Facing a choice about pregnancy - are you considering abortion?

If you're facing an unexpected pregnancy, you may be feeling a whole range of emotions from 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 need to be wanted, accepted and supported. Your ability to make decisions will be affected. Many women think an abortion is the only choice - 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 will also bring its own effects.

• 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. 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.

Considering your formerly held view on abortion before you found yourself pregnant will allow you to consider how you will manage emotionally and psychologically if there is a difference.

Seeking independent, non-directive counselling allows you to fully explore your thoughts, feelings and reactions. Good 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.

• Give yourself time to consider your feelings.

• Identify and explore any pressures 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.

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, or bringing an end to a pregnancy.

Abortion is sometimes described as 'removing the lining of the uterus', or the 'contents of the womb'. Other words often used for abortion are 'termination of pregnancy' ('T.O.P.' or 'termination').

Sometimes the unborn baby is referred to as 'products of conception', 'foetal tissue', 'protoplasm' or 'a blob of cells'. The correct title for an unborn child in the first eight weeks of development is embryo; from then until birth the appropriate title is foetus.
 

Abortion is most commonly performed between the 8th-12th week of pregnancy, counted from the first day of the woman's last period (6-10 weeks after conception). If abortion is attempted earlier than 8 weeks, 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 no longer has the appearance of a mass of cells, but is almost fully formed. The embryo is 2.5cm (1 in) long and weighs only 1 gram, but has all the internal organs of an adult 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.

At twelve weeks (10 weeks since conception) the unborn child, now known as a 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.

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.

SUCTION ASPIRATION is by far the most common method of abortion in Australia - it is used in 98% of abortions up to 12 weeks since last period. The various anaesthetic choices are:

• General anaesthetic where the woman is unconscious during the procedure.
• Nitrous Oxide or similar gas - referred to as "twilight" anaesthesia, where sedation is given to make the woman drowsy but she is awake.
• Local anaesthetic where the woman is awake but is given an injection into the cervix to deaden the pain.
• Local anaesthetic plus intravenous sedation - a combination of sedation and a paracervical block..

The entrance to the uterus (the cervix) is stretched open by inserting metal rods of increasing size.

A plastic tube (diameter 7 - 9mm), with an angled 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 uterine lining.

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.
 

Abortion after 12 weeks (10 weeks from conception) requires a more involved preparation of the cervix. These preparations may include:

• Hormone blocking tablets are taken to soften the cervix. These are taken orally or inserted into the vagina. They take about 2 hours to work. The abortion is then performed using instruments and a suction apparatus.

• The cervix is widened and a special device is inserted into it which swells over several hours. Other drugs may be used also. The abortion is usually performed 1 or 2 days later in hospital.

Abortions performed within the first 12 weeks of pregnancy cost between AUS$160 - $450 depending on the anaesthesia and the type of hospital or clinic. Costs increase with the stages of pregnancy. The Medicare rebate ranges from AUS$116.50 - $165.50. An uninsured woman who has a general anaesthesia in a private hosiptal can incur out-of-pocket expenses of approximately AUS$600 after the Medicare rebate of ASU$165.50.

The proportion of women who are reported as having complications has fallen from 5.8% in the early years (1970-74) to 0.4% in the year 2005 (Third Annual Report of the South Australian Abortion Reporting Committee 2005).

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 the early and later risks and effects associated with 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.
 

Pre-medication: It is usual prior to anaesthetic (local or general) to be given sedating medication. The problem with this medication, apart from the small risk of reacting badly to the drug, is that some women may change their mind about having the abortion at the last minute 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 some 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: There are 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 an Adherent Placenta (where the placenta has not been completely removed). To stop the bleeding, the abortion procedure would need to be repeated to remove any missed tissue and, if the woman has lost a lot of blood, she may require a blood transfusion.

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 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, which is 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).
 

Future Fertility: Infertility 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. There is a slight risk of miscarriage in a subsequent pregnancy when there is a short interval between the two. Premature birth of a subsequent pregnancy is also possible (RANZCOG, 2005)

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, 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.

Tubal (Ectopic) Pregnancy: Inflammation or scarring of the fallopian tubes following abortion may lead to a later ectopic pregnancy (where a developing embryo implants in the fallopian tube, being unable to pass through the narrowed tube). The pregnancy cannot survive and the woman would need 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 would require emergency surgery and blood transfusions.

The Breast Cancer Link: Whilst it is not conclusive that women who have terminations will get breast cancer in later life, there are a number of studies in the US and UK that suggest there is an increased incidence of breast cancer in women who have aborted their first pregnancy.

The surgical interruption of a first time pregnancy cuts off the process of necessary hormonal changes that transform and prepare the breast for first-time lactation (breast feeding). Where this process is interrupted, the rapid growth of breast cells is left in transition and therefore breast tissue is considered to be more vulnerable to carcinogens.

A new study published by The Journal of American Physicians and Surgeons, 2007, showed that countries with a higher abortion rate could expect a substantial increase in breast cancer (Carroll, 2007).

Women who have a history of breast cancer in their families may wish to consider this aspect in their decision-making.

The initial response to abortion may vary depending on the individual and the circumstances.

Relief: Initial feelings of relief may follow an abortion as there is often 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 which 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.

When we experience the loss of someone or something close, we move through a normal grieving process which, in time, results in resolution and acceptance of 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 do not expect to feel a sense of loss. So we can find the woman who tried to pick up her pre-abortion life-style struggling with depression, tearfulness, anxiety, guilt, anger and sadness.

She may find these feelings occur around the date of the abortion or the date her baby would have been born. She may find it difficult to face others who are pregnant or have babies. She may also experience envy and hostility towards others with babies, which, in turn, causes her to feel guilty.

Her reactions may be to turn these feelings inwards, 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 later 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.

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 (Gissler et al, 1997, Reardon & Ney, 2000).

One aspect of the post abortion experience that is well worth mentioning is 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 conscious or unconscious need to undo the abortion and turn back the clock. Many women do proceed with the second pregnancy.

However, the number of repeat abortions is quoted as an area of concern to the Department of Health, South Australia: "Out of the 4,712 women who had abortions, 1,826 (38%) had had an earlier termination", Dept of Health, 2005). The concern is that those women who have 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 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 encounter 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.

Is support available for women who have had abortions?

Open Doors has a specialist counselling service for women needing support following an abortion. Coping with an abortion can be a very lonely experience. Many women feel very isolated with few people they can talk to. Skilled and caring listeners can help ease the pain and confusion of hidden or unresolved grief.

This information 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 right now you can call

OPEN DOORS COUNSELLING
5 Greenwood Ave Ringwood. 3134
Ph: (03) 9870 7044
Freecall outside Melbourne 1800 647 995
Email: info@opendoors.com.au

 

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.

Carroll, Patrick, The Breast Cancer Epidemic, The Journal of American Physicians and Surgeons, Vol 12, No. 3, 2007..

Gissler, M. et al, Pregnancy-associated deaths in Finland 1987 - 1994 - a definition of problems and benefits of record linkage. Acta Obstericia et Gynecololgica, Scandinavia 76:651 - 657.

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

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

South Australian Abortion Reporting Committee 2005. Third Annual Report. Parliament of South Australia. Pub. 2007.

Termination of Pregnancy - a resource for health professionals. The Royal Australian and New Zealand College of Obstetricians & Gynaecologists. Nov, 2005.

Thirty-first Annual Report - For the Year 2000. Committee appointed to examine and report on abortions notified in South Australia.
Department of Human Services.

© Copyright Open Doors Counselling and Educational Services Inc.

Updated Oct 2007