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.
above in mind, you might consider
the facts you can't make a fully informed
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
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
MAKE A FINAL DECISION
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.
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').
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
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
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
If you would like to see a picture
of an 8 week old embryo, click
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.
you would like to see a picture of
a 12 week old foetus, click
method of abortion used depends on both
the gestation (age) of the foetus and therefore
its size and the risk of complications to
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
- General anaesthetic
where the woman is unconscious during
- 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..
entrance to the uterus (the cervix) is stretched
open by inserting metal rods of increasing
plastic tube (diameter 7 - 9mm), with an
angled tip is inserted into the uterus through
a vacuum pump attached to the tubing, powerful
suction is used to remove the foetus along
with the placenta and uterine lining.
walls of the uterus are then scraped with
a curette - a small sharp instrument with
a spoon-shaped end - to check that the uterus
after 12 weeks (10 weeks from conception)
requires a more involved preparation of
the cervix. These preparations may include:
How much does
an abortion cost?
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
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.
following is a brief outline of the early
and later risks and effects associated with
abortion. Both physical and emotional aspects
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
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
is important for women not to sign abortion
consent forms when under the influence of
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
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.
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).
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)
main causes of infertility following an
fallopian tubes caused by pelvic infection
tissue caused by damage to the uterus
during the abortion
damage caused by over-stretching or
tearing (see below)
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.
(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.
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
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.
initial response to abortion may vary depending
on the individual and the circumstances.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
can put you in touch with appropriate referrals
- medical, financial, adoption etc. We can
also assist with access to baby goods and
support available for women who have had
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.
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
5 Greenwood Ave Ringwood. 3134
Ph: (03) 9870 7044
Freecall outside Melbourne 1800 647 995
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.
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.
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,
Thirty-first Annual Report
- For the Year 2000. Committee appointed
to examine and report on abortions notified
in South Australia.
Department of Human Services.
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