Morning After Pill
This is a form of “emergency contraception” typically used by women who have unprotected or unplanned sexual intercourse, or birth control failure (such as a broken condom). The drug regimen is usually started within 72 hours of this incident.
The pills that are taken contain high doses of estrogen and/or progesterone. They are usually taken in two doses, 12 hours apart. The two FDA-approved drugs on the market are Preven (progesterone-like) and Plan B (a combination of progesterone-like and estrogen related).
These medications work on the woman’s reproductive system in one of several ways. They may prevent or delay the release of an egg from the ovaries (ovulation), they may slow the transport of the egg or the sperm in the fallopian tube, or they may make the lining of the uterus thinner and less hospitable for the implantation of an egg that is already fertilized.
These emergency contraception medications prevent about 75-89% of pregnancies that occur after unprotected sexual intercourse.
Side effects from these medications may include nausea, vomiting, abdominal pain, fatigue, headache, and changes in menstrual bleeding. A woman’s next menstrual cycle may start earlier or later than expected, and the flow may be heavier or lighter than usual. Still, most women will start their next period within 7 days of when it is expected. If she has not started it within 3 weeks after taking MAP, it is possible that she is pregnant, and she should see her healthcare provider.
Emergency contraception drugs do not appear to harm an early pregnancy, but due to the effect of slowed transport, a failed MAP may result in an increased possibility of an ectopic pregnancy (fertilized egg that implants in the fallopian tube instead of the uterus) which can lead to very serious complications.
Emergency contraception is available by prescription only. Some providers will require an office visit before the prescription is written.
This medication is used, along with misoprostol (Cytotec) in a two-step process resulting in a medical abortion. It is used for established pregnancies up to 49 days (7 weeks).
The first medication, RU-486, is given orally. Three pills will be given. The medication works by blocking the activity of progesterone, a substance that your body produces to help continue a pregnancy. This causes the placenta to separate from the endometrium (lining of the uterus), and also softens the cervix and causes the uterus to contract to allow the baby to pass through.
You must then return to your doctor within 48 hours to confirm whether or not your pregnancy has ended. If not, you will be given two tablets of another medication, Cytotec, to be taken orally or inserted vaginally. This will cause stronger uterine contractions, so that the baby will be delivered. The clinic may keep you there for up to 4 hours to be observed for any complications, or they may send you home. Some healthcare providers will allow you to take this second medication at home.
Fourteen days later, you must return to your doctor for an exam and/or ultrasound to make sure that your pregnancy has ended. If not, a surgical abortion will be done to complete the process. The medications used can cause major fetal defects, so patients are asked to agree to the surgical abortion before the medical abortion is attempted.
Side effects of this procedure may include cramping, vaginal bleeding, nausea/vomiting, headache, dizziness, weakness, abdominal/pelvic pain, and fainting. If you have heavy bleeding, such as soaking 2 or more maxi pads per hour for 2 hours in a row, or fever of 100.4 or higher, you need to call your doctor immediately.
Complications from this medical abortion procedure greatly increase if these medications are used with a pregnancy that is further along than 7 weeks (49 days), therefore if you decide to undergo this procedure, it is very important that you have the gestational age of your baby determined accurately. You also need to confirm that your pregnancy is in your uterus, and not in your fallopian tube (ectopic).
The medications given will not abort this type of pregnancy, but you may mistake pain and bleeding as side effects of the medication. There is a serious danger of complications to you and your reproductive organs if you ignore these warning signs of an ectopic pregnancy. To avoid both of these uncertain situations, an ultrasound should be considered before any medication is taken.
In the state of North Carolina for the year 2002 (the most recent year that statistics are available at this time), 46.1% of abortions were performed using this method.
It is typically used for pregnancies that are less than 12 weeks along. The opening of the uterus (cervix) is manually dilated with either a metal rod or rods or a seaweed product called laminaria that is placed in the cervix and left there to absorb moisture and expand the opening. When the cervix is opened sufficiently for the size of the suction tubing that is needed, the tubing (which is attached to a suction machine), is inserted into the uterus. The uterine lining and baby are suctioned through the tubing and out of the uterus into a container outside of the body. Sometimes a curette, a loop shaped knife, is necessary to scrape any remaining uterine lining or fetal body parts out of the uterus.
Anesthesia used for this type of abortion is typically local, meaning an injection of numbing medication into the cervix itself. Other short acting sedative medications may also be available.
D & E
In the state of North Carolina for the year 2002 (the most recent year for which statistics are available at this time), 38.0% of abortions were performed using this method. This technique is used in pregnancies up to 20 weeks along.
The cervix is dilated in the same manner as suction curettage, but this method is commonly used with pregnancies that are further along, so the dilation may need to be wider to allow for larger instruments to be used in the uterus. The baby is typically too large to fit through suction tubing if this method is used, so the body parts have to be pulled out with forceps, breaking them into pieces beforehand if necessary.
Tubing that is attached to a suction machine may then inserted into the uterus to remove any remaining uterine lining or body parts of the baby. If necessary, the uterus will also be scraped, using a curette to be sure all parts of the baby, uterine lining, and placenta have been removed.
Dilation and Extraction (D&X)
This procedure is used late in pregnancy when the baby is too large for other abortion methods, typically after 20 weeks of pregnancy. The entire process takes three days to complete. In the first two days, the cervix is dilated with laminaria in two or more sessions and medication can be given for cramping.
On the day of the actual procedure, the laminaria are removed, and the membranes that hold fluid around the baby are ruptured. The patient will then be injected with Pitocin to induce contractions. The doctor will use an ultrasound to locate the baby’s legs in the patient’s uterus. The doctor will reach into the uterus with forceps, grasp a leg, and pull it into the patient’s vagina. The doctor will deliver the rest of the baby with his hands (body, shoulders, and arms) up until the head.
The doctor will then hook his fingers over the shoulders of the baby, and insert a pair of surgical scissors into the base of the skull to create an opening. Removing the scissors, the doctor will insert a suction tube into the opening and suction out the contents of the skull so that without the brain, it will collapse. The doctor will then remove the placenta with forceps and suction and/or scrape the uterine wall with a curette.