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About Our Abortion ServicesHeritage Clinic for Women offers three types of abortion procedures from conception through 22 weeks.. To determine the appropriate type(s) of procedure(s) to offer, an ultrasound is performed to determine the woman's length of pregnancy from the first day of her last menstrual period (LMP). Medical Abortions, or non-surgical abortions, are offered when a woman is 63 days (9 weeks) or less from her last menstrual period (LMP). The process involves a minimum of two visits to the clinic but gives a woman the opportunity to experience the abortion at home. The Suction Curettage procedure is offered from 5-13 weeks LMP and is performed in the clinic by the physician. The Dilation and Evacuation (D&E) abortion is a two step procedure, performed in the second trimester of pregnancy (14-22 weeks LMP) by the physician. For those women who are between six and nine weeks and eligible for both the Medical Abortion and the Suction Curettage procedure, we have provided a Comparing Medical and Surgical Abortion section at the end of this page. The purpose of this comparison is to offer help in choosing the procedure which is most comfortable and comforting to the individual, and is the best fit for her schedule and her resources. At Heritage Clinic for Women, our goal is to provide as safe and as comfortable an abortion as possible, both physically and emotionally. To accomplish this goal, we provide thorough information and sensitive support as each woman schedules her appointment, registers at the front desk, receives the ultrasound and diagnostic tests, and meets privately with one of our counselors. During the counseling session, each woman will evaluate and review her unique history, birth control needs, abortion decision, coping skills, and support system with the counselor. The counselor will explain the appropriate procedure(s), describe the medications we will use and identify the staff support she will receive. Once all her questions are addressed and the consents are signed, she will meet with our medical staff to proceed with the abortion procedure appropriate for her pregnancy length.
MEDICAL (NON-SURGICAL) ABORTION Medical, non-surgical abortion using Mifeprex and Cytotec is an alternative abortive method available to women who are 63 days or less from their last menstrual period (approximately 9 weeks LMP or 7 weeks from conception). Mifeprex (Mifepristone) is a drug which blocks the action of progesterone, a hormone needed to continue the pregnancy by keeping it attached to the wall of the uterus. Mifeprex has been approved by the United States Food and Drug Administration (FDA) for early abortion and has been used by millions of women in Asia and Europe (it has been referred to as "RU486" in the media). Cytotec (Misoprostol) is a drug used in the United States to prevent irritation or ulcers in the stomachs of people using non-steroidal anti inflammatory drugs. When the FDA approved Mifeprex, it was approved for use in combination with Cytotec. When used together, Mifeprex and Cytotec are over 95% effective in causing an abortion in early pregnancy. Procedure On day one of the Medical Abortion process, the patient will take one Mifeprex pill orally in our office. Mifeprex will cause the pregnancy to release from the uterus. On day two, the patient is instructed to insert four Cytotec tablets vaginally and lie down for several hours. Cytotec will cause the woman to experience heavy cramping and bleeding, similar to a heavy period or a miscarriage, and pass the pregnancy at home. Although the abortion is usually complete within four to ten hours, the process may range from several hours to several days. Each patient is required to return to the clinic two weeks after her first visit for a follow up ultrasound to confirm that the process is complete. The Mifeprex protocol outlined and approved in 2000 by the Food and Drug Administration utilizes the same medications and order of treatment as we use. We provide an alternate protocol which offers changes in dosage, method of administering the medication and location of events. These changes allow for an increase in privacy, a decrease in cost and an equal success rate in completion of the abortion process. Considerations, Side Effects, and Risks Women considering medical abortion are screened by our counselors to make sure they fit the criteria. Candidates must:
Medical abortion is not an option for women who have chronic adrenal gland failure; inflammatory bowel disease; an inherited porphyria disorder; a bleeding disorder; a known allergy or intolerance to Mifepristone (Mifeprex), Misoprostol (Cytotec) or any prostaglandin medication; an intrauterine device (I.U.D.) in place or a known or suspected ectopic (tubal) pregnancy. Women considering Medical abortion must not be currently taking corticosteroids or blood thinning medication. There have been no reports of significant side-effects or long term risks with Medical abortion. Minor side effects such as nausea, vomiting, diarrhea, fever, headaches, and chills have been reported. Approximately 2% of patients will have an incomplete abortion or continuing pregnancy and will require a surgical procedure, at no additional fee, to complete the abortion. Other risks include the possibility of allergic reaction to the medication and bleeding or infection of varying degree.
The Suction Curettage abortion procedure is the most common method of abortion performed in the United States. Heritage Clinic for Women offers the Suction Curettage procedure to women whose length of pregnancy ranges from five through thirteen weeks LMP. Procedure Each woman will prepare for the procedure by changing into an exam gown. She will be accompanied into the exam room by a member of our medical staff who will remain there as support for the woman and as an assistant to the physician. It is normal to experience cramping with an abortion which may range in intensity from less than to greater than a woman's normal menstrual period cramps. To help maximize a woman's comfort, we provide a narcotic before and during the procedure called Fentanyl which acts as a pain reliever. Fentanyl may also cause a woman to feel drowsy or medicated which will help ease her emotionally as well as physically. Once the client has received the narcotic and our physician has performed a basic pelvic exam, he numbs the cervix with a local anesthetic. He will then insert a series of increasingly larger dilating rods into the cervical canal which will open or dilate the cervix. Once the cervix is dilated, the physician will insert a small, sterile, plastic aspirating tube into the uterus which provides suction and removes the pregnancy. The physician will complete the procedure by inserting a small, sterile, looped instrument called a curette to rub the walls of the uterus to insure all tissue is removed. The entire Suction Curettage procedure takes approximately three to five minutes to complete. Conscious Sedation The local anesthesia and narcotic we traditionally use is more than adequate to provide relief for the discomfort and cramping possible during a first trimester abortion. However, if a woman is experiencing a level of anxiety so high that she believes it will interfere with her ability to cope during the abortion procedure, it may benefit her to have additional sedation during the abortion. We offer the option of Conscious Sedation which is a combination of the pain relieving narcotic we normally use with a sedative-hypnotic drug called Versed. Conscious Sedation alters a woman's state of consciousness, helping her to feel more relaxed and less anxious during the abortion. This combination provides increased sedation without the high risks associated with general anesthesia by allowing the patient to maintain her breathing independently, be easily aroused and respond to physical stimuli and verbal commands. If a client feels she would benefit from using this additional medication, she should come prepared for an extra fee (please contact the clinic for current fees) and should not eat or drink anything after midnight on the day of her appointment. Considerations, Side Effects and Risks First trimester abortions are considered the safest way a pregnancy can end. Women may experience cramping and bleeding during the healing process after an abortion although it is rarely severe and often mild. Women are given thorough instructions regarding restrictions, recovery and aftercare to minimize the risk of problems occurring. More than 97% of all first trimester abortions take place without any complications. Of the remaining percentage, 2.5% experience minor complications such as infection, retained tissue and heavier bleeding which if addressed promptly can be handled with medication or a return visit to the clinic. Continuing pregnancy is possible after a very early suction curettage abortion due to multiple pregnancies, a double uterus, or an ectopic pregnancy; however, due to a routine ultrasound prior to every abortion, these conditions are normally discovered and addressed before the abortion even occurs. More major complications such as perforation of the uterus, prolonged infection or prolonged hemorrhage might require additional medical support although the need for hospitalization or surgery is less than .005%. It is extremely rare that anyone would have a complication or require treatment for a complication that is severe enough to cause damage to the reproductive system, damage a woman's health or threaten her life. These risks are possible regardless of how the pregnancy ends: miscarriage, abortion, C-section or vaginal delivery. Statistically speaking, a first trimester abortion is the safest way a pregnancy can end. Our counseling and medical staff provide thorough aftercare instructions and existing clients have emergency access to our physician 24 hours a day.
DILATION AND EVACUATION (D & E) Dilation and Evacuation (D & E) abortion procedures constitute approximately 10% of all abortions performed in the United States with less that 1% performed after 20 weeks. Heritage Clinic for Women offers the D & E procedure to women whose length of pregnancy ranges from fourteen through twenty two weeks LMP. Procedure The D & E procedure is performed in two steps. The first step involves inserting a natural fiber, dilating substance called Laminaria into the cervical opening during a pelvic exam. Since the cervix needs to be opened farther in the second trimester, slower dilation is necessary to minimize the risk of cervical harm. The laminaria remains in the cervix over several hours or overnight as it absorbs moisture and swells, pressing the cervix open. During the second step, the physician removes the pregnancy with sterile instruments (such as the curette and forceps) and suction aspiration. The option to schedule both steps on the same day is available through 16 weeks LMP. Procedures after 16 weeks must be scheduled over two consecutive days. Conscious Sedation, a combination of the pain relieving narcotic called Fentanyl with a sedative-hypnotic drug called Versed, is administered during the D & E procedure for physical and emotional comfort. Conscious Sedation alters a woman's state of consciousness, helping her to feel more relaxed and experience less discomfort and anxiety during the abortion. This combination provides increased sedation without the high risks associated with general anesthesia by allowing the patient to maintain her breathing independently, be easily aroused and respond to physical stimuli and verbal commands. The second step of the procedure usually takes between ten and fifteen minutes. Considerations, Side Effects and Risks More than 97% of all second trimester abortions take place without any complications. Of the remaining percentage, 2.5% experience minor complications such as infection, retained tissue and heavier bleeding which if addressed promptly can be handled with medication or a return visit to the clinic. The risk of more major complications such as perforation or laceration of the uterus or cervix, prolonged infection or prolonged hemorrhage, all of which might require additional medical support, is slightly higher than in the first trimester although the need for hospitalization or surgery is still less than one percent. It is extremely rare that anyone would have a complication or require treatment for a complication that is severe enough to cause damage to the reproductive system, damage a woman's health or threaten her life. These risks are possible regardless of how the pregnancy ends: miscarriage, abortion, C-section or vaginal delivery. Statistically speaking, a first trimester abortion is the safest way a pregnancy can end and a second trimester abortion does not carry any risks higher than carrying a pregnancy full term. Our counseling and medical staff provide thorough aftercare instructions and existing clients have emergency access to our physician 24 hours a day.
COMPARING MEDICAL AND SURGICAL ABORTION For women who are 5 to 9 weeks LMP
Advantages and Disadvantages Medical abortion is simply another alternative to a suction aspiration procedure (described below). One procedure is not better than the other, they are just two different ways of experiencing an abortion. The perceived advantages and disadvantages with each option will vary depending on individual circumstances and perspectives. We have learned much about the Medical abortion experience from our clients who have chosen that option. Women have made their decision during discussions with our counseling staff and have shared what the process was like with our medical staff during their follow up. The following table will outline a number of the perceived advantages and disadvantages which previous patients have shared with us. Please use it to gain insight into which process seems to fit you best. Please consider your feelings about your choice; what will work best with your work and home schedule; the level of support you feel you will need to carry out each option and whether you have that level of support available to you; the level of comfort you feel with your body in relation to inserting medication vaginally or having a surgical procedure; whether you'd feel most comfortable leaving the clinic having the procedure done and going home to recover versus having started the process at the clinic and going home to privately pass the pregnancy. Be assured YOU DO NOT HAVE TO FINALIZE YOUR DECISION UNTIL THE END OF THE COUNSELING SESSION. You will have ample opportunity during your appointment to have both procedures explained in person by one of our counselors and to have all your questions answered. Come prepared financially for the most you expect you will need (please contact the clinic for current fees) and we will see what the ultrasound indicates you will qualify for.
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