Are You Considering Abortion?

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Facing a choice about pregnancy – are you considering abortion?

Before you make a decision about your pregnancy, it’s important for you to understand as much as possible about what may be involved – emotionally as well as physically

(Updated October 2015.  For further reading on unplanned pregnancy and pregnancy loss issues for women and men, including articles for health and welfare professionals, go to Open Doors Education pages.)


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CONTENTS

  • What is abortion?
  • When is abortion done?
  • How is abortion performed?
  • Medical abortion (RU486)
  • Surgical abortion
  • Abortion after 12 weeks
  • What are the risks of abortion? (physical, emotional)

If you’re facing an unexpected pregnancy, you may be feeling a whole range of emotions ranging across shock, disbelief, anger, fear, desperation, confusion or sadness. It’s difficult to make the decision that’s right for you when your emotions and thoughts are racing and you’re not sure of your options and what their outcome might be.

Before you make a decision about your pregnancy, it’s important for you to understand as much as possible about what may be involved – emotionally as well as physically.

There are no simple or easy answers, especially if you’re feeling pressure to choose a particular way. You may feel very vulnerable and your ability to make decisions may be affected. Many women think an abortion is the only choice – often for their own personal survival. Whatever you decide will impact on you to some degree as every decision we make has consequences. To continue the pregnancy will bring about change; to have an abortion can also bring its own effects.

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Bearing the above in mind, you might consider
  • Speaking to someone who has had an abortion and find out how that affected her.
  • Approaching someone who has gone ahead with her pregnancy and discuss what that has meant.
  • Getting more medical facts.
  • Making detailed inquiries about educational and career options.
  • Exploring your financial entitlements.

Without the facts you can’t make a fully informed decision.

If you’ve only just discovered that you’re pregnant, you may still be in shock. You need to allow yourself time to come to terms with the news in order to decide what’s best for you.

It’s more difficult to be objective when upset or anxious. Your ability to make decisions will be affected. Making a snap decision, without considering all the relevant information and considering how your decision may impact on you, may not be the most helpful for you in the long term.

Consider the views you held about abortion before you found yourself pregnant. This will allow you to consider how you might manage emotionally and psychologically if there’s a difference.

Seeking independent, non-directive counselling allows you to fully explore your thoughts, feelings and reactions. Non-directive counselling will empower you to make your own decision by allowing you time to reflect on your true feelings about this pregnancy and by providing full, accurate information about your choices.

It is important that counselling is from an independent service not financially or politically involved in providing abortion or in campaigning about the issue.

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BEFORE YOU MAKE A FINAL DECISION
  • Give yourself time to consider your feelings.
  • Identify and explore any pressures from people or circumstances that may be influencing you towards termination.
  • Find out the real facts about abortion and how it may affect you – this website will be a start.
  • Find out about the supports available to you if you continue this pregnancy.
  • I’m Pregnant – What are my choices?  Use this Help Page to assist you think about your situation.

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What is abortion?

Technically, abortion is the miscarriage of a pregnancy, whether naturally (a `spontaneous abortion’, normally just called a miscarriage) or artificially caused (an `induced abortion’). In everyday terms, however, abortion means bringing about a miscarriage to end a pregnancy.

Sometimes the pregnancy is referred to as ‘products of conception’, ‘foetal tissue’, or ‘a blob of cells’. The correct title in the first eight weeks of development is embryo; from then until birth the term “foetus” is the correct term.

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When is abortion done?

Abortion is most commonly performed between the 6th–12th week of pregnancy, counted from the first day of the woman’s last period (6–10 weeks after conception). If a surgical abortion is attempted too early, the embryo may be missed due to its small size, requiring the woman to undergo the procedure a second time.

At eight weeks (6 weeks since conception), the embryo becomes a foetus and no longer has the appearance of a mass of cells, but is almost fully formed. The embryo is 2.5cm long and weighs only 1 gram, but has all the internal organs in various stages of development. The heart has been beating for two weeks and the nervous system is functioning. The head, arms and legs are moving.

If you would like to see a picture of an 8 week old embryo, click here..

At twelve weeks (10 weeks since conception) the foetus is 6-8cm long and weighs about 18 grams. Closed eyelids are distinguishable as the face becomes properly formed. Muscles are growing, making limb movements more pronounced. The foetus is now able to squint, swallow and make a fist; the foetus is responsive to touch. The fingers and toes are fully formed and have nails. Internal and external reproductive organs have become definitely male or female.

If you would like to see a picture of a 12 week old foetus, click here.

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How is abortion performed?

The method of abortion used depends on both the gestation (age) of the foetus and therefore its size and the risk of complications to the mother. There are 2 types of abortion – one a medical abortion and the other a surgical abortion.

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MEDICAL ABORTION (RU486)

Medical abortion is an alternative to surgery in the very early weeks of pregnancy. Mifepristone (RU486 – known as the abortion pill) and Misoprostol are the two drugs used. It is a 2 stage process and can be done as soon as a pregnancy is detected and can be seen on an ultrasound. In Australia a medical abortion can be performed only up to 8 – 9 weeks. Beyond this a surgical abortion is necessary.

How much does a Medical Abortion Cost?
The cost of a medical abortion is around $560.00

The First Stage: Mifepristone, a synthetic steroid, is administered by mouth or vaginally. It acts by blocking the action of progesterone that is needed to maintain the early developing pregnancy. Mifepristone changes the lining of the uterus, causing the embryo to detach. It opens the cervix and increases the sensitivity of the uterus to Misoprostol.

The Second Stage: Misoprostol (administered in tablet form) is widely used in surgical termination of pregnancies to increase the safety of the procedure and reduce the risk of bleeding. For medical abortion it is administered approximately 48 hours after the Mifepristone and causes the uterus to contract, assisting in the expulsion of the embryo and associated tissue.

Follow Up After A Medical Abortion:

It’s important to have a follow-up appointment with the doctor or healthcare professional to confirm the pregnancy has ended. At this appointment an ultrasound (and possibly a blood test) should be done to make sure the termination is complete. In about 2 percent of cases, the abortion is not complete and a surgical termination is needed.

Possible Side Effects And Risks Of A Medical Abortion Are:

  • Cramping of the uterus or pelvic pain
  • Nausea or vomiting
  • Diarrhoea
  • Warmth/fever or chills
  • Headache
  • Dizziness
  • Fatigue
  • Inability to get pregnant due to an infection or complication of an operation
  • Allergic reaction to drugs used
  • Haemorrhage (heavy bleeding) possibly requiring treatment with an operation, a blood transfusion or both
  • Incomplete removal of the pregnancy, placenta or contents of the uterus requiring follow up surgery
  • Death – rarely

Before You Have A Medical Abortion (RU486) You Will Need To:

  • Have an ultrasound to check the stage of your pregnancy
  • Talk with a nurse, doctor or counsellor
  • See a doctor who will ask you about your medical history

Some Women Should Not Take Mifepristone:

Mifepristone is not recommended for all women and so a thorough medical history needs to be taken to rule out anything that may mean it would be unsafe for you to take it including if you –

  • have blood disorders
  •  have high blood pressure
  • have an ectopic (tubal) pregnancy
  • are more than 9 weeks pregnant
  • have allergic reaction to medications containing mifepristone
  • are fitted with an intrauterine device (IUD). The device would need to be removed before taking Mifepristone.

Disadvantages Of Taking Mifepristone Include:

  • The abortion happens at home – something that women can find distressing
  • There may be a lot of bleeding which could result in the need to have a surgical abortion or, in rare cases, a blood transfusion
  • There may be infection
  • The procedure fails in around 2 per cent of women who then may need a surgical abortion
  • Though rare, Mifepristone can take days to work

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SURGICAL ABORTION

Suction Aspiration is by far the most common method of abortion in Australia – it is used in 90% of abortions up to 12 weeks (since last period). The procedure is performed:
(a) with a local anaesthetic, where the woman is awake but is given an injection into the cervix to deaden the pain,
(b) with a “twilight” anaesthesia, where sedation is given to make the woman very drowsy but she is awake or
(c) with a general anaesthetic where the woman is unconscious during the procedure.

  • The entrance to the uterus (the cervix) is stretched open by inserting metal rods of increasing size
  • A plastic tube (diameter 7 – 9mm), with a sharp tip is inserted into the uterus through the cervix
  • Using a vacuum pump attached to the tubing, powerful suction is used to remove the foetus along with the placenta and lining of the uterus
  • The walls of the uterus are then scraped with a curette – a small sharp instrument with a spoon-shaped end – to check that the uterus is empty.

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Abortion after 12 weeks

Abortion after 12 weeks (11 weeks from conception) is done in a 2 stage procedure. The foetus is larger by this stage and that means other procedures will need to be used.

These may include:

  • The insertion of Hygroscopic Rods, to soften the cervix over a number of days, before surgical removal of the foetus
  • The use of Prostaglandin suppositories to induce labour. This method is usually carried out in hospital because of the possibility of complications and also the cost.

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How much does a surgical abortion cost?

Surgical abortions performed within the first 12 weeks of the pregnancy will incur out-of-pocket expenses within Australia ranging between $300 – $500 depending on the hospital or the clinic. (www.betterhealth.vic.gov.au cited online July 2015). As the number of weeks of the pregnancy progresses, the cost for a surgical abortion rises.

What are the risks of abortion?

The proportion of women who are reported as having complications has fallen from 5.8% in the early years (1970-74) to 2.2% in the year 2012. Within this small percentage, infection made up (1.9%), haemorrhage during surgery (1.9%), failed procedure (1.6%) and retained products of conception (83.8%). (DHS, 2012).

While a lower frequency of post-abortion complications may be due to improved methods and their use earlier in pregnancy, the possibility of under-reporting was acknowledged in the above report. As report forms are required to be submitted within 14 days after the abortion, complications occurring or reported later than this time frame may not be taken into account. This may be the case especially if the woman attends a different medical practitioner to the one performing her abortion.

The following is a brief outline of both the early and later risks and effects associated with any type of abortion. Both physical and emotional aspects are discussed.

These complications can and do happen. How frequently they occur, however, is not certain; some studies show a higher incidence of complications while others show a lower incidence. All studies however, show that having an abortion (like any other surgical procedure) involves some risk.

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Early physical risks

Pre-medication: It is usual prior to anaesthetic (local or general) to be given a sedative. The concern with this is that apart from the small risk of reacting badly to the medication some women may change their mind at the last minute about having the abortion and feel powerless in their sedated state to object. It is important for you to know that you are entitled to change your mind at any stage or to delay your decision.
It is important for women not to sign abortion consent forms when under the influence of medication.

General Anaesthetic: A general anaesthetic always carries some risk of complication, regardless of the operation being performed. The main concern is to have an adequate fasting period before the operation to avoid the danger of inhalation. Recovery from a general anaesthetic varies. Some people recover quickly while others are very drowsy or feel sick for a time. It is vital that women have fully recovered before going home after an abortion. Because of the anaesthetic’s prolonged effect, women should not drive a car or operate important machinery in the first 24 hours.

Haemorrhage: As stated earlier there are still a number of reported cases of haemorrhage at the time of the abortion procedure being performed. Bleeding after an abortion should be no heavier than a normal period. Excessive bleeding following an abortion is most commonly caused by a part of placental tissue not been completely removed and needs to be reported to a doctor. To stop the bleeding, a second procedure is needed to remove any missed tissue.

Infection: It is not uncommon following any operation to have a slight rise in body temperature. A prolonged high temperature following abortion however, may be a sign of Pelvic Inflammatory Disease (P.I.D.) or an infection of the uterus and fallopian tubes. Other signs of P.I.D. are lower abdominal pain and vaginal discharge. It is possible to have P.I.D. without noticeable symptoms.

Infection following abortion may be caused by retained tissue being left behind in the uterus, which becomes infected (adherent placenta). If the woman has a sexually transmitted disease such as Chlamydia at the time of the abortion, there is a much higher risk of P.I.D. If not correctly treated with antibiotics, this infection can lead to blockage of the fallopian tubes, a major cause of infertility (inability to have children). Damage to the fallopian tubes also puts the woman at risk of ectopic (tubal) pregnancy (see below).

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Later physical complications

Future Fertility: Infertility (being unable to have children) is a known risk of the abortion procedure. The risk is greater in abortions after 12 weeks and in repeat (2nd or more) abortions, but it is still a small risk in early abortions using the suction method. The main causes of infertility following an abortion are:
• Blocked fallopian tubes caused by pelvic infection
• Scar tissue caused by damage to the uterus during the abortion
• Cervical damage caused by over-stretching or tearing (see below)

Cervical Incompetence: The cervix (neck of the uterus), which is normally firm and tight, may be damaged and weakened during an abortion by the metal rods, suction tubing and other instruments passed through its narrow opening. This damage can make the cervix “incompetent” (unable to hold the weight of a developing pregnancy), leading to miscarriage or premature birth in later pregnancies. Young women who have not previously given birth are at a greater risk of cervical damage and repeat abortions increase the likelihood of early delivery of subsequent pregnancies (BJOG, 2004).

Tubal (Ectopic) Pregnancy: Inflammation or scarring of the fallopian tubes following abortion may lead to a later ectopic pregnancy. The scarred fallopian tube is too narrow for a developing embryo to pass through to the uterus, so it implants in the fallopian tube where it is unable to survive. The woman will need emergency surgery to remove the embryo and possibly part of the fallopian tube. If not detected early enough, the pregnancy may rupture the fallopian tube causing internal bleeding. This is a life threatening condition and requires emergency surgery and blood transfusions.

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Early emotional effects

The initial response to abortion (whether medical or surgical) may vary depending on the individual and the circumstances.

Relief: Initial feelings of relief may follow an abortion as there is a strong desire to get back to the pre-pregnant state, as if the pregnancy had never happened.

Numbness: Many women also experience feelings of numbness and emptiness, which are a common early reaction to any loss. However these feelings are a part of the early stages of the normal grief response that may later give way to stronger, more intense feelings. Because of the tendency not to talk about the abortion, these effects may be pushed aside rather than acknowledged and dealt with. (Refer to the possible long-term emotional effects)

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Later emotional effects

When we experience the loss of someone or something close, we move through a normal grieving process, which, in time, results in some resolution and adjustment to our loss. With the complex and secret nature of abortion, this grieving process is often not acknowledged, making the loss difficult to come to terms with.

Many women don’t expect to feel a sense of loss and can find themselves struggling with depression, tearfulness, anxiety, guilt, anger and sadness when trying to pick up their pre-abortion lifestyle. These feelings may occur around the date of the abortion or the date the baby would have been born. It can be difficult facing others who are pregnant or have babies. There can be feelings of envy and hostility towards others with babies, which, in turn, causes feelings of guilt.

It’s not unusual to turn these feelings inward, push them down and suffer in silence. Unresolved grief can negatively impact on the woman’s relationships with her partner/husband, children, other family members, extended family and the community. It can be years before a resolution of her grief occurs, and sometimes the issue is never resolved. Many women talk about a deep underlying ache that is always with them – a numbness and emptiness.

Findings published in the British Medical Journal (Jan. 2002) indicate that women who abort a first pregnancy are at greater risk of subsequent long-term clinical depression. The study, begun in 1979, showed at an average of eight years after their abortions, married women were 138% more likely to be at a high risk of clinical depression compared to similar women who continued on with an unplanned pregnancy to term.

These findings are consistent with other research that has shown a 4 – 6 fold increase risk of suicide and substance abuse associated with a previous abortion (Reardon & Ney, 2000). Coleman et. al, 2008 found that many post-abortive women struggle with anxiety, mood and substance abuse disorders.

A study in the Canadian Journal of Psychiatry in 2010 also showed that women having abortions were 3.8 times more likely to have substance abuse disorders. An association has also been found between having an abortion and subsequent symptoms of anxiety and depression. Substance use and suicidal behaviour were found to be related with having had an abortion (Mota, et. al. 2010).

Replacement Pregnancy: One aspect of the post abortion experience for some women can be the desire to replace the pregnancy that has been terminated with another, often within the period of 3 – 6 months after the abortion. This desire is thought to be motivated by the unconscious need to undo the abortion and turn back the clock. Many women can be aware of a strong desire to do this and will proceed with the second pregnancy.

However, the number of repeat abortions is an area of concern to the Dept of Human Services. “Out of 4,765 women who had terminations, 1,729 (36.3%) had a previous abortion (Tenth Annual Report, 2012). The concern is that those women who have had a number of unplanned pregnancies, possibly to unconsciously replace a previously aborted pregnancy, may find themselves drawn into the cycle of repeat abortions. For those who have repeat abortions the potential for difficulties (both physical and emotional) obviously increases.

What support is there if I continue the pregnancy?

Open Doors can offer you ongoing counselling and support for the duration of your pregnancy or according to your needs. Working with your own counsellor can provide you with the security of someone who is willing to be there if you encounters any difficulties, and support you as your pregnancy develops and you prepare for the birth of your baby.

We can put you in touch with appropriate referrals – medical, financial, adoption etc. We can also assist with access to baby goods and support groups. Our fees for counselling are low and can be discussed with your counsellor in the case of hardship. Sessions are unlimited and are available for women, men, teens and couples.

Is support available for women who have had abortions?

Open Doors has a specialist counselling service for women who need support following an abortion. Talking about their experience with someone who wasn’t involved in the situation can be very benefical. Skilled and caring listeners can help ease the pain and confusion of hidden (dis-enfranchised) or unresolved grief. A post abortion support group is also available at our Ringwood centre.

Struggling to cope after an abortion can be a very lonely, isolating experience. Despite abortion being freely available, there is still a lot of pressure to keep it secret but it is okay to talk about it, whether it happened recently or years ago. Feelings and reactions may change over time and you are always able to return for further counselling.

Men are also welcome to access Open Doors post abortion counselling services as they can be deeply affected by an abortion decision.

Click here to read more about common post abortion reactions and emotions: After the Abortion

The information on this website is not a substitute for personal counselling. You should always seek outside help if you are unsure what to do. If you need to talk to someone you can call –

OPEN DOORS COUNSELLING
5 Greenwood Ave Ringwood. 3134 Victoria Australia
Ph: (03) 9870 7044
Freecall outside Melbourne 1800 647 995
Or use our Contact Form to request an appointment or a call back, or to ask a question 

CLICK HERE if you would like to see a full photographic story of the development of the foetus from conception to birth. The accompanying article is written from the point of view of a young person finding out all about before they were born.

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References

Coleman, PK, Coyle, CT, Shuping, M and Rue, VM, Induced abortion and anxiety, mood, and substance abuse disorders: Isolating the effects of abortion in the national co-morbidity survey. Journal of Psychiatric Research (2008).

Mota, NP, Burnett, M and Sareen, J, Associations between Abortion, Mental Disorders, and Suicidal Behaviour in a Nationally Representative Sample, Canadian Journal of Psychiatry 2010.

Reardon, DC and Ney, PG, Abortion and subsequent substance abuse. American Journal Drug Alcohol Abuse, 2000; 26(1): 61-75.

Reardon, DC and Cougle, JR, Depression and unintended pregnancy in the national Longitudinal Survey of Youth: A cohort study. British Medical Journal 324:151-151, January 2002.

Previous induced abortions and the risk of very preterm delivery: results of the EPIPAGE study, Epipage Group, British Journal of Gynaecology, 2004.

Tenth Annual Report of the South Australian Abortion Reporting Committee for the year 2012. Parliament of South Australia.