Late-term Abortion: Exploring the Medical Aspects

Introduction:

Late-term abortion, also known as third-trimester abortion, is a medical procedure performed during the second or third trimester of pregnancy. It is a complex and controversial topic that involves various medical, ethical, and legal considerations. This article aims to provide an overview of the medical aspects surrounding late-term abortions, including the procedure, reasons for seeking it, potential risks, and societal perspectives.

Procedure:

Late-term abortions are invasive procedures that involve the termination of pregnancy between the 12th and the 24th week. Several methods are employed, including dilation and curettage (D&C), induction of labor, and dilation and evacuation (D&E).

Performing a D&E is typically an outpatient procedure that can be done in a clinic or hospital setting.

The process begins by softening and dilating the cervix. This step may start the day before the D&E procedure. You will be positioned on the examination table with your feet in stirrups, similar to a pelvic exam.

To widen the vaginal opening, your clinician will use a speculum. This allows them to clean your cervix and apply a local anesthetic for your comfort.

Next, a dilating stick called a laminaria stick will be inserted into your cervical canal. This stick absorbs moisture and gradually opens the cervix by swelling. Alternatively, your clinician may use another type of dilating stick called Dilapan, which can be inserted on the same day as the surgery. They may also administer a drug called misoprostol (Cytotec) to prepare the cervix further, if necessary.

Just before the D&E procedure, you will likely receive intravenous sedation or general anesthesia. This will induce sleep, ensuring your comfort throughout the procedure. Additionally, you will be given the initial dose of antibiotic therapy to reduce the risk of infection.

During the D&E, your clinician will remove the dilating stick and use a sharp-tip instrument called a curette to scrape the uterus. Vacuum suction and other surgical instruments will be used to safely extract the fetus and placenta. In some cases, ultrasound guidance may be utilized.

The entire procedure generally takes around 30 minutes to complete.

What is the cost of a later-term abortion?

The cost of a later-term abortion can vary depending on several factors. According to Planned Parenthood, a dilation, and evacuation (D&E) procedure can cost up to $750 in the first trimester, with second-trimester abortions mostly being pricier. It’s worth noting that having the procedure done in a hospital may be pricier compared to a clinic.

While some health insurance policies cover abortion, others may provide partial coverage or none. To determine the extent of your coverage, your clinician’s office can contact your insurance provider on your behalf. If you don’t have insurance or have limited coverage, there are other options for financial assistance. Numerous organizations across the country specialize in helping individuals fund their abortion procedures. For more information, consider checking out the National Network of Abortion Funds.

How can you prepare for a later-term abortion?

Before scheduling the procedure, you will have a detailed consultation with a doctor or healthcare professional. During this conversation, you will discuss important aspects such as your overall health, any preexisting conditions you may have, and the medications you take. The healthcare provider will advise you on whether you need to stop taking certain medications before the abortion. In some cases, you may also need to visit your clinician the day before the surgery to begin the process of dilating your cervix. Your clinician’s office will provide you with specific instructions to follow before and after the surgery.

It’s essential to note that you may be advised to avoid eating for approximately 8 hours before the procedure. Additionally, it will be helpful to make arrangements for transportation after the surgery, since you won’t be able to drive yourself. It’s also recommended to have a supply of sanitary pads ready, as tampons should not be used after the procedure. Lastly, become familiar with your birth control options to ensure a smooth transition post-abortion.

What should you expect after a late-term abortion?

Following the abortion procedure, you will need a few hours of observation to ensure there are no excessive bleeding or complications. During this time, you may experience some cramping and spotting. When you are discharged, you will be given antibiotic therapy to prevent infection, and your clinician will provide precise instructions on how to take it. If required, consult your clinician about taking Acetaminophen (Tylenol) or Ibuprofen (Advil) for pain management, and follow their recommended dosage. It is important to avoid Aspirin (Bayer) or medications containing aspirin, as they can increase bleeding.

Recovery time can vary for each individual, so it is crucial to listen to your body and adhere to your clinician’s guidance on resuming daily activities. While some individuals may feel fine the next day, others may require an additional day off work, school, or other activities. It is recommended to avoid intense exercise for at least a week to minimize the risk of increased bleeding or cramping.

Reasons for Seeking Late-term Abortion:

Women may seek late-term abortions for various reasons, including fetal abnormalities, maternal health complications, and unforeseen personal circumstances. Fetal abnormalities that are incompatible with life or pose significant health risks to the baby are one of the primary reasons for late-term abortions, as parents may face difficult decisions regarding the quality of life for the child.

Maternal health complications, such as severe medical conditions or risks to the mother’s life, may also necessitate a late-term abortion. Additionally, unforeseen personal circumstances, such as financial hardships or relationship breakdowns, can influence a woman’s choice.

Possible side effects of a D&E procedure may include the following:

1. Cramping, is typically experienced between the third and fifth days after the procedure.
2. Nausea, especially within the first two days.
3. Tender breast or chest tissue.
4. Light to heavy bleeding lasting 2 to 4 weeks. If you saturate more than two maxi-pads an hour for 2 or more consecutive hours, it is important to inform a healthcare professional.
5. Blood clots, which can be as large as a lemon. Notify a healthcare professional if they exceed this size.
6. Low-grade fever. Contact a healthcare professional if the fever rises above 100.4 °F (38 °C).

Menstruation and ovulation

Regarding menstruation and ovulation, your body will immediately start preparing for ovulation. Expect your first menstrual period within 4 to 8 weeks after the procedure. While your usual menstrual cycle may return immediately, it could take several months for your periods to normalize. Some people may experience irregular or heavier/lighter periods compared to before the procedure.

To minimize the risk of infection, it is advised not to use tampons for at least a week after the procedure.

When it comes to sex and fertility, it is recommended to refrain from penetrative vaginal activity (including fingers, sex toys, or a penis) for at least a week to promote healing and prevent infection. Your clinician will inform you when it is safe to resume such activities. The procedure should not impact your ability to enjoy sexual activity, and your fertility will not be affected. It is possible to conceive immediately after a D&E, even without having had a period.

Consult a healthcare professional to determine the most suitable birth control option for you. If you use a cervical cap or diaphragm, you will need to wait approximately 6 weeks for your cervix to return to its normal size. During this time, you will require a backup birth control method.

Possible complications

Complications from a D&E procedure, although rare, can occur. These may include:

1. Allergic reaction to medications.
2. Excessive bleeding.
3. Blood clots are larger than a lemon.
4. Severe cramping and pain.
5. Laceration or perforation of the uterus.
6. Cervical incompetence in future pregnancies.

Another potential risk is infection in the uterus or fallopian tubes. Seek immediate medical attention if you experience any of the following symptoms:

1. Fever above 100.4 °F (38 °C).
2. Shaking and chills.
3. Severe pelvic or abdominal pain.
4. Strong-smelling discharge.

To prevent infection during the first week after the procedure, avoid using:

1. Tampons.
2. Douching.
3. Engaging in penetrative vaginal sex.
4. Taking baths (opt for showers instead).
5. Swimming pools, hot tubs, and other bodies of water.

Sex and Fertility After a D&E Procedure:

It is advised to abstain from penetrative vaginal sex, including the use of fingers, sex toys, or a penis, for at least one week following a D&E procedure. This precaution is crucial to prevent potential infections and allow your body to heal properly.

Your healthcare provider will inform you when it is safe to resume penetrative vaginal sex. Rest assured, the procedure should not have any impact on your ability to enjoy sexual activity.

Furthermore, your fertility will not be affected. It is possible to conceive immediately after a D&E, even if you haven’t had a menstrual period yet.

If you are unsure about the most suitable birth control method for your needs, it is recommended to discuss this with a healthcare professional. They can guide the advantages and disadvantages of each type. If you currently use a cervical cap or diaphragm, it is necessary to wait approximately six weeks for your cervix to return to its usual size. During this time, you’ll need to use a backup birth control method.

When is the right time to consult a healthcare professional?

Regardless of whether you have made a final decision or not, it is crucial to seek guidance from a trusted healthcare professional. They must allocate sufficient time to answer your questions and ensure that you have a comprehensive understanding of the procedure and what to expect.

To ensure you remember all your questions and concerns, it may be beneficial to write them down before your appointment.

Your clinician should be willing to provide you with information about all your available options. If you find it uncomfortable to communicate with them or believe that you are not receiving all the necessary information, do not hesitate to see another physician if possible.

Where can you find support following a late-term abortion?

The emotional reactions to ending a pregnancy can vary for each individual. You might experience feelings of sadness, depression, loss, or even relief. Some of these emotions could be attributed to hormonal changes.

If you are facing persistent sadness or depression, discussing your feelings with a healthcare professional could be beneficial.

If you are considering terminating a pregnancy during the second or third trimester, or if you are having difficulty navigating your options, there is help available. Gynecologists, general practitioners, clinic workers, or hospital advocates can refer you to a mental health counselor or an appropriate support group.

Ethical and Societal Perspectives:

Late-term abortion is a highly debated topic from ethical and societal standpoints. Different cultural, religious, and personal beliefs shape these perspectives. Proponents argue that late-term abortion is a healthcare decision that should be available to women when medically necessary or if the pregnancy poses significant risks. However, opponents say that late-term abortions infringe upon the rights of the developing fetus and advocate for more excellent protection of fetal life. The complexity of these viewpoints highlights the importance of open dialogue, respectful debate, and the need for comprehensive legislation to govern these procedures.

Legal Considerations:

The legality of late-term abortions varies across countries and jurisdictions. Some regions have comprehensive laws that outline the circumstances under which late-term abortions are permitted, while others have more restrictive regulations. It is crucial for individuals seeking late-term abortions to be aware of their local legal framework to ensure they follow the appropriate guidelines and access safe and legal procedures.

Nonetheless, it is essential to note that laws are often subject to change, and staying informed of any legislative updates is essential. Consulting with healthcare professionals and legal advisors is recommended to navigate the legal aspects of late-term abortion.

Prevention and Education:

While late-term abortions are sometimes necessary under certain circumstances, it is vital to emphasize the importance of prevention and education regarding reproductive health. Access to comprehensive sex education, affordable contraceptives, and family planning services are essential components for helping individuals make informed decisions about their reproductive health and reducing the need for late-term abortions.

Healthcare providers, organizations, and communities play a significant role in promoting sexual health and education, ensuring accessible contraception, and providing necessary support to prevent unintended pregnancies.

Conclusion:

Late-term abortion remains a complex and contentious issue, encompassing medical, ethical, and legal considerations. Understanding the medical aspects surrounding late-term abortions is crucial for both healthcare providers and society at large. Recognizing the emotional and psychological impact on individuals, ensuring access to supportive care and counseling, and promoting comprehensive reproductive health education are essential.

Author

Dr. Kopp Kallner. M.D. in Obstetrics & Gynecology, Columbia University Medical School.