Non-surgical Abortion | Surgical Abortion | Emergency Contraception

Non-surgical Abortion

Non-surgical abortion is commonly called or known as “abortion by pill.” It is also referred to as medical abortion. It is a non-invasive procedure for terminating a pregnancy. The name of the abortion pill is Mifeprex, and it has also formerly been called mifepristone and RU-486.

Mifeprex has been available as a legal, early abortion method in the United States since September 2000, although several other countries around the world made mifepristone and RU-486 a legal, early abortion method a decade or two earlier. While studies have shown that various regimens for administering the medications can work effectively and safely, the FDA has approved one regimen for administration. Therefore, some doctor’s offices and clinics may use the FDA approved method, while others may use an alternative method, though they should all have similar success rates. The non-surgical abortion is known as an early abortion method because the FDA has approved Mifeprex for use up to 7 weeks last menstrual period (LMP), and depending on the facility’s protocols, may be offered to patients until 9 weeks LMP.

Mifeprex is used with another medication called misoprostol (also called cytotec) to cause a process similar to miscarriage. There are three steps to non-surgical abortion, and the time it takes to complete the abortion varies. The non-surgical abortion usually requires at least 2 visits to the healthcare facility.

• Step 1:

The first step of the non-surgical abortion regimen is to take the Mifeprex pill orally at the healthcare facility. This will stop production of the hormones necessary to sustain the pregnancy, and will cause the pregnancy to detach from the uterus.

• Step 2:

The second step is to take the misoprostol, either orally or inserted vaginally, 6 to 72 hours after taking the first medication. The doctor administering the medication will indicate which method should be used, and whether this may be done at home, or if another visit to the office is necessary. The misoprostol will cause the uterus to contract and the patient will begin bleeding in order to expel all the pregnancy tissue from the uterus. The patient will bleed anywhere from several days to 4 weeks. The bleeding will be heavier than a normal period.

• Step 3:

The third step is to return to the facility two weeks after taking the Mifeprex pill. During this visit, the facility staff will run some tests to ensure all the pregnancy tissue has been removed, and that there are no current complications.

In the event that all pregnancy tissue is not expelled at the time of the follow-up visit, the healthcare provider may give the patient more misoprostol to try to remove the remaining tissue or perform a surgical abortion. About 5-8 out of 100 women will need a surgical procedure to end the pregnancy.

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Surgical Abortion

First Trimester Abortion

A first trimester surgical abortion, which is measured approximately up to 14 weeks from the first day of the last menstrual period (LMP), is completed by a procedure known as dilatation and evacuation.The procedure alone will take approximately 5 minutes, although the visit to the healthcare facility clinic may take several hours.

The procedure will begin with the physician performing a pelvic exam to determine the size and location of the pregnancy in the uterus. The doctor will then insert a speculum into the vagina so that he/she can view the cervix. The cervix is the lower end of the uterus, and is located at the top of the vaginal canal. He/she will clean the vaginal canal with an antiseptic. Next, he/she will dilate, or open, the cervix by inserting a series of sterile metal rods, one by one, into the opening of the cervix. These rods, called dilators, gradually increase in width. Dilation for a first trimester abortion is minimal. Once the cervix is opened, the physician will be able to remove the pregnancy from the uterus. The doctor will insert a sterile, plastic, flexible tube called a cannula into the uterus. The cannula is attached by a tube to a machine called a vacuum aspirator, which creates a suction that removes the pregnancy. Once these steps are complete, the surgeon will clean the inside of the uterus with an instrument called a curette to ensure that all pregnancy tissue has been removed. The whole process generally takes about 5 minutes. After surgery, the patient will be monitored for about 30-45 minutes, or until she is medically cleared to return home.

A second trimester abortion take place from about 14 weeks of from the first day of the last menstrual period (LMP) through 24 weeks LMP. A second trimester surgical abortion is performed in the same manner as a first trimester abortion; however, the patient’s cervix must be dilated, or opened, several hours or days prior to her surgery. The cervix is dilated through the administration of a medication called misoprostol (cytotec) and/or laminaria/lamicel insertion. The misoprotol is either taken as a pill orally or inserted into the vagina. Laminaria or lamicel must be inserted by the physician into the patient’s cervix. Laminaria are made of sterilized seaweed and look like tiny tampons. Lamicel are similar, but made of a synthetic material. The laminaria/lamicel act like a sponge by absorbing the moisture in the patient’s vagina and expanding. As the laminaria or lamicel expands, the cervix is slowly dilated. Depending on the gestational age of the pregnancy and the patient’s medical history, the physician will decide on the best method of dilation with misoprostol (cytotec) and/or laminaria or lamicel. The physician will perform the surgical abortion after dilation is complete in a manner similar to the method described for first trimester abortion. Since the dilation process is different for every woman, a second trimester abortion surgery may be performed on the same day as the dilation or up to 1 to 2 days afterwards.

Both first and second trimester surgical abortions can be performed with various types of anesthesia – local anesthesia, twilight, and general anesthesia. These methods can help to control pain and discomfort during the procedure, and each will have benefits and drawbacks. The doctor and facility staff will aid each patient in determining which method is best for her.

If the procedure is performed under local anesthesia, the patient will be awake and conscious as normal during the procedure. Patients will be able to see and hear as usual during the procedure, and will be able to remember everything that happened during the surgery after it is over. While local anesthetics can be administered differently, generally speaking the physician will inject the anesthetic into the patient’s cervix. This will lessen the pain, but the patient will still experience cramping and discomfort during the procedure. Sometimes medications, such as ibuprofen, are also offered both before and after the surgery to ease pain. Breathing exercises may also be used in conjunction with local anesthetic to minimize discomfort. Local anesthesia allows women to remain alert during the process, which may be more empowering for some individuals. In addition, this method allows women to avoid some of the side effects and risks often associated with sedation methods of twilight anesthesia and general anesthesia explained below.

Twilight anesthesia, sometimes called light sedation or conscious sedation, will be administered by a qualified anesthesiologist or certified registered nurse anesthetist. Twilight anesthesia may contain a combination of medications, usually given through an intravenous (IV) needle inserted into the hand or arm. Twilight anesthesia will relax and partially sedate the patient. She will have no memory of the procedure, but may appear conscious or partially asleep, and will usually be able to respond to simple requests. The patient will remain in this state for a couple of minutes up to a few hours depending on how much medication is administered.

If the procedure is performed under general anesthesia or deep sedation, the patient will be completely sedated, and she will not see, hear or feel any part of the surgery and will not remember anything about the surgery afterwards. General anesthetics are usually administered through an IV, in the same manner described above. While this is an optimal method for women who wish to decrease pain, it may not be appropriate for obese women or women with certain medical conditions. Sedation may also cause side effects such as nausea, dizziness, and feeling cold. The general anesthesia also takes longer time to wear off entirely and the patient will feel drowsy for several hours or a full day. This means the patient will be required to have a friend or family member escort her home after surgery.

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Emergency Contraception

Emergency contraception, more commonly known as the “morning after pill,” is a contraceptive or birth control method that can prevent pregnancy immediately after unprotected sexual intercourse or contraceptive failure, but before pregnancy begins. Reasons for unprotected sex and contraceptive failure vary greatly, but some situations include sexual assault or rape, the condom breaking, or not having access to a contraceptive method during the time of intercourse. Emergency contraception is intended for emergency situations, and not as a regular method of birth control.

Emergency contraception prevents pregnancy by delaying ovulation, inhibiting fertilization and/or preventing implantation. Emergency contraception will not interrupt an established pregnancy and does not function as “abortion pill.” Emergency contraception will not be effective if taken after a woman is already pregnant.

Emergency contraception should be taken within 72 hours of unprotected sexual intercourse and can reduce the risk of pregnancy by 89%. Some clinical trials have shown that efficacy (how well it works) was greatest when emergency contraception was taken within 24 hours of unprotected intercourse, decreasing somewhat during each subsequent 24-hour period. However, in some areas, emergency contraception may be available as many as 5 days after unprotected sex. Since emergency contraception is currently available only as a prescription medication, it must be obtained from a clinic, doctor, or other healthcare facility.

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