities like Down syndrome, Turner syndrome, or birth defects like spina bifida, heart or kidney disorders, meningocele, etc., the mother can seek an abortion. Doctors can also advise an abortion due to pregnancy complications like stillbirth, neonatal death, or an impending miscarriage.
- Lack of support – Unmarried young women often chooses to terminate their pregnancies due to a lack of support from their family and friends. The cultural stigma and the absence of financial and mental support can force a pregnant woman to seek an abortion.
The choice of having an abortion in a clinic or hospital depends on the type of abortion. If a patient is having a medical abortion, she can have it at home or a small clinic. In the case of surgical abortion, patients can choose the doctor’s clinic or a private hospital.
- Privacy and confidentiality.
- Dedicated hospital staff and one-to-one care.
- cost is less compared to big hospitals.
- Access to high-end medical facilities is limited.
- Small clinics may not be well-equipped to handle emergency situations.
- Dedicated doctors and well-maintained infrastructure.
- 24/7 emergency care.
- Well-trained staff and access to multiple medical facilities.
- Expensive procedures.
- Lack of privacy.
Cost of surgery
The cost of surgery depends on various factors such as:
- The clinic or hospital where the patient is having the treatment.
- Underlying costs like hospital care, cost of operation, etc. Big hospitals charge more than small clinics.
- Doctor’s fees for consultation and operation.
- The state or the city where you live in.
- The type of abortion, for e.g., abortion pills are cheaper than a surgical procedure.
- Equipment used during the abortion.
- Type of hospital or clinic room where the patient stayed for post-operative care.
Post-op care and things to keep in mind
After an abortion, your doctor will ask you to:
- Take proper rest at home.
- Avoid strenuous activities including heavy lifting.
- Take your antibiotics properly for infection as well as your pain medications.
- Take showers instead of bath.
- While you are still bleeding, avoid using tampons or menstrual cups. Use sanitary napkins.
- Avoid sexual intercourse as it increases the risk of infection.
- Doctors may prescribe contraception to prevent getting pregnant afterwards.
- If you are feeling distressed or emotional after an abortion, it is best to talk to a counselor for guidance.
- Avoid driving for 24 hours immediately after abortion as you may still be under the anesthetic effect.
Complications of abortion
Complications after the termination of pregnancy may include:
- Infection – After an abortion, some women may develop a chronic infection in the uterus and cervix. There are also high possibilities of PID or pelvic inflammatory disease. Infections may cause high fevers and vaginal discharge with a pungent smell. Infections can be treated with antibiotics.
- Hemorrhage – Excessive menstrual bleeding and cramping. In some rare cases, a blood transfusion may be needed.
- Blood clots – Blood clots are common after an abortion, however, if the blood clots are more than the size of a lemon, patients should immediately consult a doctor.
- Uterine injury – The insertion of surgical instruments may cause scarring and damage to the uterine walls and tissues.
- Uterine perforation – The surgical instruments may cause a hole in the uterus and damage the surrounding organs. This may require surgery.
- Cervix injury – The abortion procedure may tear the cervix that may require stitches.
- Incomplete abortion – This may happen in medical abortion where the patient may persist to have pregnancy symptoms. Additional surgery may be needed to complete the termination of the pregnancy.
- Side effects of abortion pills – Some patients may be allergic to abortion pills and may have persistent vomiting and diarrhea.
Termination of pregnancy can be physically as well mentally exhausting. The abortion procedure may be traumatic especially for a young woman. Goficure has a team of expert medical providers who understand the sensitivity of the treatment. They guarantee full confidentiality and privacy to the patients. Everything from arranging appointments, post-operative care, and follow-up visits will be handled by the team of experts.
- Wear sanitary pads
- Take proper rest
- Take light showers
- Use tampons
- Sexual intercourse after an abortion
- Go swimming
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