Abortion Procedures

If you choose to have an abortion here in Cleveland, take time to understand the risks. Be sure you are willing and able to accept them. As most procedures require an ultrasound you can schedule one at our center free of charge to determine if you are in fact pregnant, the approximate age of the fetus, and if it is in fact a viable pregnancy.

Mifeprex/Mifepristone (RU 486, Abortion Pill):

The abortion pill is used very early in pregnancy. While it is often described as a “quick and easy” way to have an abortion in the privacy of your own home, you actually have to visit a clinic typically for three visits during this type of abortion. Costs for this type of abortion vary. You must be certain that you wish to have medical abortion prior to taking the first pill (1). On the first visit, a woman is given pills(mifepristone) that cause the death of the embryo. Two days later, a return visit is required to determine if the abortion has occurred. If the fetus/embryo hasn’t been expelled, a second drug ( misoprostol) is given which causes cramping to expel the fetus/embryo. More than half of women abort within four or five hours after taking the second medicine. For others, it takes longer. But most women abort within a few days (1). The last visit is to determine if the procedure has been completed (2).

Before taking the abortion pill, you will need to:

  • discuss your options
  • talk about your medical history
  • have laboratory tests
  • have a physical exam. This usually includes an ultrasound (1).
  • read and sign papers
Immediate & Long Term Risks of Abortion
Pregnancy Symptoms & Fetal Development

Suction Abortion about 4-13 weeks after the Last Menstrual Period (LMP)

This surgical abortion is done throughout the first trimester. Varying degrees of pain control are offered ranging from local anesthetic to full anesthesia. Prices and costs for this type of abortion vary. For early pregnancies, a long, thin tube is inserted into the uterus which is attached to a manual suction device and the embryo is suctioned out. Late in the first trimester, the cervix needs to be opened wider because the fetus is larger. The cervix may be softened the day before using medication placed in the vagina and/or slowly stretched open using thin rods made of seaweed inserted into the cervix. The day of the procedure, the cervix may need further stretching by metal dilating rods. This can be painful, so local anesthesia is typically used. Next the doctor inserts a plastic tube into the uterus and applies suction by either an electrical or manual vacuum device. The suction pulls the fetus’ body apart and out of the uterus. The doctor may also use a loop-shaped tool, called curette, to scrape any remaining fetal parts out of the uterus (3).

Immediate & Long Term Risks of Abortion
Pregnancy Symptoms & Fetal Development

Dilation & Evacuation (D&E) About 13 to 24 weeks after LMP

The majority of second trimester abortions are performed using this method. The cervix must me opened wider than in the first trimester abortion because the fetus is larger. This is done by inserting numerous thin rods made of seaweed a day or two before the abortion and/or giving other oral or vaginal medications to further soften the cervix. Up to about 16 weeks gestation, the procedure is identical to the first trimester one (mentioned above). After the cervix is stretched open and the uterine contents suctioned out, any remaining fetal parts are removed with a grasping tool (forceps). A curette (a loop- shaped tool ) may also be used to scrape out any remaining tissue.

After 16 weeks, much of the procedure is done with the forceps to pull fetal parts out through the cervical opening, as suction alone will not work due to the fetus’ size. The doctor keeps track of what fetal parts have been removed so that none are left inside as this can potentially cause infection. Lastly, a curette, and/or the suction machine are used to remove any remaining tissue or blood clots, which if left behind could cause infection or bleeding (4).

Medication Methods for Second Trimester Induced Abortion

This technique induces abortion by using medicines to cause labor and eventually delivery of fetus and placenta. Like labor at term, this procedure typically involves 10-24 hours in a hospital’s labor and delivery unit. Digoxin or potassium chloride is injected into the amniotic fluid, umbilical cord or fetal heart prior to labor to avoid the delivery of a live fetus. The cervix is softened with the use of seaweed sticks and/or medications. Next, oral mifepristone and oral or vaginal misoprostol are used to induce labor. In most cases, these drugs result in the delivery of the dead fetus or placenta. The patient may receive oral or intravenous pain medications. Occasionally, scraping of the uterus is needed to remove the placenta. Potential complications include hemorrhage and the need for blood transfusion, retained placenta and possible uterine rupture (splits open) (4). Costs and prices for this abortion vary.

It’s important to know that Alternaterm does not offer, preform or refer for abortions.

Immediate & Long Term Risks of Abortion
Pregnancy Symptoms & Fetal Development

D&E When live birth is possible

This procedure typically takes 2-3 days and is associated with the increased risk to the life and the health of the mother. Because a live birth is possible, injections are given to cause fetal death. This is done in order to comply with the federal Partial –Birth Abortion Ban Act of 2003 which requires that the fetus be dead before removal from the mother’s body. The medications (digoxin and potassium chloride) are either injected into the amniotic fluid, the umbilical cord or directly into the fetus’ heart. The remainder of the procedure is the same as the second trimester D&E. Fetal parts are reassembled after the removal from the uterus to make sure nothing is left behind to cause infection.

An alternative technique, called “Intact D&E” is also used. The goal is to remove the fetus in one piece, thus reducing the risk of leaving parts behind or causing damage to the woman’s body. This procedure requires the cervix be opened wider; however, it is still often necessary to crush the fetus’ skull for removal as it is difficult to dilate the cervix wide enough to bring the head out intact (5).

Immediate & Long Term Risks of Abortion
Pregnancy Symptoms & Fetal Development

These are brief descriptions of abortions that may be available in Cleveland area. Once you have established the gestational age of your baby, more detailed information can be discussed if desired. if you are not sure how far along you are, or if you are even pregnant, schedule today for a free pregnancy test at our center.

Before You Decide

Here is a sample pregnancy termination form that women have found useful to help in asking your health care provider the right questions. Be careful not to sign any medical release forms until you fully understand the answers to these questions:

  • What is the name of the doctor performing the abortion?
  • At which hospital does the doctor have privileges?
  • What will the abortion cost?
  • What does that fee cover?
  • Are there any additional fees? If yes what are they?
  • Will the abortion be painful for me? If yes, how long will I be in pain? How long will I bleed?
  • What kind of abortion procedure will be done? Describe the procedure in detail.
  • What does the fetus look like right now? What can the baby do and feel?
  • Will the doctor provide STD testing, RH testing, & ultrasound photos? If no describe the risk of pelvic inflammatory disease, or hemolytic diseases.
  • Will the doctor treat me for complications?
  • Is follow-up or emergency care provided in the cost?
  • Has the doctor ever had any complaints or malpractice suits against him/her?
  • What options and support services are available to me if I choose not to abort?

Alternaterm does not offer, perform, or provide abortions therefore we do not have any monetary ties to your decisions to abort. All appointments in our center are confidential and geared to provide women facing an unplanned pregnancy, honest and factual information regarding all options available.

(1) Planned Parenthood.org June 3, 2013

(2) US Food and Drug Administration. Mifeprex medication guide. How should I take mifeprex? Available at www.fda.gov/downloads/drugs/drugsafety/ucm0888643.pdf. Accessed February 13, 2011

(3) Abortion procedures pg 15. before you decide pamphlet-Carenet 2011

(4) CareNet 2011 pamphlet – Before You Decide – Abortion Procedures page 16

(5) CareNet 2011 pamphlet – Before You Decide – Abortion Procedures page 17

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