Abortion Care

Mifeprex has been available as an early abortion method in the United States since September 2000, although in several other countries around the world, mifepristone and RU-486 have been legal, early abortion methods for more than 10 years. While studies have shown that various regimens for administering the medications can work safely and effectively, the FDA has approved only one regimen for administration in the U.S. While some doctor’s offices and clinics may use the FDA approved method, others may use an alternative or “off label” method which should have similar success and safety rates. Here, at the Atlanta Women’s Medical Center (AWMC), we use an “off label” method for administering a non-surgical abortion.

The non-surgical abortion is known as an early abortion method because the FDA has approved Mifeprex for use up to 7 weeks from the last menstrual period (LMP). Depending on the facility’s protocols, the pill may be offered to patients up to 8 weeks LMP. At AWMC, you may choose a non-surgical abortion to end your pregnancy if you are between 6 and 8 weeks pregnant based on your LMP, live within 45 minutes of our facility and are an appropriate candidate.

Mifeprex is used with another medication called misoprostol (also called cytotec) to cause a process similar to miscarriage. There are three steps to non-surgical abortion, and the time it takes to complete the abortion varies. The non-surgical abortion usually requires at least 2 visits to the healthcare facility.

• Step 1:

On the day of your first appointment, you will go through a pre-procedural assessment, which includes having an ultrasound, vital sign and blood testing, medical consultation, counseling session, and payment. Following your assessment, you will meet with the obstetrician/gynecologist who will perform a pelvic exam. The non-surgical procedure will begin when the doctor administers, Mifeprex. This medication is taken orally and will stop production of the hormones necessary to sustain the pregnancy which will cause the pregnancy to detach from the uterus.

• Step 2:

24 – 48 hours after taking Mifeprex you will take an oral dose of Misoprostol. Misoprostol is a medication that induces the uterus to contract and expel the pregnancy. You can expect the first symptoms of abortion within 4 – 6 hours of taking the misopostol. You will begin to experience strong cramping and heavy bleeding. Some women say that the procedure is very much like a heavy period while other women describe the bleeding and cramping as much more intense. Please keep in mind that everyone responds to this non-surgical abortion differently.

The heaviest of the bleeding and cramping should pass within the first 48 – 72 hours. Afterwards your bleeding should then begin to resemble a normal period. You may continue to bleed and have some mild cramping for up to 30 days.

• Step 3:

You will return to AWMC for a follow-up exam which includes a urine pregnancy test and ultrasound. This is the most important part of the procedure, as this is the only way to determine if the abortion is complete and that there are no current complications. If the non-surgical abortion fails to remove all the pregnancy tissue, the physician may give you more misoprostol to expel the remaining tissue from your uterus or perform a surgical abortion. 5-8 out of 100 women will need a surgical procedure to end the pregnancy.

Surgical Abortion Care

First Trimester Abortion (up through 12 weeks 6 days LMP)
A first trimester surgical abortion, which is measured approximately up to 12 weeks from the first day of the last menstrual period (LMP), is completed by a procedure known as dilatation and evacuation.The procedure alone will take approximately 5 minutes, although the visit to our office will take several hours.

The procedure will begin with the physician performing a pelvic exam to determine the size and location of the pregnancy in the uterus. After this exam, anesthesia medication may be given through an IV. This will sedate the patient for the length of the surgery, so that she does not hear or feel anything. It is generally the patient’s decision if she would like sedation or not. Patients who choose not to receive sedation will be given a local anesthetic to numb the cervix, which will make the procedure more comfortable. More information on anesthesia is given below.

After the pelvic exam, the doctor will insert a speculum into the vagina so that he/she can view the cervix. The cervix is the lower end of the uterus, and is located at the top of the vaginal canal. He/she will clean the vaginal canal with an antiseptic. Next, he/she will dilate, or open, the cervix by inserting a series of sterile metal rods, one by one, into the opening of the cervix. These rods, called dilators, gradually increase in width. Dilation for a first trimester abortion is minimal. Once the cervix is opened, the physician will be able to remove the pregnancy from the uterus. The doctor will insert a sterile, plastic, flexible tube called a cannula into the uterus. The cannula is attached by a tube to a machine called a vacuum aspirator, which creates a suction that removes the pregnancy. Once these steps are complete, the surgeon will clean the inside of the uterus with an instrument called a curette to ensure that all pregnancy tissue has been removed. He/she will then remove the speculum. The whole process generally takes about 5 minutes. After surgery, the patient will be monitored in the Recovery Room by the Nursing Team for approximately 45 minutes, or until she is medically cleared to return home.

Second Trimester Abortion (up through 24 weeks 6 days LMP)
At Atlanta Women’s Medical Center, a second trimester abortion takes place from about 12 weeks from the first day of the last menstrual period (LMP) through 24 weeks LMP. A second trimester surgical abortion is performed in the same manner as a first trimester abortion; however, after about 14 weeks, the patient’s cervix must be dilated, or opened, prior to her surgery. The length of this dilation depends on the physician’s protocols, as well as the patient’s medical history, pregnancy history, and other factors. In general, patients who are 14 to 18 weeks pregnant at the Atlanta Women’s Medical Center will need to dilate for 1 to 6 hours before surgery is done. Patients approximately 18 weeks and over will require an overnight dilation, as well as possible continued dilation on the morning of the second day, before surgery is done. Patients do not stay in the facility overnight, and are given specific, strict guidelines and instructions for their home care between day one and day two.

The cervix is dilated through the administration of a medication called misoprostol (cytotec) and/or laminaria/lamicel insertion. The misoprotol is either taken as a pill orally or inserted into the vagina. Laminaria or lamicel must be inserted by the physician into the patient’s cervix. Laminaria are made of sterilized seaweed and look like tiny tampons. Lamicel are similar, but made of a synthetic material. The laminaria/lamicel act like a sponge by absorbing the moisture in the patient’s vagina and expanding. As the laminaria or lamicel expands, the cervix is slowly dilated. Depending on the gestational age of the pregnancy and the patient’s medical history, the physician will decide on the best method of dilation with misoprostol (cytotec) and/or laminaria or lamicel. The physician will perform the surgical abortion after dilation is complete in a manner similar to, but more extensive than, the method described for first trimester abortion.

If the procedure is performed under local anesthesia, the patient will be awake and conscious as normal during the procedure. Patients will be able to see and hear as usual during the procedure, and will be able to remember everything that happened during the surgery after it is over. While local anesthetics can be administered differently, generally speaking the physician will inject the anesthetic into the patient’s cervix. This will lessen the pain, but the patient will still experience cramping and discomfort during the procedure. Sometimes medications, such as ibuprofen, are also offered both before and after the surgery to ease pain. Breathing exercises may also be used in conjunction with local anesthetic to minimize discomfort. Local anesthesia allows women to remain alert during the process, which may be more empowering for some individuals. In addition, this method allows women to avoid some of the side effects and risks often associated with sedation methods of twilight anesthesia and general anesthesia explained below.

Twilight anesthesia, sometimes called light sedation or conscious sedation, will be administered by a certified registered nurse anesthetist, or CRNA. Twilight anesthesia may contain a combination of medications, usually given through an intravenous (IV) needle inserted into the hand or arm. Twilight anesthesia will relax and partially sedate the patient. She will have no memory of the procedure, but may appear conscious or partially asleep, and will usually be able to respond to simple requests. The patient will remain in this state for a couple of minutes up to a few hours depending on how much medication is administered. As a typical abortion procedure usually lasts from 3 to 20 minutes, the patient will only be sedated for this time. However, anesthesia often causes grogginess, so many patients will sleep off and on for the rest of the day.

If the procedure is performed under general anesthesia or deep sedation, the patient will be completely sedated, and she will not see, hear or feel any part of the surgery and will not remember anything about the surgery afterwards. General anesthetics are usually administered through an IV, in the same manner described above. While this is an optimal method for women who wish to decrease pain, it may not be appropriate for obese women or women with certain medical conditions. Sedation may also cause side effects such as nausea, dizziness, and feeling cold. The general anesthesia also takes longer time to wear off entirely and the patient will feel drowsy for several hours or a full day. This means the patient will be required to have a friend or family member escort her home after surgery. Patients who are 16 weeks or more into the pregnancy will be required to undergo anesthesia, and must meet certain guidelines for sedation.

Follow-Up
Atlanta Women’s Medical Center believes that it is important for patients to have medical care available after an abortion procedure, and provides a 24-hour hotline for patients experiencing medical difficulties. Patients are also scheduled for a routine follow-up exam, usually 3-4 weeks after the procedure. There is no additional charge for this check up, or for any follow-up care at Atlanta Women’s Medical Center. The follow up time allows patients an opportunity to bring any problems to the practitioner’s attention, to discuss birth control, and to obtain a referral for ongoing healthcare. Testing for sexually transmitted infections can also be performed free of charge during the abortion procedure, and results are usually available at the follow-up appointment.

When a patient calls to make an appointment, she will be asked for some information. Below are some of the usual questions a patient will be asked

• Name
• Age
• Date of birth
• Phone number (this is required, though the office generally does not need to contact patients, and we will NOT identify ourselves if you do not want us to).
• Approximate height and weight
• First day of last menstrual period
• Medical history questions – any illnesses, allergies, current medications, etc.
• Pregnancy history
• Insurance information (if any)

Some of these questions may seem very personal, or not necessary. However, our phone counselors require a range of information in order to create a full picture of each patient’s medical history, and any special needs she may have. Atlanta Women’s Medical Center strives to make every patient’s experience as personalized, smooth and streamlined as possible, and will make every effort to identify any potential problems prior to the patient’s arrival at the office. In order to achieve this goal, it is important for a patient to be as honest and complete as possible when discussing her medical history and other information. Remember, all information is kept confidential, and is used to ensure the safest care possible.

For more information on services at Atlanta Women’s Medical Center, or to schedule an appointment, please call the office at 404.257.0057 or 1.800.877.6332.  For more information on abortion care, you can also visit AbortionUSA.com.