The United States Supreme Court recently released a decision that will affect some second-trimester abortions (16-20 weeks gestation) provided at Planned Parenthood Golden Gate. For more information on what this means and how it will affect services, please read:

Open Letter to Clients on Supreme Court Abortion Ruling.

• Planned Parenthood Golden Gate provides surgical abortions for women between 4 and 18.6 weeks of pregnancy
• We offer local anesthesia and pain medicine during surgical abortions
• We do not provide general anesthesia or abortions later than 18.6 weeks, but we can refer you to other providers for these services
• Our abortion services include pregnancy options, counseling, lab tests, the procedure, and follow-up care

More information on Early Surgical Abortion (4-13 weeks)
More information on Mid-Trimester Abortion (14-18.6 weeks)

What is Early Surgical Abortion?
Deciding if Surgical Abortion is Right for You
Before the Abortion
Preparing the Cervix
Pain Relief and Sedation
The Abortion Procedure
How Long the Procedure Takes
After the Abortion
Possible Problems
Follow-up Care for Surgical Abortion
Abortion and Future Pregnancies
Abortion and Breast Cancer

Early surgical abortion is a way to end a pregnancy during the first trimester. The safest method of early abortion is a surgical procedure called vacuum aspiration. This procedure ends an early pregnancy by gently suctioning the lining of the uterus and removing all of the tissues of the pregnancy. Planned Parenthood offers this method of abortion until the 14th week of pregnancy, counting from the first day of the last menstrual period. Planned Parenthood offers mid-trimester abortion up to 18.6 weeks of pregnancy and will give referrals for women who are more than 18 weeks, 6 days pregnant.

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Before you decide to have an abortion, you will meet with a counselor to discuss the three options regarding a pregnancy—parenthood, adoption, or abortion—and to address any questions or concerns you may have. If you do decide to have an abortion, you and the counselor can also discuss whether surgical or medication abortion is best for you. You can change your mind at any time before beginning the procedure. Remember that it is entirely your choice to have an abortion.

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Once you check in at Planned Parenthood, you will:

• Complete a medical history form and other paperwork.
• Meet with a counselor who will spend some time with you to explain the procedure, obtain your written consent, and answer any questions that you may have.
• Be offered various medications for pain relief in order to make you more comfortable during the procedure.
• Early abortion by vacuum aspiration is a very safe procedure. However, because it is a surgical procedure, a counselor will also review with you the possible risks and problems.

A number of tests will be done, including:

• A pregnancy test
• A blood test to check your Rh type and to check for anemia
• Screening for sexually transmitted infections

A little later:

• A medical provider will review your medical history
• Other tests may be performed

We will perform an ultrasound examination prior to performing the procedure. An ultrasound examination is done by moving a scanner over your abdomen or inserting a probe into the vagina to accurately determine how many weeks pregnant you are.

The final decision as to whether the abortion will be performed in the clinic will depend on your medical history, your physical examination and the results of your laboratory tests.

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In some cases, especially for pregnancies more than 12 weeks, osmotic dilators are placed into your cervix the day before your abortion or medication is placed in your vagina on the day of your abortion to slowly stretch or soften the opening of the cervix. If either of these is to be used, you will be given information on exactly how they work, instructions for your care, and a telephone number so that you can get in touch with the clinic staff should any problems arise. If used, the insertion of an osmotic dilator is considered the beginning of the abortion procedure.

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Various medications for pain relief will be discussed and offered to you in order to make you more comfortable during the procedure. We offer medication just before the procedure for sedation either by mouth or by injection. In addition we routinely give local anesthesia to numb the cervix. However, we do not offer general (asleep) anesthesia. If you prefer to be asleep for your abortion, we can refer you to other clinics in the community that provide abortion with general anesthesia.

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Prior to starting the actual procedure, the doctor will:

• Examine your heart and abdomen
• Perform a pelvic examination to check the size of your uterus

To begin the abortion, the doctor will give you a local anesthetic (numbing medicine) in your cervix, which will make the procedure more comfortable.

The next step is to gradually stretch the opening of the cervix with a series of narrow instruments called dilators, each a little larger than the one before.

When the cervix is open wide enough, a small plastic tube is inserted into the uterus and is connected to a suction machine. The tube is moved along the inside of the uterus for 2-3 minutes in order to remove all of the pregnancy tissue with gentle suction.

During and after the procedure, you may feel cramping as the uterus shrinks down to its normal size. The doctor then may do a final check with a spoon-shaped instrument called a curette.

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The abortion procedure usually takes less than 10 minutes.

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You will spend 30 minutes to one hour under our medical supervision following the abortion. A nurse will monitor your recovery, including blood pressure and heart rate, and will also give you more information on:

• Post-abortion self-care
• Post-abortion medications
• Birth control methods

Although problems from the abortion are very rare, you will be told what warning signs and symptoms to look for. Any of these problems must be reported right away. Remember, most problems can be prevented by carefully following the nurse’s instructions. When you feel comfortable, usually after 30 minutes, you may leave. Because you may feel a little weak, we strongly advise you to arrange beforehand for someone to drive you home. If you wish to receive any sedation medication, you must have a ride home.

When you leave Planned Parenthood after the abortion, you will be given a telephone number to reach the clinic or a nurse should any problems occur. You can call Planned Parenthood 24 hours a day.

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Early abortion is one of the safest surgical procedures. Serious complications are very rare.

• In about one out of 100 abortions there can be excessive bleeding or infection of the uterus.
• Occasionally tissue from the pregnancy is incompletely removed or blood clots accumulate in the uterus and a repeat procedure is required.
• About one time in a thousand abortions there can be damage to the uterus.
• Most complications can be managed through our clinics or even by phone, but hospitalization, other operations or blood transfusions rarely may be needed.

After an abortion some women report emotional reactions ranging from relief and joy to sadness at having to make such a difficult decision. Most emotional reactions go away quickly; however, women who experience emotional changes should discuss them with a clinician.

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It is very important to have a check-up 2 to 3 weeks after a completed abortion. This check-up is available at any Planned Parenthood health center and includes:

• A review of lab results from the day of the abortion
• A breast exam and a pelvic exam
• A Pap test if you have not had one in the last year

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It is very unlikely that uncomplicated abortion will effect a woman’s ability to get pregnant in the future.

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Abortion does not increase a woman’s risk of breast cancer.

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