It is important to understand what happens inside a woman's body when a pregnancy begins. A number of years ago, the medical community redefined the beginning of pregnancy from the time of fertilization to when an embryo implants in the uterus. However, the scientific reality is that when the sperm and egg unite and fertilization occurs, the genetic make-up of a unique human is established, including gender, hair and eye color and to some extent, personality and intelligence.9
Only eight out of one hundred women will become pregnant after a single act of intercourse in mid-cycle (when ovulation occurs).10 How likely is it that you could get pregnant right now? Learn the facts before exposing your body to artificial hormones.
This new individual continues to develop during the next week while it travels to the uterus and implants. Although clearly alive, some disagree about when this human life becomes a person. All forms of emergency contraception have the potential to prevent the new life from implanting. This is not a contraceptive effect, but abortive, resulting in the embryo's death.11
1. Plan B One-Step12
Plan B One StepTM (also known as the "morning-after pill) is intended to prevent pregnancy after known or suspected contraceptive failure, unprotected intercourse or forced sex. It is a single pill that contains large amounts of levonorgestrel, a progestin hormone found in some birth control pills. It is recommended to be taken within 72 hours of sex. It may work by preventing the egg and sperm from meeting. It won't disrupt an implanted pregnancy, but may prevent a newly formed life from implanting in the uterus and continuing to develop, which is a form of early abortion.
Side effects may include changes in periods, nausea, lower abdominal pain, tiredness, headache and dizziness.13 If your period is more than a week late, you may be pregnant. Plan B One-StepTM should not be taken during pregnancy nor used as a routine form of birth control.14
Women who experience severe abdominal pain after taking the drug may have an ectopic (tubal) pregnancy, and should get immediate help.15
A systematic review of 14 studies about emergency contraception (ED) (a total of over 13,000 women) concluded that increased access increases its use, but was not shown to reduce unintended pregnancy rates.16 This study also said that Plan B's effectiveness is not precisely known, but is significantly lower than the original estimates.
There are no long-term studies on the safety of current forms of EC if used frequently over long periods of time.17
ella® (ulipristal) is an FDA-approved emergency contraceptive for use within 5 days of unprotected sex or contraceptive failure. It is to be used only once during a menstrual cycle. If used as directed, ella® is reported to reduce the chance of pregnancy but is not effective in every case.19 Ella may reduce the chance of pregnancy by preventing or postponing ovulation. It also may also work by preventing an embryo from implanting in the uterus, which is a form of early abortion.20 ella® is a chemical cousin to the abortion pill Mifeprex. Both share the progesterone-blocking effect of disrupting the embryo's attachment to the womb, causing its death.21 Ella's impact on existing human pregnancies was not tested. However, ella did cause abortions in pregnant animals, including monkeys, and carries the same potential in humans.22
The most common adverse reactions of ella® include headache, nausea, stomach (abdominal) pain, menstrual cramps, tiredness and dizziness.23 Women who experience abdominal pain after using ella® should be evaluated right away for an ectopic pregnancy. Ella may not be as effective if taken with certain drugs, or may change the effectiveness of certain drugs.24 Much is unknown about the drug, including its effect on women who are under 18, pregnant women or women who are breast-feeding.25
1st Trimester Medical Abortion Methods
Mifeprex/Mifepristone ("The Abortion Pill")
This drug is FDA (Food and Drug Administration) approved for use in women up to 49 days after their last menstrual period. However, it is commonly used "off label" up to 63 days and even beyond.26 The FDA-approved procedure usually requires three office visits. On the first visit, the woman is given pills to swallow (mifepristone) that cause the death of the embryo. Two days later, if the abortion has not occurred, she is given a second drug to swallow (misoprostol) which causes cramping that expels the baby.27 If she is beyond 8 weeks LMP, it is possible that she may see identifiable parts expelled. The last visit is to determine if the procedure has been completed.
- Bleeding: Vaginal bleeding lasts for an average of 9-16 days; 1 in 100 women bleed enough to require surgery (D&C) to stop the bleeding.28
- Infection: According to the FDA,29 "Serious infection has resulted in death in a very small number of cases; in most of these cases misoprostol was used in the vagina." The FDA recommends that anyone who "feels sick" with weakness, abdominal pain, nausea, vomiting or diarrhea, with or without fever, more than 24 hours after taking misoprostol should seek immediate medical attention. The FDA has not established the safety of off-label methods, which include using misoprostaol in the cheek or vaginally and and many of the reported deaths were associated with these alternative methods.30
- Undiagnosed ectopic (tubal) pregnancy: This abortion pill will work in the case of ectopic pregnancy where the embryo lodges outside the uterus (usually in the fallopian tube). If not diagnosed early, there could be a risk of the tube bursting, internal hemorrhage, and death in some cases.31
- Failed abortion: It doesn't always work
- At 7 weeks from LMP, anywhere from 3-8% of women will fail to abort, depending upon the regimen used.32
- When used beyond 7 weeks, the failure rate increases significantly.33
- A surgical abortion us usually done to complete a failed medical abortion.34
- Risk of fetal malformations: Research links the use of misoprostol during the first trimester with certain types of birth defects when the pregnancy continues after the regimen is used.35
- Continuation of pregnancy: Women who change their minds after taking just the first pill(s) (mifepristone) of a medical abortion and want to try to continue their pregnancies may call "The Abortion Pill Reversal" at 877.558.0333 and or visit their website at: abortionpillreversal.com or seek the help of an obstetrician.
This drug is FDA-approved for treating certain cancers and rheumatoid arthritis, but is used off-label to treat ectopic pregnancies and to induce abortion. It works by stopping the growth of rapidly dividing cells. It is used up to 49 days of pregnancy and given orally or by injection. Three to seven days after the methotrexate is taken, misoprostol (the second medication also used in "the abortion pill" method) is used vaginally.
Side effects of methotrexate include diarrhea, mouth ulcers, nausea, abdominal distress, fatigue, chills, fever and dizziness. There is the risk of severe drug interactions with certain medications including ibuprofen and aspirin.
This form of medical abortion uses only the second drug given in "the abortion pill" method. It is typically inserted vaginally, requires repeated doses and has a significantly higher failure rate than "the abortion pill" method. It is associated with nausea, vomiting, diarrhea and potential birth defects in pregnancies that continue.37
1st Trimester Surgical Abortion Methods
First Trimester Suction Abortion About 4-15 Weeks After the Last Menstrual Period (LMP)38
This surgical abortion is done throughout the first trimester. Varying degrees of pain control are offered ranging from local anesthetic (typically) to full general anesthesia (not usually available). For very early pregnancies (4-7 weeks LMP), after local anesthetic is given, a
long, thin tube is inserted into the uterus which is then 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 bundles made of seaweed inserted into the cervix. The day of the procedure, the cervix may need further stretching using metal dilating rods. This can be painful, so local anesthesia is typically used. Next, the doctor inserts a stiff plastic tube into the uterus and applies suction by either an electric 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 a curette, to scrape any remaining fetal parts out of the uterus.
2nd Trimester Methods
DILATION AND EVACUATION (D & E)
ABOUT 13 WEEKS AFTER LMP39
The majority of second trimester abortions are performed using this method. The
cervix must be opened wider than in a first trimester
abortion because the fetus is larger. Sometimes laminaria and/or vaginal medications are placed in the cervical opening the night before to soften the cervix.40 Up to about 16 weeks gestation, the procedure is similar to the first trimester one (with the following addition). After the cervix is stretched open and the uterine contents suctioned out, any remaining fetal parts are removed with a forceps (grasping tool). A curette (a looped 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 our 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. 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 and bleeding.
Medication Methods for Second Trimester Induced Abortion41
This procedure induces abortion by using drugs to cause labor and eventual delivery of the 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 laminaria and/or medications. Next, pitocin, misoprostol and sometimes mifepristone are used to induce labor. In most cases, these drugs result in the delivery of the dead fetus and 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 a blood transfusion, retained placenta and possible uterine rupture.
Later term abortion methods
D&E After viability
FROM ABOUT 24 WEEKS AND UP
This procedure usually takes 2-3 days and is associated with increased risk to the life and health of the mother. Because a live birth is possible, injections are given to cause fetal death. 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 removal from the uterus to make sure nothing is left behind to cause infection or bleeding.
An alternative procedure, 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 to 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.
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the immediate risks of abortion
Abortion carries the risk of significant complications such as bleeding, infection and damage to organs. Serious medical complications occur infrequently in early abortions, but increase with later abortions.43 Current information reports the following risks:
Some bleeding after abortion is normal. However, there is a risk
of severe bleeding known as hemorrhaging. This may result from cervical tears, uterine punctures, retained tissue or when the uterus fails to contract after it is emptied. When this happens, a D&C may be required to stop the bleeding and sometimes a blood transfusion may be necessary.44
Incomplete or Failed abortion45
Sometimes, a surgical abortion fails to suction out the embryo and the pregnancy continues. This is more common in very early pregnancies (4-6 weeks LMP). In other cases, the abortion removes some, but not all of the pregnancy tissue. This can lead to infection and bleeding.
Infection can develop from the insertion of medical
instruments into the uterus, or from fetal parts that are
mistakenly left inside (known as an incomplete abortion).
This may cause bleeding and/or a pelvic infection requiring antibiotics and may result in the need for a surgical procedure to fully empty the uterus. Infection may cause scarring of the pelvic organs. Also, see "Mifeprex abortion" (above) to learn about a rare, fatal infection that is associated with abortion.
Damage to Organs47
The cervix and/or uterus may be cut, torn or punctured by abortion instruments. This may cause excessive bleeding requiring surgical repair resulting in scarring of the uterine lining. If the uterus is punctured, the bowel and bladder may be injured. The risk of these types of complications increases with the length of the pregnancy.
* Getting complete information on the risks associated with abortion is limited due to incomplete reporting and lack of record keeping linking abortions to complications.48
Local anesthetics, sedatives and pain medications may cause allergic reactions of varying degrees of severity. Convulsions, heart complications and, in extreme cases, death are known risks of general anesthesia.49
Every pregnant woman should receive blood type testing to learn if her blood type is "Rh positive" or "Rh negative." All pregnant women who are Rh negative should receive Rhogam® to prevent the formation of antibodies that may harm current or future pregnancies.50
In extreme cases, complications from abortion (excessive bleeding, infection, organ damage, blood clots and adverse reactions to anesthesia) may lead to death.51 The risk of death immediately following an induced abortion performed at or below 8 weeks is extremely low (approximately 1 in a million) but increases with length of pregnancy. For pregnancies over 21 weeks, the risk of dying from induced abortion is 91 in a million.52
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Consider the Long Term
Risks of Abortion
Finding out the real risks associated with abortion is difficult due to incomplete reporting of complications. There is evidence that induced abortion can be associated with significant loss of both emotional and physical health long term.53 Get the facts before going through a procedure or taking medicine that could have long-term effects on your health.54
Abortion and Pre-term Birth
undergo one or more induced abortions carry a significant
increased risk of delivering prematurely in the future.55
Premature delivery is associated with higher rates of
children with cerebral palsy, as well as all other complications (respiratory, bowel, brain, and eye problems).56
Medical experts continue to debate the
association between abortion and breast cancer. Research has shown the following:
1) Carrying a pregnancy to full term gives
a measure of protection against breast cancer, especially a woman's first pregnancy before the age of 30.57 Terminating such a pregnancy results in loss of that protection.58
2) The hormones of pregnancy cause breast tissue to grow rapidly in the first 3 months, but it is not until after 32 weeks LMP that breasts mature enough to produce milk and become more cancer resistant. That's why a premature birth before 32 weeks LMP significantly increases a woman's risk of breast cancer, as with late term abortions.59
3) The majority of worldwide studies report a positive association (increased risk) between induced abortion and the later development of
Abortion & Placenta Previa61
Placenta previa occurs when the placenta covers or partially covers the cervix. This can result in unpredictable massive bleeding that threatens the life of baby and mother, especially during labor. In addition to the risk of bleeding, it is associated with the risk of preterm birth and death early in infancy. The risk of placenta previa is higher in women who, among other factors, had a prior induced abortion (especially the D&C type), are over 34, had a prior C-section and/or had prior placenta previa.
Psychological / Emotional Impact
After an abortion, most women say they initially felt relief and looked forward to their lives returning to normal. But some women report negative emotions after abortion that linger, unresolved. For others, problems related to their abortion emerge months or even years later. There is evidence that abortion is associated with a decrease in long-term emotional and physical health.62
In line with the best available evidence, women should be informed that abortion significantly increases risk for:
- Clinical depression and anxiety63
- Drug and alcohol abuse64
- Symptoms consistent with post-traumatic stress disorder (PTSD)65
- Suicidal thoughts and behavior66
The bottom line is that the scientific evidence indicates that the abortion is more likely to be associated with negative psychological outcomes when compared to miscarriage or carrying an unintended pregnancy to term.67
If you or someone you know is struggling with unwanted feelings after an abortion, pregnancy centres offer confidential, compassionate support to help women (and men) work through these feelings. You are not alone.