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Critical Things to Know Before Scheduling an Abortion

At Heartbeats, we know it’s your life that will be impacted by the decision you make about your pregnancy. So, before you pay someone to perform an abortion, it is your right to know all of your options and have all of the information you need to make an educated, and safe, decision. While for-profit clinics and hospitals are often driven more by money than concern for the patient, we exist solely because we care about you, without making a profit.

Our knowledgeable, compassionate staff are committed to thoroughly and honestly sharing the information you need to make an informed decision, including answering these three critical questions before scheduling an abortion.

Is Your Pregnancy Viable?

A viable pregnancy means you are carrying a baby that has a reasonable chance to develop fully and survive outside the womb. A non-viable pregnancy, then, means the fetus has either died or has no chance of being born alive and living outside the womb1 . Some non-viable pregnancies, such as an ectopic pregnancy (a pregnancy that is growing outside of the uterus), can pose a significant risk to the mother and cannot be addressed through abortion. For this reason, having an ultrasound prior to scheduling an abortion is critical, as it is the only way to definitively determine viability. At Heartbeats, we can perform this ultrasound free of charge.

Non-Viable Pregnancies

Again, a non-viable pregnancy means that the baby has zero chance of surviving outside the womb. While there are strict medical guidelines for determining pregnancy viability, it is important that you are fully informed before moving forward with any medical procedure.

You’re much more likely to have a failed, or non-viable, pregnancy in the first trimester (the first 0-13 weeks of pregnancy)2. Any suspicion of a non-viable pregnancy should be discussed with your medical professional and all options explored before action of any kind is undertaken. A second opinion is always a good idea. While 10-20% of known pregnancies end in miscarriage3, there are other pregnancies that continue despite being non-viable and can potentially cause health risks. With that in mind, here are some of the most common causes of non-viability that may be detected through an ultrasound performed at 6 weeks gestation or later.

  • No heartbeat. Keep in mind that if the gestational age of the pregnancy has not definitively been determined, it may be too early to detect a fetal heartbeat. Waiting a week or two and repeating the vaginal ultrasound may be in order. If a second ultrasound does not show a heartbeat, it could mean that you have miscarried or that the baby has died in utero. There could be a variety of reasons that the baby failed to thrive and develop. Consult with your medical professional regarding the need for a procedure known as dilation and curettage (D&C) or other method to ensure the safe and full expulsion of the fetus, placenta and pregnancy tissue from the uterus. During a D&C, the cervix is dilated and the contents of the uterus are removed using suction and/or a looped tool called a curette4.
  • Ectopic pregnancy. This condition occurs when the fertilized egg implants outside of the uterus, most often in the fallopian tubes. An ectopic pregnancy affects 1% to 2% of all pregnancies and poses a significant threat to women of reproductive age. If left undiagnosed or untreated, the fetus can grow until it ruptures the fallopian tube, which will cause heavy internal bleeding in the abdomen and may lead to shock. It is the leading cause of maternal death during the first trimester of pregnancy and is responsible for 9% of pregnancy-related deaths in the United States5.

To prevent these life-threatening complications, the ectopic tissue must be removed using medication, laparoscopic or abdominal surgery. The method depends on your symptoms and when the ectopic pregnancy is discovered6.

  • Anembryonic Gestation/Blighted Ovum. When a fertilized egg attaches to the uterine wall, it begins to develop a gestational sac around itself. In the case of anembryonic gestation, or blighted ovum, the gestational sac continues to grow, but the egg inside it does not, and it never develops into an embryo. This condition is believed to be the result of chromosomal abnormalities and often ends in miscarriage before or shortly after the woman becomes aware she is pregnant7.

If a miscarriage does not occur, the condition can be detected during an ultrasound that shows the gestational sac to be empty. At that point, your doctor may recommend waiting for a natural miscarriage to occur or suggest a D&C.

  • Molar Pregnancy. This is a rare complication (1 in 1,000 pregnancies) that can present as either a complete or partial molar pregnancy. In a complete molar pregnancy, the placental tissue develops abnormally, becoming swollen and forming fluid-filled cysts that may appear like grapes on an ultrasound. A fetus does not form in this type of molar pregnancy because the egg that is fertilized is empty, meaning that the genetic material comes solely from the father’s sperm. A partial molar pregnancy, on the other hand, may contain both normal and abnormal placental tissue that forms simultaneously. A fetus may also form, but it is rarely able to survive because the abnormal tissue overtakes the fetus and/or because two sperm fertilize the same egg, thus providing two sets of male chromosomes, or two sets of the father's genetic material. If a doctor suspects a molar pregnancy, blood tests and an ultrasound will usually be ordered. If the pregnancy doesn’t end in miscarriage, other treatment options will be explored8.

In extremely rare instances, an embryo does develop and survive into the late weeks of a molar pregnancy, so while considered a non-viable pregnancy, it is always important to get conclusive evidence before moving forward. Women who are younger than 20 or older than 35 are at slightly higher risk of having molar pregnancies. There is also a chance that the molar pregnancy can develop into a cancerous tumor and spread beyond the uterus if not treated successfully9,10.

How Far Along Are You?

The gestational age of the fetus, or number of weeks since conception, is a key factor in determining the type of abortion you will receive, as well as its cost. Even though many women have a general idea of the date of their last period, the exact time the pregnancy began is an estimation. An ultrasound is the only way to definitively identify the true age and size of the fetus. In fact, without it, you could be offered the wrong type of abortion. A chemical abortion (the abortion pill), for example, could be recommended when you are actually past the 10-week window for that procedure’s safety or effectiveness. For this reason, a tele-medicine consultation is insufficient, as it cannot provide proof of pregnancy, proof of gestational age, or proof of a viable pregnancy, potentially putting you at risk. At Heartbeats, we personally provide all of this information at no cost to you.

Types of Abortions*

There are two categories that abortions fall into – chemical abortion and surgical abortion. Stage of pregnancy and personal health information determine the type of abortion procedure used to end a pregnancy. That’s why an ultrasound is necessary to pinpoint gestational age and ensure a viable pregnancy. A visit with a medical professional is also critical to identify any risk factors. Below is an overview of the most common abortion procedures. We are here to answer any questions you may have and offer you a free pre-abortion screening. Call us at 740-349-7558 in Newark or at 740-450-5437 in Zanesville.

Chemical/Medication Abortion (up to 10 weeks gestation)

Chemical, or medication, abortions now make up more than 40% of all pregnancy terminations. Also known as the abortion pill, self-managed abortion, or RU-486, this method involves taking two pills: mifepristone (RU-486) and misoprostol. Mifepristone blocks the uterus from receiving progesterone, which is a hormone necessary to sustain pregnancy. Without the hormone, the lining of the uterus begins to deteriorate and inhibits the transfer of life-sustaining nutrients to the unborn child, causing it to die. Following mifepristone, the woman takes the second drug, misoprostol, 24-48 hours later. This causes the uterus to initiate contractions to expel the fetus and uterine contents11.

Because a chemical abortion is not performed in a medical facility, the woman is responsible for monitoring her body’s response to the medication. As a result, it is imperative that she contact her doctor or seek emergency assistance if complications arise, such as uncontrolled bleeding or intense pain. Since the abortion is completed at home, the woman is also responsible for disposing of the remains.

Recently, the abortion pill has become more easily accessible, usually through a tele-medicine consultation and mail-order prescription. As a result of the overall increase in medication abortions, the FDA says that more than 20 women have died from taking the drug combination12. Research studies also show that chemical abortions are four times more likely to have complications than surgical abortions (5 per 10013), whether due to infection, ectopic pregnancy, septic shock, or the regimen’s ineffectiveness. In fact, up to 7% of self-administered chemical procedures result in incomplete abortions, which then requires the woman to pay for a surgical abortion to fully extract the fetus from the womb14.  It is important that the woman seek a follow-up exam and ultrasound to ensure that the abortion was complete.

Surgical Abortion

The type of surgical abortion used is also dependent on the gestational age of the baby and health factors of the mother. Cost for each varies, as well, but generally increases for procedures performed later in pregnancy. According to the Mayo Clinic, “Women who have multiple surgical abortion procedures may also have more risk of trauma to the cervix15,” which can pose problems for future pregnancies.

D&C – Dilation and Curettage, or Vacuum Aspiration (6-14 weeks gestation)

In this surgical abortion, the cervix is stretched open, or dilated. Next, a tube is attached to a suction machine and inserted into the uterus. The fetus is then suctioned out of the uterus and a tool called a curette is used to scrape any remaining fetal parts or pregnancy tissue from the uterine wall. Though infrequent, complications from a D&C can include uterine perforation, uterine infection, uterine bleeding, or Asherman’s syndrome, all which are treatable if diagnosed early16.

Dilation and Evacuation - (12-24 weeks gestation)

This is the most common abortion method used after 12 weeks of pregnancy. The cervix is slowly stretched open over a period of hours, most often using a substance called laminaria. Next, a numbing agent or general anesthesia is administered to control pain. A suction catheter is then inserted into the uterus to empty the amniotic fluid surrounding the baby17. This is followed by a sopher clamp that the abortionist uses to dismember the body for removal, especially after 16 weeks, as it is too big to be delivered intact. Once the fetus has been extracted, the abortionist uses a curette to scrape the uterus to remove the placenta and any remaining tissue. The body parts of the baby are then collected and reassembled to ensure that nothing was left inside the woman’s uterus18.

The procedure is not without risks. Extreme blood loss, cervical damage, uterine perforation and scarred tissue can all cause complications, both immediately following the abortion and long-term, including future miscarriage and preterm birth. In severe cases, uterine rupture can lead to death. The CDC estimates that the risk of death from a D&E increases by 38% for each additional week of gestation19. There are also studies that indicate the risk of depression, anxiety, and suicide is greater for a woman who aborts an unwanted pregnancy than it is for a woman who carries an unwanted pregnancy to term.20

Induction of Labor - (Third Trimester)

Abortions performed after 22 weeks are more involved, as the baby has reached the point of viability, or living outside the womb, if delivered alive. For this reason, abortion by induction of labor is usually done in the hospital. In most cases, the abortionist will take measures to stop the baby’s life prior to induction so that the mother delivers a stillborn child. This is done by injecting a lethal dose of either digoxin or potassium chloride through the abdomen or vagina into the baby’s heart, torso or head. This causes the baby to have fatal cardiac arrest (a heart attack)21.

Following this procedure, the abortionist will prepare for delivery by inserting a substance into the cervix to soften and stretch it. After a time, a second ultrasound may be performed to ensure the baby is no longer living. If still alive, a second dose of digoxin or potassium chloride will be administered. The woman is then injected with medication that initiates contractions, usually either prostaglandin or oxytocin. Because this can take a number of hours, women may return home or to a hotel room to wait until contractions begin, returning to the hospital or clinic to deliver the stillborn child. In some cases, the woman may not have time to make it to the hospital and will deliver the baby where she is, usually talking with a doctor or nurse on the phone and waiting for medical personnel to arrive22.

Labor induction carries with it the slight chance that the baby is born alive, a chance that increases with gestational age. If this happens, the baby may be left unattended to die naturally. If all tissue is not emptied out of the uterus during the labor and delivery process, the walls of the uterus will need to be scraped. In the event the baby is not delivered fully intact, a D&E is likely performed. It should also be noted that studies have listed “induced abortion” as a breast cancer risk factor23.

Hysterotomy/Cesarean Abortion - (Third Trimester)

Also performed after the baby is viable (~22 weeks), a hysterotomy abortion is much like a cesarean section delivery. The abortionist enters the womb via a surgical incision in the woman’s abdominal wall. The primary difference between delivery vs abortion, however, is that, before extracting the baby, the life of the baby is stopped one of two ways: a lethal injection of digoxin or potassium chloride into the baby’s heart, head or torso to cause cardiac arrest; or cutting the umbilical cord to stop the flow of oxygen to the child, causing suffocation. In rare cases, the baby is delivered alive and left unattended to die. Hysterotomy is rare but is the preferred abortion method if the induction method fails or cannot be used for other reasons24.

If you are considering abortion, contact us today for your free pre-abortion screening and consultation.

*Heartbeats does not perform or refer for abortions.

Do You Have an STD?

You may wonder what having an STD has to do with getting an abortion, but it is extremely important. If you have an STD, especially one of the two most common, chlamydia or gonorrhea, and aren’t treated before having an abortion, your risk of developing Pelvic Inflammatory Disease (PID) increases by 23% if the cervical infection is forced up into the uterus during the medical procedure25. PID increases your chances of having a future ectopic pregnancy, can decrease fertility, and can cause life-long pelvic inflammation and pain26. Testing is especially important because these STDs can be present without any symptoms. Other STDs, such as cervical syphilis27, HIV/AIDS28, and Human PapillomaVirus (HPV)29, also need to be tested for early in pregnancy, regardless of your pregnancy intentions, as they can pose significant risks to your health.

The majority of abortion facilities do not test for STDs prior to performing an abortion procedure. If they do, they charge an additional fee. At Heartbeats, we can confidentially have you tested and treated for these STDs at no charge. Results of STD testing are usually available within one week.

STDs that Impact Abortion

If you have scheduled or are considering an abortion, it is important to get tested beforehand for two STDs that can pose a risk during the procedure. Why? Because women who have an untreated STD like chlamydia or gonorrhea are up to 23% more likely to develop Pelvic Inflammatory Disease (PID) following an abortion procedure30.

Chlamydia31
The most common bacterial STD in the U.S. is chlamydia, and it is nearly symptom-free in 85% of women. When it progresses to display symptoms, women might experience a noticeable discharge, a foul vaginal odor, bleeding after having sex, or irregular monthly bleeding. Because chlamydia primarily affects a woman’s cervix (the lowest region of the uterus that attaches the uterus, or womb, to the vagina), serious complications of going undetected can include Pelvic Inflammatory Disease (an infection of a woman’s reproductive organs); ectopic, or tubal, pregnancy (a pregnancy that is growing outside of the uterus); and even infertility. If you are pregnant and have chlamydia at the time of delivery, it can cause an eye infection in your baby. Chlamydia is treatable with antibiotics.

Gonorrhea32

Gonorrhea is another common and easily treated STD, but it can be symptom-free, as well. When symptoms do appear, they resemble those of chlamydia for women, but may also include itching and abdominal pain. In men, symptoms usually consist of burning during urination and/or a yellow discharge. If left untreated, gonorrhea can lead to a chronic liver disease call Fitz-Hugh-Curtis syndrome, as well as PID, ectopic pregnancy and infertility. Gonorrhea is treatable with antibiotics.

Get Your Pre-abortion Screening

At Heartbeats, we are here to give you the answers to these three critical questions before undergoing an abortion. Our no-cost pre-abortion screenings include a pregnancy test, an ultrasound and STD testing all performed by a licensed medical professional. Call us at 740-349-7558 in Newark or at 740-450-5437 in Zanesville to schedule your screening today.

References

  1. Clement EG, Horvath S, Mcallister A, Koelper NC, Sammel MD, Schreiber CA. The language of first-trimester nonviable pregnancy: Patient-reported preferences and clarity. Obstet Gynecol.2019;133(1):149-154. doi:10.1097/AOG.0000000000002997
  2. (2021, June 15). A Determined Look into Non-Viable Pregnancy: Heartbreak and The Way Forward | Mommy Labor Nurse. Mommy Labor Nurse | Educating Expecting Parents About What’s To Come! https://mommylabornurse.com/non-viable-pregnancy/
  3. Miscarriage – Symptoms and causes. (2019, July 16). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298
  4. How a D&E Differs From a D&C. (2020, November 8). Verywell Family. https://www.verywellfamily.com/what-is-dilation-and-evacuation-d-e-for-miscarriage-2371460
  5. Hillson, B. B. J. H. M. (2014, July 1). Diagnosis and Management of Ectopic Pregnancy. American Family Physician. https://www.aafp.org/afp/2014/0701/p34.html
  6. Ectopic pregnancy – Diagnosis and treatment – Mayo Clinic. (2020, December 18). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/diagnosis-treatment/drc-20372093
  7. Blighted Ovum: A Non-Viable Pregnancy With No Obvious Symptoms. (2020, March 25). Verywell Family. https://www.verywellfamily.com/understanding-blighted-ovum-2371492
  8. How Are the Symptoms of a Molar Pregnancy Treated? (2020, October 25). Verywell Family. https://www.verywellfamily.com/molar-pregnancy-causes-symptoms-and-treatment-2371405
  9. Symptoms & Treatment For Molar Pregnancy Cancer. (2020). Www.Pregnancy-Baby-Care.Com. http://www.pregnancy-baby-care.com/molar-pregnancy/molar-pregnancy-cancer.html
  10. Feature Editor. (2019, August 28). Molar Pregnancy – What is it and Why Does it Happen?Com. https://pregged.com/molar-pregnancy/
  11. Abortion Pills – First Trimester Medical Abortion. (Accessed October 2021). abortionprocedures.com. https://www.abortionprocedures.com/abortion-pill/#1465365763472-92a2fc8d-9104.
  12. Center for Drug Evaluation and Research. (2021, April 13). Questions and Answers on Mifeprex. U.S. Food and Drug Administration. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifeprex
  13. Incidence of Emergency Department Visits and Complications. . . : Obstetrics & Gynecology. (2015). LWW. https://journals.lww.com/greenjournal/Fulltext/2015/01000/Incidence_of_Emergency_Department_Visits_and.29.aspx
  14. Niinimäki, M. (2009). Immediate complications after medical compared with surgical termination of pregnancy. PubMed. https://pubmed.ncbi.nlm.nih.gov/19888037/
  15. Elective abortion: Does it affect subsequent pregnancies? (2020, September 19). Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/expert-answers/abortion/faq-20058551?reDate=15102021
  16. Dilation and Curettage (D&C): Treatment, Risks, Recovery. (2021, March). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/4110-dilation-and-curettage-d–c
  17. Lohr, Patricia A.  “Surgical Abortion in Second Trimester”, Reproductive Health Matters, May 2008, 156. ncbi.nlm.nih.gov/pubmed/18772096.
  18. D&E Abortion – Second Trimester. (Accessed October 2021). abortionprocedures.com. https://www.abortionprocedures.com/#1466802055946-992e6a14-9b1d.
  19. Bartlett, L. A. (2004, April). Risk factors for legal induced abortion-related mortality in the United States. PubMed. https://pubmed.ncbi.nlm.nih.gov/15051566/
  20. Fergusson, David M with Joseph M. Boden and L. John Harwood. “Does abortion reduce the mental health risks of unwanted or unintended pregnancy? A re-appraisal of the evidence.” Australian & New Zealand Journal of Psychiatry, Sept. 2013, Vol. 47, No. 9, pp. 819-827. http://www.ncbi.nlm.nih.gov/pubmed/23553240 .
  21. Darney, P.D., et al. “Digoxin to facilitate late second-trimester abortion: a randomized, masked, placebo-controlled trial.,” Obstetrics and Gynecology, Vol. 97, Issue 3, Mar.2001, pp. 471-476. ncbi.nlm.nih.gov/pubmed/11239659 .
  22. Induction Abortion – Third Trimester. (Accessed October 2021). abortionprocedures.com. https://www.abortionprocedures.com/induction/#1466802482689-777ef64c-4991.
  23. Dolle, J. M. (2009, April 1). Risk Factors for Triple-Negative Breast Cancer in Women Under the Age of 45 Years. Cancer Epidemiology, Biomarkers & Prevention. https://cebp.aacrjournals.org/content/18/4/1157.full
  24. Induction of fetal demise before abortion. (in press). Society of Family Planning. https://www.societyfp.org/_documents/resources/InductionofFetalDemise.pdf
  25. L, W., T, P., & J, S. (1982, September 1). Significance of cervical Chlamydia trachomatis infection in postabortal pelvic inflammatory disease. Abstract – Europe PMC. https://europepmc.org/article/med/7121913
  26. Pelvic Inflammatory Disease – CDC Fact Sheet. (1999). CDC. https://www.cdc.gov/std/pid/stdfact-pid.htm
  27. STD Facts – Syphilis. (2017, June). CDC. https://www.cdc.gov/std/syphilis/stdfact-syphilis.htm
  28. About HIV/AIDS | HIV Basics | HIV/AIDS | CDC. (2021, June). CDC. https://www.cdc.gov/hiv/basics/whatishiv.html
  29. STD Facts – Human papillomavirus (HPV). (2021, January). CDC. https://www.cdc.gov/std/hpv/stdfact-hpv.htm
  30. L, W., T, P., & J, S. (1982, September 1). Significance of cervical Chlamydia trachomatis infection in postabortal pelvic inflammatory disease. Abstract – Europe PMC. https://europepmc.org/article/med/7121913
  31. STD Facts – Chlamydia. (2014, January). CDC. https://www.cdc.gov/std/Chlamydia/stdfact-Chlamydia.htm
  32. STD Facts – Gonorrhea. (2014, January). CDC. https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm
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