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 The following represents a compendium
of procedures most commonly used to perform legal
abortions, along with an explanation of how they are
done, the risks involved, and the cost of the procedure.
Note that the cost of your procedure will vary depending
on the part of the country you are in, whether you get
yours done in a clinic setting or a hospital, how far
along your pregnancy is, and whether or not your have
insurance that will cover the procedure. Approximately
half of all insurance policies cover elective abortion.
In most states, however, Medicaid can only be used to
pay for abortion in the case of rape, incest or health
of the mother.
MEDICAL ABORTIONS (Performed during 1st Trimester
only)
MTX (Methotrexate &
Misoprostol). MTX a medical abortion procedure
used up to the first seven weeks of pregnancy.
At the 1st clinic visit methotrexate is given orally or
by injection. Methotrexate is primarily used in the
treatment of cancer and rheumatoid arthritis because it
attacks the most rapidly growing cells in the body. In
the case of an abortion, it causes the fetus and
placenta to separate from the endometrium, or lining of
the uterus. This use of the drug is not approved by the
FDA.
At the 2nd clinic visit, usually 5-7 days later, tablets
of misoprostol are given orally or inserted vaginally.
The woman is sent home for misoprostol to start
contractions/labor, expelling the fetus and placenta in
a few hours or up to few days.
At a 3rd clinic visit, approximately 7 days later, a
physical exam is done to make sure the abortion is
complete, and no complications occurred.
Failure Rate: 10%, requiring surgical abortion and
additional payment.
Side Effects/Risks: Cramping, nausea, diarrhea, heavy
bleeding, fever. This process is not advised for women
who have anemia, bleeding disorders, liver or kidney
disease, seizure disorder, or acute inflammatory bowel
disease, or use an intrauterine device (IUD).
Cost: Around $200 - $300
RU486/The Abortion
Pill/Mifepristone (Mifeprex) and Misoprostol: Used
up to the first seven to nine weeks of pregnancy. It is
also referred to as RU-486 or the “abortion pill.”
At the 1st clinic visit, a physical exam is given to
determine if patient can not take mifepristone due to:
ectopic pregnancy, ovarian mass, IUD, corticosteroid
use, adrenal failure, anemia, bleeding disorders or use
of blood thinners, asthma, liver or kidney problems,
heart disease, or high blood pressure. Then mifepristone
is given orally to block progesterone from the uterine
lining, causing the fetus to die. This alone, may cause
contractions to expel the fetus and placenta.
At the 2nd clinic visit, 36-48 hours later, misoprostol
is given orally or vaginally to cause contractions/labor
to expel the fetus and placenta. Some clinics may keep
patient for 4 hours to be monitored for severe side
effects, others may be given misoprostol to take at home
and then deliver at home usually with in 4 hours,
occasionally with in 2 weeks.
At a 3rd clinic visit, approximately 2 weeks later, a
physical exam is performed to make sure the abortion was
complete and no complications occurred.
Failure Rate: 8-10%, requiring surgical abortion and
additional fees.
Side Effects/Risks: Nausea, vomiting, diarrhea, severe
cramping, bleeding, infection.
Cost: Between $300 - $600.
SURGICAL ABORTIONS
Suction
Aspiration/Suction Currettage/Vacuum Aspiration.
Performed between 6-12 weeks. This is the most common
method of non-medical abortion, and may be used if a
medical abortion fails (or is incomplete) for any
reason.
Procedure: Abortion provider may give pain medication
and misoprostol in preparation of procedure. Patient
lies on back with feet in stirrups and a speculum is
inserted to open vagina. Patient is given a local
anesthetic to cervix. Then a tenaculum is used to hold
the cervix in place for the cervix to be dilated by cone
shaped rods. When the cervix is wide enough, a cannula,
which is a long plastic tube connected to a suction
device, is inserted into the uterus to suction out the
fetus and placenta. Procedure usually lasts 10-15
minutes, but may require staying at the clinic up to 5
hours.
Side Effects/Risks: Most women will experience cramping,
nausea, sweating or may feel faint during the procedure.
Some may experience heavy bleeding, damage to the
cervix, blood clots, perforation of the uterus;
infection due to retained products of conception or
bacteria from an STD causing fever, pain, abdominal
tenderness; scar tissue that blocks fallopian tubes;
emotional problems.
Cost: Usually between $350 and $600, though it will be
higher if done in a hospital.
Dilation & Curettage
(D&C). Performed usually first 12 wks, possibly
13-15 wks.
Procedure: Similar to Suction Aspiration with the
introduction of a curette, which is a long, looped
shaped knife that scrapes the lining, placenta and fetus
away from the uterus. A cannula may be inserted for a
final suctioning. Usually lasts 10 minutes with a
possible stay of 5 hours.
Side Effects/Risks: Same as Suction Aspiration, with
higher risk for perforation of uterus.
Cost: Between $350 and $600, though will be higher if
done in a hospital.
Dilation & Evacuation
(D&E). A second trimester procedure, done between
15 and 21 weeks.
Procedure: Twenty-four hours before the procedure,
laminaria (seaweed) or synthetic dilator is inserted
into the cervix. Then a tenaculum is clamped to the
cervix to keep the uterus in place. Cone-shaped rods of
increasing size continue the dilation process. The
cannula is inserted to begin pulling tissue, placenta
and fetus away from the lining. Then using a curette,
the lining is scraped to remove tissue, placenta and
fetus. If needed, forceps are then used to grasp and
pull out larger pieces of the fetus. The last step is
usually a final suctioning to make sure the contents are
completely removed. A D&E usually takes 30 minutes, and
is usually done in a hospital, because of the greater
risk for complications. Usually, the fetus will be
examined to make sure everything was removed and the
abortion is complete.
Side Effects/ Risks: Most women will experience nausea,
bleeding and cramping for about 2 weeks after the
procedure. Risks include: damage to uterine lining or
cervix, perforation of the uterus, infection due to
retained products of conception or untreated STD, blood
clots.
Cost: Between $750 and $1,000. Cost is higher the
further along the pregnancy the abortion takes place.
Induction Abortion.
Second or third trimester procedure.
Procedure: Inducing (starting) labor and delivery 1 of 3
ways: salt water, urea, digoxin or potassium chloride is
injected into the amniotic sac; prostoglandins inserted
into vagina; pitocin injected into a vein (intravenous
or IV). Laminaria is usually inserted into cervix to
begin dilation. Used very rarely, usually used in cases
of medical problem or illness in the fetus or women.
Side Effects/Risks: Same as above, with the addition of
accidental injection of saline or other medications into
mother's blood stream, excessive bleeding and cramping.
Cost: Between $600 and $1,000 depending on how far along
the pregnancy is.
Dilation and Extraction
(D&X): Sometimes referred to as “Partial Birth Abortion;” performed after
21 weeks.
Procedure: Two days before the procedure laminaria is
used to dilate the cervix and is sent home. On the third
day the women's water breaks and she returns to the
clinic. Then the fetus is rotated, forceps are used to
grasp and pull the legs , shoulders and arms through the
birth canal. Then scissors are forced through the base
of the skull, opened to enlarge the hole in order to
insert a suction catheter to suction out the brains. The
skull collapses and the fetus is pulled the rest of the
way out.
Side Effects/Risks: Same as above, significant emotional
problems
Legality: This procedure was outlawed by the federal government (in the US) and in some states
unless the life of the mother is in danger.
Cost: $750 and up, usually in the $3000 range
Sources:
"Induced Abortion." The American College of
Obstetricians and Gynecologists. 2001.
Pymar HC, Creinin MD (2000).
Alternatives to mifepristone regimens for medical
abortion. American Jouranl of Obstetrics and Gynecology,
183 (2): s54-s64.
Paul M, et al. (1999). A Clinician's Guide to Medical
and Sugical Abortion. New York: Churchill Livingstone.
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