What Is a Therapeutic Abortion?

December 21, 2023 9:23

December 27, 2023 19:30

Reading time: 7 minutes

A therapeutic abortion is a necessary medical procedure recommended by healthcare professionals. It is performed when continuing the pregnancy poses a significant risk to your health or when the pregnancy is not viable and the fetus is unlikely to survive without long-term complications.

The distinction between a “therapeutic” abortion and an “elective” or “voluntary” abortion lies solely in the medical rationale behind it. The process for terminating a pregnancy or treating a miscarriage is often the same, regardless of the reason for seeking medical care.

Terms like “elective abortion,” “therapeutic abortion,” and “spontaneous abortion” are primarily used by legislators to define what is considered “acceptable” or “unacceptable” in terms of medical services. Insurance providers also utilize these terms to determine the coverage they offer.

It’s important to recognize that the concept of “medical necessity” is subjective and can vary depending on individual circumstances. Unfortunately, pregnant individuals are frequently denied access to life-saving abortion care based on moral or legal grounds. This denial typically leads to preventable mental, emotional, and physical complications, and in some cases, even death.

When might a therapeutic abortion be considered?

Your healthcare provider may discuss the option of termination if continuing the pregnancy poses a higher-than-usual risk, which could be due to preexisting medical conditions like cancer, heart disease, or kidney disease. It may also be recommended if a condition arises during pregnancy, such as premature rupture of membranes (PROM), placental abruption, or preeclampsia, which can present serious health risks.

Additionally, the option of a therapeutic abortion may be presented if prenatal screening indicates a fetal anomaly. Certain anomalies, like anencephaly, hydrocephalus, Merkel-Gruber syndrome, Potters syndrome, or thanatophoric dysplasia, can significantly increase the risk of fetal death during pregnancy or shortly after birth.

Are there alternatives to therapeutic abortion? The alternatives available to you depend on the specific circumstances of your pregnancy and the laws in your region. It’s important to note that access to certain options may be limited based on your state’s regulations.

If the pregnancy is deemed high-risk for you but not for the fetus, one option might be to continue the pregnancy and induce labor once the fetus has reached a stage of development where it could potentially survive outside the uterus. This decision would be made in consultation with your healthcare provider.

In the case of a suspected fetal anomaly, you may also consider carrying the pregnancy to term. However, it’s essential to have an open discussion with your clinician about the potential implications and outcomes for your specific situation. It’s possible that the anomaly could result in stillbirth, death shortly after birth, or a reduced lifespan. Developmental differences may also lead to conditions requiring long-term or lifelong care.

Are complications possible without treatment?

Opting to continue a pregnancy that poses a risk to your life or health can indeed lead to serious complications. It’s crucial to be fully informed about the potential risks and outcomes so that you can make the best decision for your circumstances. If you choose not to have an abortion, it is important to discuss with your clinician the options available for managing symptoms, minimizing risks, and preparing for delivery. Updating your advance directives for medical care may also be worth considering.

It’s significant to note that in some cases, continuing with the pregnancy could result in death for both you and the fetus, so identifying support resources might be beneficial. While thinking about end-of-life wishes can be challenging, having these discussions can relieve some burden on your loved ones if the need arises.

How are therapeutic abortions performed?

More than half of the abortions performed in medical facilities in the United States are medication abortions. These can be done using two medications, mifepristone and misoprostol, or misoprostol alone. The Food and Drug Administration (FDA) has approved the use of mifepristone and misoprostol for terminating pregnancies up to 10 weeks.

During the first trimester, another method called suction (vacuum) aspiration can be used to empty the uterus. This is a minor surgical procedure that typically takes about 5–10 minutes. Sometimes, cervical dilation may be necessary before the procedure. In some cases, a dilation and curettage (D&C), which involves using a curette to scrape the uterine lining and ensure it’s empty, may be performed during this process.

During the second and third trimesters, surgical abortion is performed using a method called dilation and evacuation (D&E). This procedure involves dilation and aspiration, with additional instruments, such as forceps, used to remove the pregnancy.

First-trimester prenatal screening usually takes place between weeks 10 and 13 of pregnancy, while second-trimester screening is performed between weeks 15 and 22. As a result, certain fetal anomalies may not be suspected or diagnosed until the second trimester.

While medical abortion can be an option until week 15, it is generally recommended that surgical abortion be performed by healthcare professionals.

What to expect after a therapeutic abortion?

Having an abortion guided by a healthcare professional is a safe and effective procedure. It’s important to understand that there are natural side effects associated with the different methods used.

For medical or medication termination, the process may begin at a clinic and then be completed at home. After taking misoprostol, some individuals may experience a combination of symptoms, including nausea, weakness, fever, chills, vomiting, headache, diarrhea, and dizziness. It is crucial to monitor these symptoms closely. They may peak in intensity between days 3 and 5 and gradually diminish over the following weeks.

In the case of surgical termination, sedation may be provided to increase your comfort during the procedure. Some post-procedure bleeding and cramping are to be expected, although generally lighter than the bleeding caused by medical termination. Most individuals are able to return home on the same day and feel physically capable of resuming their usual activities the next day.

It is common for various emotions to arise after an abortion, and these feelings may change over time. It’s important to remember that there is no right or wrong way to feel, and allow yourself to grace as you navigate through the experience. Some individuals may experience symptoms of post-traumatic stress, which can fade with time.

Results from a long-term study published in 2008, following over 500 women until the age of 30, indicated that termination for medical reasons may have a greater impact on mental health compared to other reasons for termination or miscarriage, possibly because the latter often occurs early in pregnancy.

A 2021 review of research emphasized the significance of a person’s physical, mental, and emotional well-being before pregnancy and termination in understanding the potential mental health impact. Generally, researchers found that mood usually improved significantly after termination compared to the period before. Negative mental health impacts were less common and primarily observed as severe or persistent depression or anxiety, affecting approximately 10% of individuals, according to research from 1992.

Negative impacts were more frequent among individuals with preexisting mental health conditions, with intensification of preexisting symptoms rather than the onset of new ones. Additionally, various demographic, social, cultural, and economic factors can influence a person’s outcome.

Conclusion

In summary, the decision to continue or terminate a pregnancy is complex and unique to each individual’s circumstances. Seeking support from a partner, close friend, family member, or mental health professional can be helpful in navigating this decision-making process. If you don’t have a therapist or counselor, your primary care doctor or gynecologist can provide referrals and information about available options. Ultimately, the choice is yours, and you deserve support, dignity, and respect throughout the process.