ABORTION INFORMATION

A Woman's Right to Know Information
Before Your Abortion
Facts About Early Surgical Abortion 
The Abortion Pill
Mid-Trimester Abortion
Ultrasound Information
Pre-Operative Medications
Caring for Yourself Afterward

To help make your appointment go more smoothly, it is important that you read and understand these instructions. Please don't hesitate to ask questions. Call if you're unclear about anything.

Other Important Instructions

1. If you have a blood type card or a card showing your Rh status (positive or negative) please bring that to the clinic. You may be able to avoid an additional blood test.  
2. If you are having a surgical abortion, it is important that you not eat or drink anything the day of your abortion. Eat a normal dinner the night before you are scheduled, but nothing after midnight. You should drink plenty of non-caffeinated fluids the day before your appointment and avoid alcohol beverages. If you are having a medication abortion there are no restrictions on food.
3. Wear loose, comfortable clothing. The clinic is usually very cold, so you should dress in layers or bring a sweater. In the exam room you will be asked to undress from the waist down. You may keep your socks on. Wear comfortable underwear because you will be sent home wearing a sanitary pad.
4. Purchase or borrow an oral thermometer so you have one at home after the abortion. Bring it with you if you have any trouble reading it. You may also want to have a heating pad or hot water bottle at home.
5. You may bathe or shower before your appointment. You may brush your teeth but do not swallow any water. 
6. Be prepared to use sanitary pads for 3 weeks.

The cost is $390 and includes:

• There is a 1 in 100 chance that an infection of the uterus will develop after the abortion. While this problem routinely is treated with antibiotics, there is a small chance that a repeat aspiration, a D&C, hospitalization, or even surgery may be necessary.
• In 1 in 100 cases, tissue is left inside of the uterus, leading to an "incomplete" abortion. This problem may lead to excessive bleeding, infection, or both. If this complication occurs, you could require a repeat aspiration or a D&C in a clinic or hospital, or other tests or treatment.
• There is about a 1 in 500 chance that the uterus will be perforated (an instrument may go through the wall of the uterus and could damage internal organs such as intestines, bladder, or blood vessels). Treatment may consist of observation, laparoscopy, or abdominal surgery. The likelihood of hysterectomy (removal of the uterus) in this setting is 1 per 10,000 abortions.

Other Risks Include

• Allergic reaction, which can be due to an allergy to the local anesthetic or any other medications used. All medicines and drugs, including street drugs, may cause serious reactions during anesthesia. It is important that you use only medically necessary drugs and avoid alcohol or other non-prescription drugs on the day of the abortion and that you tell the clinicians about all drugs or medications you have taken.
• Hemorrhage (excessive bleeding), which may require treatment by medications, repeat aspiration, D&C, or rarely surgery (including possibly hysterectomy). Hemorrhage severe enough to require transfusion occurs in less than 1 per 1000 cases.
• Blood clots in the uterus, which may cause severe cramping and abdominal pain. The risk is about 1 in 100 cases. Treatment is a repeat aspiration.
• Cervical tear, in less than 1 in 100 cases, which may be treated with medicines, or rarely, stitches in the cervix.
• Failure to end the pregnancy, which occurs 1 in 500 cases and may be due to a divided uterus, very early pregnancy, or other causes. Another aspiration procedure is recommended when this happens. A tubal (ectopic) pregnancy is not ended by abortion and usually requires an abdominal operation to remove.
• Emotional problems after abortion are uncommon, and when they happen, usually go away quickly. Most women report a sense of relief, although some experience depression or guilt. Serious psychiatric disturbances (such as psychosis or serious depression) after abortion appear to be less frequent than after childbirth.
• Impact on future pregnancies, which is very unlikely with an uncomplicated early abortion.
• Death, which occurs in less than 1 per 100,000 abortions. This may be compared with the risk of death from a full-term pregnancy and childbirth, which is seven times greater than that from an early abortion.

• It has been more than 63 days (9 weeks) since the first day of your last menstrual period began
• you are unwilling to have a surgical abortion if indicated
• you have a medical condition preventing a surgical abortion
• you have significant cardiac (heart) disease (AHA Class 3 or worse when not pregnancy), renal failure, or severe liver disease
• you do not have easy access to a telephone in the rare event of a medical emergency (emergency treatment after incomplete abortion, blood transfusions or emergency resuscitation and transportation)
• you use concurrent or long term systemic corticosteroid use (asthma inhalers)
• An IUD  is in place and you will not have it removed
• you have a known or suspected ectopic pregnancy (based on signs, symptoms, serial beta HCG's and transvaginal ultrasound) or adnexal mass suspicious for an ectopic pregnancy
• you are allergic to Mifeprex or Misoprostol or other prostaglandin
• you have chronic adrenal failure
• you are taking anticoagulants or have hemorrhagic disorder or inherited porphyries
• you cannot return to the clinic for follow-up visits or if medically indicated
• there is a strong suspicion for molar pregnancy

1. It is important for you to understand the benefits and risks of using Mifeprex and to have all of your questions answered once you have decided Mifeprex is right for you. The Informed Consent process includes an educational session where the Mifeprex process is explained, your questions addressed and several different consent forms are signed, including:
   o Mifeprex Medication Guide and the Patient Agreement
   o Planned Parenthood of Waco Request for Surgery or Other Special Services
   o Planned Parenthood of Waco Supplement to Mifeprex (mifepristone) Patient Agreement
   o Planned Parenthood of Waco Client Information for Informed Consent: Vacuum
   Aspiration Abortion (As the patient, you must agree to have a surgical abortion in the rare event that the Mifeprex/Misoprostol process fails to end the pregnancy.)
2. The examination / review of contraindications includes an ultrasound to confirm that you're not beyond the limits of the procedure (63 days or 9 weeks since the first day of your last menstrual period). The nurse will review your medical history to make sure you don't have any medical contraindications. If all is well, then the clinician will provide you with the appropriate medications and review in detail how and when to take the Mifeprex and Misoprostol.
3. The selection of the appropriate regimen and the administration of the medication.

Second and Third Days: You will take the 4 Misoprostol orally at home and will have instructions on what to expect. If, after 48 hours of the first dose of Misoprostol no bleeding has occurred, you will need to call the nurse.  She may recommend you take a second dose but not until she hears from you.  If you don't start bleeding after a second dose of Misoprostol, then a surgical procedure is recommended.

The cost ranges from $390 (up to 13 weeks 6 days) to $525 (14 weeks to 15 weeks 6 days) and includes:

Complications may include, but are not necessarily limited to:

• a 1 in 100 chance that an infection of the uterus will develop after the abortion. While this problem is routinely treated with antibiotics, there is a small chance that a repeat aspiration (suction), a D&C, a hospitalization, or even surgery may be necessary.
• in 1 in 100 cases, tissue is left inside of the uterus, leading to an "incomplete" abortion. This problem may lead to excessive bleeding, infection, or both. If this complication occurs, you could require a repeat aspiration or a D&C in the clinic or hospital, or other tests or treatment.
• about a 3 in 1000 chance that the uterus will be perforated (an instrument may go through the wall of the uterus and could damage internal organs such as intestines, bladder, or blood vessels). Hospitalization is required, and an abdominal operation usually is performed to repair the damage. The likelihood of hysterectomy (removal of the uterus) in this setting is less than 1 per 1000 D&E abortions.
• Other risks include:
  • allergic reaction - which can be due to an allergy to the local anesthetic or to any other medications used. All medicines and drugs, including street drugs, may cause serious reactions alone or during anesthesia. It is important that you use only medically necessary drugs and avoid alcohol or other non-prescription drugs on the day of the abortion and that you tell the clinicians about all drugs you have taken;
  • hemorrhage (excessive bleeding) - which may require treatment by medications, repeat aspiration, D&C, or rarely, surgery, including possible hysterectomy. Hemorrhage severe enough to require transfusion occurs in fewer than 1 per 1000 cases;
  • blood clots in the uterus - which may cause severe cramping and abdominal pain. The risk is about 1 in 100 cases and the treatment is to perform re-aspiration;
  • cervical tear - in fewer than 1 in 100 cases, which may be treated with medicines, or rarely, stitches in the cervix;
  • an emotional reaction after the abortion - Emotional problems after abortion are uncommon, and when they happen they usually go away quickly. Most women report a sense of relief, although some experience depression or guilt. Serious psychiatric disturbances (such as psychoses or serious depression) after abortion appear to be less frequent than after childbirth;
  • an impact on future pregnancies - with an uncomplicated mid-trimester abortion, this risk is unlikely;
  • death - The risk of death from D&E is about equal to that of death from full-term pregnancy and childbirth.

When you leave our clinic, you will be given a number to reach us if these or any other problems occur. You also should plan on returning to the clinic for your follow-up exam.  If emergency medical care is needed in a hospital or from a provider other than Planned Parenthood, you will be responsible for paying for that care.
 

Ultrasound is a procedure that helps the clinician to see the pregnancy in order to tell the age of the embryo or fetus and to look at your uterus. This is done with an instrument that sends sound waves through the tissues. This ultrasound is being done only to determine the age of the embryo or fetus and its location and not to detect abnormalities of the pregnancy, fetus, or reproductive tract. If more studies are needed, you will be referred to an appropriate provider. There are limitations to all imaging techniques, and none is 100% accurate or reliable.

1. Doxycycline 100 mg (given to all patients) one capsule twice a day for seven days. Doxycycline is an antibiotic to prevent infection. Take with food as this will decrease stomach upset. Doxycycline can increase your skin sensitivity to sunlight, so wear a sunscreen when you are in the sun, and around tanning lights.
2. Diazepam - Valium Many women who have an abortion find that this drug helps reduce anxiety. It is a mild muscle relaxant. It will not cause you to be less aware of what is happening, although it can make you drowsy, slightly
   dizzy or feel like you have a dry mouth. You will not be given this medication if you do not have someone to drive you home.
3. Ibuprofen - Motrin Many women who have an abortion find this drug helps reduce cramping or discomfort. It works by blocking the release of prostaglandins which cause painful uterine cramps. You should not take this drug if you are sensitive to aspirin, have ulcers, ongoing stomach problems or nasal polyps.
   OR
   3b. Acetaminophen - Tylenol
   
   This drug can be taken to help reduce cramping or discomfort. ost women do very well with the above medications. However, you may wish to consider the following medication as well:
4. Fentanyl (injection by a needle into a vein in the arm) - Sublimaze
   This is a strong narcotic that helps relieve pain, reduces anxiety, and aids in relaxation. It does not put you to sleep. It begins acting immediately after injection and wears off in 30-60 minutes, although some people will feel slightly drowsy for several hours. The most common side effect is dizziness.
   Occasionally, there will be nausea and vomiting afterwards. A rare, but potentially serious side effect is respiratory depression (slower, more shallow or difficult breathing). Medications are available to counteract this problem when necessary. Remember, it is extremely important for you to share with us any recent drug (legal or illegal) and/or alcohol use. You will not be given this medication if you do not have someone to drive you home.
5. Midazolam - Versed
   This is a strong narcotic that reduces anxiety and aids in relaxation. It does not put you to sleep. It begins acting immediately after injection and wears off in 30-60 minutes, although some people will feel slightly drowsy for several hours. The most common side effect is dizziness. Occasionally there will be nausea and vomiting afterwards. A rare, but potentially serious side effect is respiratory depression (slower, more shallow or difficult breathing). Medications are available to counteract this problem when necessary. Remember, it is extremely important for you to share with us any recent drug (legal or illegal) and/or alcohol use. You will not be given this medication if you do not have someone to drive you home.

Now that your abortion is over, you^ll want to know what to expect in the next week or so. This information describes what usually occurs after an abortion to help you decide whether your experiences are normal or if you need additional medical attention. Keep this information until your next period and refer to it if you have questions. This chart will help you decide if the symptoms you are having are normal or if a problem is developing. If you are unsure, please call the clinic where you had your abortion.

WHAT IS NORMAL?

• Normal Bleeding:
  • light or heavy bleeding, or no bleeding
  • scant, spotty, dark brown or red discharge
  • heavier than a period
  • lasts 1-14 days
  • often there will be no bleeding for a few days after the abortion, and then bleeding (as heavy as a period) may begin around the 3rd to 5th day after the abortion. This bleeding is caused by hormonal changes and medicines, and you may have more cramps.
  • you may not bleed at all
• Normal Clotting:
  • small clots as large as a quarter are normal
• Normal Discharge:
  • brown tinged or dark brown to black
  • mucus
• Normal Cramps:
  • cramping is due to the uterus returning to its smaller non-pregnant size
  • menstrual-like cramps for the first few days
  • may increase as bleeding increases - particularly on the 3rd to 5th day as mentioned above
  • 2 Ibuprofen tablets every 4 hours usually helps cramps
  • use of a heating pad may also help
• Normal Temperature:
  • may fluctuate up to 101 degrees
• Normal Nausea:
  • nausea usually goes away within 48 hours
• Normal Breast Soreness, Swelling and Nipple Discharge:
  should go away in a few days to two weeks. Wear a supportive bra and avoid breast stimulation.
   
  If you have an emergency, Planned Parenthood staff will be available 24 hours of every day. During regular clinic hours, you can call the clinic number and explain that you were seen for an abortion at PPCT and your call will be forwarded to the on-call nurse. You will also be given an after hours/weekend number to call. The staff will assess the problem and provide you with care at our clinic, if appropriate (at no charge), or help you get medical care elsewhere (at your expense). If you were told that tissue was sent to the lab, call us in 6-8 working days if we have not called you.

CALL US IF ANY OF THE FOLLOWING OCCURS:

• Bleeding
  Heavy bleeding; soaking 2 full-sized pads in a hour
• Clotting
  Clots larger than a quarter
• Discharge
  Itchy and painful
  Foul (bad smelling) odor
  Pus-like
• Cramps
  severe cramps that keep you from normal activity
  cramps not relieved by Tylenol or Ibuprofen
  constant cramping or pain
• Temperature
  • fever greater than 101
  • chills or shaking
• Nausea and Breast Soreness
  • if nausea continues for more than 3 days and if breast soreness or swelling continues for more than 14 days

And be ready to tell us...

• your temperature within the past hour
• the number of sanitary napkins you have soaked in the past 2 hours
• the medications you’ve taken and when in the last 6 hours

POST ABORTION MEDICATION
Methergine: Some patients will receive a 3-day supply of Methergine. Do not take Methergine if you have high blood pressure (tell the doctor or the nurse). Take a pill three times a day - morning, noon and bedtime. Methergine helps your uterus return to a normal size and controls bleeding. It does this by making the muscle of the uterus cramp. It is normal to have menstrual-like cramps and you may have back or leg pain from the Methergine. A mild headache, nausea, vomiting and dizziness are also normal side effects. Call the clinic if you have a severe headache, severe cramps, ringing in the ears, rapid heartbeat, unusual sweating, chest pain or trouble breathing. Expect your bleeding to be heavier in the morning when you first get up and for a few days after you finish Methergine. Take 2 (500 mg) Tylenol every 4 hours to help cramps or a headache. Avoid taking aspirin.

PREVENTING INFECTION
Infection in the uterus and fallopian tubes is the most common complication following an abortion. You need to be aware of the signs of an infection -- fever above 101, abnormal pain, foul smelling discharge. Call us if these occur.
To prevent infection:

1. Take your temperature twice daily for the first week -- once in the morning, and once before dinner. Call us if it is above 101.
2. To prevent germs from moving from your vagina to the uterus, for the next two weeks after your abortion: DO NOT put anything in your vagina – this includes NO SEX, NO TAMPONS, NO DOUCHING
3. Only take showers, no sit-down baths. Do not go swimming or sit in a hot-tub.

EXERCISE AND REST
Most women prefer to take it easy for the day following an abortion, and then are able to return to normal activity. Some women feel fine immediately, while others require more time -- let your body be your guide. No matter how well you are feeling you should not exercise strenuously for the first week. Heavy exercise will cause bleeding to be heavier and may cause more cramping.

FEELINGS
Women experience a variety of emotions when they are pregnant and when they have an abortion. Feelings of relief, elation, sadness, depression and a sense of loss are common. Some of these feelings do not last very long. It may be helpful to talk with someone close to you, or you may want to return to the clinic and talk further with a Planned Parenthood staff member. In addition, your partner or someone else close to you may have feelings or concerns they would like to discuss. Counselors are available during clinic hours for them as well.

BIRTH CONTROL
If you have intercourse and don^t want to become pregnant, you need to use some method of birth control. If you know about the different methods and have made a choice, we can provide you with that method at the time of your abortion or at your follow-up appointment. If you need more information about birth control, we will provide this at your appointment. Anytime you have questions or concerns about birth control or pregnancy, you are encouraged to call the clinic. A counselor is always available to talk with you.
If you were given birth control pills, you should start them the first Sunday following the abortion. Spotting and breakthrough bleeding are very common during the first package of birth control pills used after pregnancy. It should go away by the second cycle, as the lining of the uterus repairs itself.

DISABLED PATIENTS 
All medical services are accessible to disabled persons at the clinic

SUCCESSFUL COPING AFTER AN ABORTION
The decision whether or not to have an abortion is a very personal matter. Any woman considering having an abortion needs to feel that an abortion is the best choice for her at the time, even if the decision is a very difficult one.

There is no "right" way to feel after an abortion. There may be a number of feelings, both positive and troublesome, and it is important to know that your feelings are valid, no matter what they are. Planned Parenthood encourages discussion of these feelings before and after the abortion.

There is a false belief that women sink into depression, guilt and grief after an abortion. According to research, the majority of women who have abortions have no regrets and would make the same choice again in similar circumstances. 91% report a sense of relief after the abortion. It can present an opportunity to reconsider attitudes and relationships. Many are happy to have a fresh start in life and be back to normal.

For some women, there is a mixture of both positive and negative feelings. Relief, mixed with sadness, guilt or anger is not unusual. Sometimes hormonal changes after an abortion can result in a period of "the blues". Most women cope well and move on in a short period of time.

Occasionally, some women do have very negative feelings after an abortion. If you should be one of these women, do not think there is something wrong with you. Your feelings are valid and need to be expressed. Sharing feelings with your partner, a close friend or a counselor can help.

Serious emotional problems (such as severe depression or psychosis) after an abortion appear to occur less frequently than after childbirth. For less than 5% of women abortion will bring serious sadness, guilt, anger or regret. These feelings are troublesome because many people do not know how to cope in positive ways when experiencing these feelings.

Before you have an abortion, you need to look at your feelings. Pretending they are not there or that they will go away on their own can be a mistake.

There are some situations that indicate emotional problems after an abortion:

• Women who have had a psychiatric illness in the past have a higher chance of serious emotional problems after the abortion, especially if they quit taking their medications for their illness during the pregnancy. It is important for anyone with a psychiatric illness to see their psychiatrist or therapist before and after an abortion.
• Extreme difficulty making up one's mind about choosing abortion may mean problems afterward. Ambivalence is a normal part of the process, but when it becomes so painful that a clear choice cannot be made, it may indicate later problems.
• Women who are persuaded by partners, parents or others to have an abortion against their own wishes experience greater feelings of guilt and regret. If you have an abortion to please someone else, it is the wrong reason. You may blame them later and regret the decision. It must be your own choice.

Counseling is available to help you successfully cope with feelings after an abortion. We can help you find a therapist or a member of the clergy who can help you with ongoing concerns or problems.