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.

Abortion is a way to end a pregnancy. Mid-trimester abortion occurs between the 14th and 24th week of pregnancy, counting from the first day of the last menstrual period. A "D&E" (Dilatation and Evacuation) method of abortion is used. Planned Parenthood Golden Gate offers D&E abortion until 18.6 weeks of pregnancy. D&E is a two-part procedure requiring one or two days to dilate (open) the cervix and a final visit to the clinic to empty the uterus.

Early surgical abortion is done from the 4th until the 14th week of pregnancy, and medication abortion can be elected up until the 63rd day of pregnancy. The duration of pregnancy (the number of weeks) is determined in the clinic by ultrasound and/or examination by a doctor.

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 Abortions
Abortion and Future Pregnancies
Abortion and Breast Cancer

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. 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

A number of tests will be done, including:

• A pregnancy test
• A blood test to check your Rh type and to check for anemia

A little later:

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

Although it is considered a safe procedure, mid-trimester abortion is more complex than earlier abortion procedures.

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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Osmotic dilators will be used one to two days before the procedure and/or the medication misoprostol will be used on the day of the procedure to slowly stretch or soften the opening of the cervix. If either of these is to be used, you will be given information on 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. The insertion of an osmotic dilator and/or the medication misoprostol is 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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You return to clinic on the day of your procedure. Before the procedure is started, a needle will be inserted in your vein and will stay there during the time you are in the clinic. Once the needle is in place, all the medications that you need will be given through it. These medications may include drugs to help you relax and reduce discomfort.

If used, the gauze and dilators will be removed. The doctor will give you a local anesthetic (numbing medicine) in your cervix, which will make the procedure more comfortable. The opening of the uterus may need to be stretched more, which will be done gradually with a series of narrow instruments called dilators, each a little larger than the one before. When the cervix is open wide enough, a plastic tube will be inserted into the uterus and is connected to a suction machine. The content of the uterus will then be removed by a combination of suction and instruments, usually taking 5-15 minutes. 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. Later, the doctor will examine the pregnancy tissue to check whether it has been removed completely.

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The abortion procedure usually takes between 5-15 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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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.

Emotional reactions are uncommon and if they occur, they usually go away quickly. Most women having an abortion experience a sense of relief. 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 affect 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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