ABORTION. Making. Decision

Transcription

1 ABORTION Making Decision

2 T h i s p u b l i c a t i o n w a s p r o d u c e d i n c o m p l i a n c e w i t h R. S. 40: (ACT 648, 1995). The Louisiana Department of Health and Hospitals acknowledges contributions for this publication from: L e n n a r t N i l s s o n ( i n u t e r o p h o t o g r a p h s u s e d b y p e r m i s - sion, A Child is Born); portions of text from Pennsylvania Department of Health and from Ohio Department of Health; cover design and illustrations by Wesley Jerome B o y d o f L o u i s i a n a D e p a r t m e n t o f H e a l t h a n d H o s p i t a l s.

3 INTRODUCTION L o u i s i a n a l a w r e q u i r e s y o u r d o c t o r t o t e l l y o u a b o u t t h e n a t u r e o f t h e p h y s i c a l a n d e m o t i o n a l r i s k s o f b o t h t h e a b o r t i o n p r o c e d u r e a n d c a r r y i n g a c h i l d t o t e r m. T h e d o c t o r m u s t t e l l y o u h o w l o n g y o u h a v e b e e n p r e g n a n t a n d m u s t g i v e y o u a c h a n c e t o ask questions and discuss your decision carefully and privately. This brochure offers some basic facts to help you make an informed decision a b o u t w h e t h e r o r n o t y o u w a n t t o h a v e a n a b o r t i o n. T h e i n f o r m a t i o n w i l l t e l l y o u a b o u t n o r m a l h u m a n e m b r y o n i c a n d f e t a l d e v e l o p m e n t a n d a b o u t t h e m e t h o d s a n d r i s k s o f a b o r t i o n s. The term embryo refers to a developing human from conception until the eighth week. An embryo becomes a fetus after the eighth week. Embryo and fetal ages in this brochure are listed from both the estimated date of conception and from the first day of the last normal menstrual period. Fetal lengths are measured from the top of t h e h e a d t o t h e r u m p. I f y o u d e c i d e t o p l a c e y o u r b a b y u p f o r a d o p t i o n o r n e e d t o l o c a t e p u b l i c a n d private agencies that offer medical and financial help, as well as counseling services, a list is included in the Directory of Services accompanying this brochure. By calling or visiting the agencies and offices, you can find out about alternatives t o a b o r t i o n, a d o p t i o n, a n d t h e k i n d s o f a s s i s t a n c e a v a i l a b l e t o h e l p y o u t h r o u g h p r e g n a n c y a n d c h i l d b i r t h a n d w h i l e y o u a r e r a i s i n g y o u r c h i l d. F u r t h e r m o r e, y o u should know: I t i s u n l a w f u l f o r a n y i n d i v i d u a l t o c o e r c e y o u t o u n d e r g o a n a b o r t i o n ; A n y p h y s i c i a n w h o p e r f o r m s a n a b o r t i o n u p o n y o u w i t h o u t o b t a i n i n g a n i n f o r m e d c o n s e n t o r w i t h o u t a c c o r d i n g y o u a p r i v a t e m e d i c a l c o n s u l t a t i o n maybe liable to you for damages in a civil action at law; Y o u a r e n o t r e q u i r e d t o p a y a n y a m o u n t f o r t h e a b o r t i o n p r o c e d u r e u n t i l t h e h o u r p e r i o d h a s e x p i r e d ; T h e f a t h e r o f y o u r c h i l d i s l i a b l e t o a s s i s t i n t h e s u p p o r t o f t h a t c h i l d, e v e n i n instances where the father has offered to pay for an abortion; and The law permits adoptive parents to pay costs of prenatal care, childbirth and neonatal care. There are many public and private agencies willing and able to help you carry your child to term. They also will assist you and your child after your child s birth, w h e t h e r y o u c h o o s e t o k e e p y o u r c h i l d o r t o p l a c e h i m o r h e r u p f o r a d o p t i o n. T h e State of Louisiana strongly urges you to contact them before making a final decision about abortion. The law requires that your physician or his agent give you the opportunity to call agencies like these before you undergo an abortion. - Louisiana Act 648 of

4 FETAL DEVELOPMENT First things first A pregnant woman may notice her first missed menstrual period at the end of the second week after conception, or about four weeks after the first day of her last n o r m a l p e r i o d. There are different kinds of urine tests for pregnancy. Some may not be accurate for up to three weeks after conception, or five weeks after the first day of the last n o r m a l p e r i o d. Week 2 (4 weeks after the first day of the last Implantation begins the first w e e k a n d t h e e m b r y o continues to grow. The e m b r y o i s a b o u t 1 / o f a n inch long at this time. Week 4 (6 weeks after the first day of the last T h e e m b r y o i s a b o u t 1 / 6 i n c h l o n g a n d h a s d e v e l o p e d a h e a d a n d a t r u n k. Structures that will become arms and legs, called limb buds, begin to appear. The heart, now is a tubular f o r m, b e g i n s t o b e a t b y t h e 2 5 t h day.

5 Week 6 (8 weeks after the first day of the last T h e e m b r y o i s a b o u t 1 / 2 i n c h a n d h a s a f o u r c h a m b e r e d h e a r t and nostrils. Electrical activity begins in the d e v e l o p i n g b r a i n a n d n e r v o u s s y s t e m. F i n g e r s a n d t o e s b e g i n t o f o r m. Week 8 (10 weeks after the first day of the last The fetus, until now called an e m b r y o, i s a b o u t 1-1 / 4 i n c h e s l o n g, w i t h t h e h e a d m a k i n g u p about half this size. T h e b e g i n n i n g s o f a l l k e y b o d y p a r t s a r e p r e s e n t, a l t h o u g h t h e y a r e n o t c o m p l e t e l y p o s i t i o n e d i n t h e i r final locations. Structures that will form eyes, ears, arms and legs are identifiable. 3

6 Week 10 (12 weeks after the first day of the last T h e f e t u s i s a b o u t 2-1 / 2 i n c h e s f r o m h e a d t o r u m p. Fingers and toes are distinct and have nails. The fetus begins small, r a n d o m m o v e m e n t s, t o o s l i g h t to be felt. T h e f e t u s h e a r t b e a t c a n b e detected electronically. Week 12 (14 weeks after the first day of the last T h e f e t u s i s a b o u t 3-1 / 2 i n c h e s f r o m h e a d t o r u m p a n d w e i g h s a b o u t 4 o u n c e s. The fetus can swallow, the k i d n e y s m a k e u r i n e, a n d b l o o d b e g i n s t o f o r m i n t h e b o n e marrow. Your doctor maybe able to tell y o u t h e s e x t h r o u g h s p e c i a l t e s t s.

7 Week 14 (16 weeks after the first day of the last T h e f e t u s i s a b o u t 4-3 / 4 i n c h e s f r o m h e a d t o r u m p a n d w e i g h s 4 o u n c e s. T h e h e a d i s e r e c t a n d t h e a r m s a n d l e g s a r e d e v e l o p e d. Week 16 (18 weeks after the first day of the last T h e f e t u s i s a b o u t 5 i n c h e s f r o m h e a d t o r u m p a n d w e i g h s a b o u t 8 o u n c e s. T h e s k i n i s p i n k a n d transparent and the ears stick o u t f r o m t h e h e a d. 5

8 Week 18 (20 weeks after the first day of the last T h e f e t u s i s a b o u t 6-1 / 4 i n c h e s f r o m h e a d t o r u m p. All organs and structures have b e e n f o r m e d, a n d a p e r i o d o f simple growth begins. Respiratory movements occur, b u t t h e l u n g s h a v e n o t d e v e l o p e d e n o u g h t o p e r m i t survival outside the uterus. B y t h i s t i m e t h e w o m a n c a n f e e l t h e f e t u s m o v i n g. Week 20 (22 weeks after the first day of the last T h e f e t u s i s a b o u t 7-1 / 2 i n c h e s f r o m h e a d t o r u m p, h a s f i n g e r p r i n t s a n d p e r h a p s s o m e head and body hair. There is little chance before this time that a baby could survive outside the woman s body.

9 Week 22 (24 weeks after the first day of the last T h e f e t u s i s a b o u t 8-1 / 4 i n c h e s f r o m h e a d t o r u m p a n d w e i g h s a b o u t 1-1 / 4 p o u n d s. C h a n g e s a r e o c c u r r i n g i n l u n g d e v e l o p m e n t s o t h a t s o m e babies are able to survive with intensive care services. Surviving babies may have long-term disabilities. Week 24 (26 weeks after the first day of the last T h e f e t u s i s a b o u t 9 i n c h e s f r o m h e a d t o r u m p a n d w e i g h s a b o u t 2 p o u n d s. T h e f e t u s c a n r e s p o n d t o s o u n d. A b o u t 4 o u t o f 1 0 b a b i e s b o r n now will survive (with intensive care services). 7

10 Week 26 (28 weeks after the first day of the last T h e f e t u s i s a b o u t 1 0 i n c h e s f r o m h e a d t o r u m p a n d w e i g h s a b o u t 2-1 / 2 p o u n d s. T h e e y e s a r e p a r t i a l l y o p e n. A b o u t 9 o u t o f 1 0 b a b i e s b o r n now will survive (with intensive care services). Week 28 (30 weeks after the first day of the last T h e f e t u s i s a b o u t / 2 i n c h e s f r o m h e a d t o r u m p a n d w e i g h s a l m o s t 3 p o u n d s. T h e f e t u s h a s l u n g s t h a t a r e c a p a b l e o f b r e a t h i n g a i r, a l t h o u g h m e d i c a l h e l p m a y b e n e e d e d. T h e f e t u s c a n o p e n a n d c l o s e its eyes, suck its thumb and cry. Nearly all babies born now will survive (with intensive care s e r v i c e s ).

11 Week 30 (32 weeks after the first day of the last T h e f e t u s i s a b o u t 1 1 i n c h e s f r o m h e a d t o r u m p a n d w e i g h s m o r e t h a n 3 p o u n d s. W r i n k l e s a p p e a r o n t h e f e e t. Almost all babies born now will live (with intensive care services). Week 32 (34 weeks after the first day of the last T h e f e t u s i s a b o u t / 4 i n c h e s f r o m h e a d t o r u m p a n d w e i g h s a b o u t 4-1 / 2 p o u n d s. T h e s k i n i s p i n k a n d s m o o t h. Almost all babies born now will live (with intensive care services). 9

12 Week 34 (36 weeks after the first day of the last T h e f e t u s i s a b o u t / 2 i n c h e s f r o m h e a d t o r u m p a n d w e i g h s a b o u t 5-1 / 2 p o u n d s. T h e f e t u s i s m o r e r o u n d a n d p l u m p. Almost all babies born now will live. Week 36 (38 weeks after the first day of the last T h e f e t u s i s a b o u t / 2 i n c h e s f r o m h e a d t o r u m p a n d w e i g h s a b o u t 6-1 / 2 p o u n d s. The fetus can grasp firmly. Almost all babies born now will live.

13 Week 38 (40 weeks after the first day of the last T h e f e t u s i s a b o u t 1 4 i n c h e s f r o m h e a d t o r u m p, m a y b e m o r e t h a n 2 0 i n c h e s o v e r a l l, a n d m a y w e i g h f r o m 6-1 / 2 t o 1 0 p o u n d s. T h e b a b y i s f u l l - t e r m a n d r e a d y t o b e b o r n. METHODS & MEDICAL RISKS There are three ways a pregnancy can end: a woman can give birth, have a miscarriage or she can choose to have an abortion. If you make an informed decision to h a v e a n a b o r t i o n, y o u a n d y o u r d o c t o r w i l l n e e d t o c o n s i d e r h o w l o n g y o u h a v e b e e n p r e g n a n t b e f o r e d e c i d i n g w h i c h a b o r t i o n m e t h o d t o u s e. Based on data from the Centers from Disease Control and Prevention (CDC), the r i s k o f d y i n g a s a d i r e c t r e s u l t o f a l e g a l l y i n d u c e d a b o r t i o n i s l e s s t h a n o n e p e r 1 0 0, FIRST TRIMESTER (From 6-12 weeks after the first day of the last Abortion Method: Suction Curettage (Vacuum Aspiration) An anti-bacterial solution will be used to cleanse the vaginal area. T h e d o c t o r w i l l s p r a y o r i n j e c t m e d i c i n e o n t h e o p e n i n g o f y o u r u t e r u s ( c e r v i x ) t o p r e v e n t p a i n. T h e o p e n i n g o f t h e c e r v i x w i l l b e g r a d u a l l y s t r e t c h e d. T h i s i s d o n e b y t h e i n s e r t i o n o f a s e r i e s o r r o d s, e a c h o n e t h i c k e r t h a n t h e p r e v i o u s o n e, i n t o t h e o p e n i n g o f t h e c e r v i x. T h e t h i c k e s t r o d u s e d i s a b o u t t h e w i d t h o f a f o u n t a i n p e n. 1 1

14 After the opening is stretched, a clear plastic tube (catheter) is inserted into the uterus. T h e s u c t i o n ( v a c u u m ) m a c h i n e i s t u r n e d o n a n d f e t a l t i s s u e s a n d o t h e r p r o d u c t s o f p r e g n a n c y a r e r e m o v e d t h r o u g h t h e c a t h e t e r. A f t e r t h e s u c t i o n t u b e h a s b e e n r e m o v e d, a n a r r o w m e t a l l o o p ( C u r e t t e ) m a y b e u s e d t o g e n t l y s c r a p e t h e w a l l s o f t h e u t e r u s t o b e s u r e i t h a s b e e n c o m p l e t e l y e m p t i e d. Medical Risks I m m e d i a t e m e d i c a l r i s k s m a y i n c l u d e t h e f o l l o w i n g, w h i c h a r e d i s c u s s e d o n p a g e s 1 6 : p e l v i c i n f e c t i o n, i n c o m p l e t e a b o r t i o n, b l o o d c l o t s i n t h e u t e r u s, h e a v y b l e e d i n g, c u t o r t o r n c e r v i x, p e r f o r a t i o n o f the wall of the uterus, pelvic infection, anesthesia-related complications. P o s s i b l e l o n g - t e r m m e d i c a l r i s k s a r e d i s c u s s e d o n p a g e 1 7. SECOND TRIMESTER (From weeks after the first day of the last menstrual period) Abortion Methods: Dilatation and Evacuation (D&E) or Labor Induction D&E A n a b o r t i o n u s i n g t h e D & E m e t h o d i s d o n e i n t w o s t e p s : d i l a t i o n ( o p e n i n g t h e c e r v i x ) a n d e v a c u a t i o n ( e m p t y i n g ) t h e u t e r u s. An antibacterial solution is used to cleanse the vaginal area. T h e d o c t o r m a y i n s e r t a s p o n g e - l i k e m a t e r i a l i n t o t h e c e r v i x. A s t h e sponge gets wet, it swells and opens the mouth of the cervix. You m a y f e e l p r e s s u r e o r c r a m p i n g w h i l e t h e d i l a t o r i s i n p l a c e. T h e d o c t o r w i l l r e m o v e t h e s p o n g e i n 2 t o 1 6 h o u r s. You may be given intravenous medications to ease pain and prevent infection. After a local or general anesthesia is given, the fetus and other p r o d u c t s o f p r e g n a n c y a r e r e m o v e d f r o m t h e u t e r u s w i t h m e d i c a l i n s t r u m e n t s s u c h a s f o r c e p s a n d s u c t i o n c u r e t t a g e.

15 Medical Risks I m m e d i a t e m e d i c a l r i s k s m a y i n c l u d e t h e f o l l o w i n g, w h i c h a r e d i s c u s s e d o n p a g e s 1 6 : p e l v i c i n f e c t i o n, i n c o m p l e t e a b o r t i o n, b l o o d c l o t s i n t h e u t e r u s, h e a v y b l e e d i n g, c u t o r t o r n c e r v i x, p e r f o r a t i o n o f the wall of the uterus, pelvic infection, anesthesia-related complications. P o s s i b l e l o n g - t e r m m e d i c a l r i s k s a r e d i s c u s s e d o n p a g e 1 7. Labor Induction L a b o r i n d u c t i o n m e t h o d i s u s e d i f t h e d o c t o r d e t e r m i n e s t h a t t h e a g e of the fetus is late in the second trimester. Labor induction usually r e q u i r e s a l o n g e r s t a y a n d i s n o t p e r f o r m e d i n a c l i n i c s e t t i n g. T h e m e d i c i n e t o i n d u c e l a b o r w i l l b e i n j e c t e d i n e i t h e r o f t w o w a y s : d i r e c t l y i n t o a v e i n o r b y i n s e r t i n g a n e e d l e t h r o u g h t h e b e l l y i n t o t h e amniotic sac. L a b o r w i l l u s u a l l y b e g i n i n 2-4 h o u r s. I f t h e a f t e r b i r t h i s n o t r e m o v e d w i t h t h e f e t u s d u r i n g l a b o r i n d u c t i o n, t h e d o c t o r m u s t o p e n t h e c e r v i x a n d u s e s u c t i o n c u r e t t a g e a s d e s c r i b e d in the first trimester. Medical Risks L a b o r i n d u c t i o n a b o r t i o n c a r r i e s t h e h i g h e s t r i s k f o r p r o b l e m s, s u c h a s i n f e c t i o n a n d h e a v y b l e e d i n g, s t r o k e a n d h i g h b l o o d p r e s s u r e. When medicines are used to start labor, there is a greater risk of r u p t u r e o f t h e w o m b t h a n d u r i n g n o r m a l c h i l d b i r t h. Other immediate medical risks may include the following, which are d i s c u s s e d o n p a g e 1 6 : p e l v i c i n f e c t i o n, i n c o m p l e t e a b o r t i o n, b l o o d c l o t s i n t h e u t e r u s, h e a v y b l e e d i n g, c u t o r t o r n c e r v i x, p e r f o r a t i o n o f the wall of the uterus, pelvic infection, anesthesia-related complications. P o s s i b l e l o n g - t e r m m e d i c a l r i s k s a r e d i s c u s s e d o n p a g e 1 7. If the labor induction method is used, there is a small chance that a fetus could live for a short period of time. (See What if the fetus is able to live outside the womb?, page 15.) 1 3

16 THIRD TRIMESTER (From weeks after the first day of the last menstrual period) A n a b o r t i o n a t t h i s s t a g e o f y o u r p r e g n a n c y m a y o n l y b e d o n e i f y o u r d o c t o r reasonably believes it is necessary to prevent your death or to preserve your health. Abortion Methods: Labor Induction or Caesarean Section Labor Induction (See What if the fetus is able to live outside the womb? ) L a b o r i n d u c t i o n u s u a l l y r e q u i r e s t h e w o m a n t o b e a d m i t t e d t o t h e hospital. Labor will be started by injecting medicines into the woman s blood s t r e a m. L a b o r a n d d e l i v e r y o f t h e f e t u s d u r i n g t h e t h i r d t r i m e s t e r a r e s i m i l a r t o c h i l d b i r t h. T h e d u r a t i o n o f l a b o r d e p e n d s o n t h e s i z e o f t h e b a b y a n d t h e readiness of the womb. Medical Risks As with childbirth, possible complications of third trimester labor i n d u c t i o n i n c l u d e i n f e c t i o n, h e a v y b l e e d i n g, s t r o k e a n d h i g h b l o o d pressure. When medicines are used to start labor, there is an increased risk of r u p t u r e o f t h e w o m b t h a n d u r i n g n o r m a l c h i l d b i r t h. Other immediate medical risks may include the following, which are d i s c u s s e d o n p a g e s 1 9 : p e l v i c i n f e c t i o n, i n c o m p l e t e a b o r t i o n, b l o o d c l o t s i n t h e u t e r u s, h e a v y b l e e d i n g, c u t o r t o r n c e r v i x, p e r f o r a t i o n o f the wall of the uterus, anesthesia-related complications. Caesarean Section T h i s m e t h o d r e q u i r e s t h a t t h e w o m a n b e a d m i t t e d i n t o a h o s p i t a l. A c a e s a r e a n s e c t i o n m a y b e p e r f o r m e d i f l a b o r c a n n o t b e s t a r t e d b y i n d u c i n g l a b o r, o r i f t h e w o m a n o r h e r f e t u s i s t o o s i c k t o u n d e r g o labor.

17 A c a e s a r e a n s e c t i o n i s r e m o v a l o f t h e b a b y b y s u r g i c a l l y c u t t i n g o p e n t h e b e l l y a n d w o m b. T h e w o m a n i s m a d e n u m b b y m e d i c a t i o n, e i t h e r i n j e c t e d i n t o t h e v e i n o r s p i n e o r i n h a l e d i n t o t h e l u n g s. Medical Risks Complications are similar to those seen with childbirth caesarean sections and with administration of anesthesia, such as severe i n f e c t i o n ( s e p s i s ) ; b l o o d c l o t s t o t h e h e a r t a n d b r a i n ( e m b o l i ) ; s t o m a c h c o n t e n t s b r e a t h e d i n t o t h e l u n g s ( a s p i r a t i o n p n e u m o n i a ) ; s e v e r e b l e e d i n g ( h e m o r r h a g e ) ; a n d i n j u r y t o t h e u r i n a r y t r a c t. Other possible immediate risks include: pelvic infection, incomplete a b o r t i o n, b l o o d c l o t s i n t h e u t e r u s, h e a v y b l e e d i n g, c u t o r t o r n c e r v i x, p e r f o r a t i o n o f t h e w a l l o f t h e u t e r u s, a n e s t h e s i a - r e l a t e d c o m p l i c a t i o n s. P o s s i b l e l o n g - t e r m m e d i c a l r i s k s a r e d i s c u s s e d o n p a g e 2 0. WHAT IF THE FETUS IS ABLE TO LIVE OUTSIDE THE WOMB? The chance of the fetus living outside the uterus (viability) increases a s t h e g e s t a t i o n a l a g e i n c r e a s e s. T h e d o c t o r m u s t t e l l y o u t h e p r o b a b l e g e s t a t i o n a l a g e o f t h e f e t u s a t t h e t i m e t h e a b o r t i o n w o u l d b e performed. I f t h e f e t u s i s v i a b l e o r h a s r e a c h e d t h e g e s t a t i o n a l a g e o f 2 4 w e e k s, a n a b o r t i o n m a y o n l y b e d o n e i f y o u r d o c t o r r e a s o n a b l y b e l i e v e s t h a t i t i s n e c e s s a r y t o p r e v e n t y o u r d e a t h o r t o p r e s e r v e y o u r h e a l t h. I f s u c h a n a b o r t i o n i s t o b e p e r f o r m e d, y o u h a v e t h e r i g h t t o a s k t h e d o c t o r t o u s e t h e m e t h o d t h a t i s m o s t l i k e l y t o p r e s e r v e t h e l i f e o f t h e u n b o r n c h i l d. If the baby is removed alive, the attending physicians have the legal obligation to take all reasonable steps necessary to maintain the life a n d h e a l t h o f t h e c h i l d. I f a n a b o r t i o n i s p e r f o r m e d a f t e r t h e d o c t o r h a s d e t e r m i n e d t h a t t h e fetus is viable, the following steps must be taken: 1. The physician who terminates the pregnancy must certify the medical reasons making performance of the abortion necessary and the probable health consequences if the abortion is not performed; 1 5

18 2. The physician must select a procedure that is most likely to allow the unborn c h i l d t o l i v e ; a n d 3. A second physician must be in attendance to provide immediate medical care t o t h e c h i l d b o r n a r e s u l t o f t h e p r e g n a n c y t e r m i n a t i o n. Medical Emergencies T h e p h y s i c i a n i s n o t r e q u i r e d t o u s e t h e a b o r t i o n m e t h o d t h a t w o u l d p r o v i d e t h e best opportunity for the baby to live if that physician determines in his or her medical judgment that use of that method poses a significantly greater risk to the woman s life or permanent damage to any of the woman s major bodily functions. In the case of a medical emergency, a physician also is not required to comply w i t h a n y c o n d i t i o n l i s t e d a b o v e w h i c h, i n t h e p h y s i c i a n s m e d i c a l j u d g m e n t, h e o r she is prevented from satisfying because of the medical emergency. MEDICAL RISKS OF ABORTION Immediate Medical Risks First trimester abortion is considered minor surgery. The risk of complications for the woman increases with advancing gestational age. (See the previous pages for a description of the abortion procedure that your doctor will be using and the specific risks listed in those pages.) The following is a description of the risks cited in those pages: Pelvic Infection: Bacteria (germs) from the vagina or cervix may enter the uterus and cause an infection. Antibiotics may clear up such an infection. In rare cases, a repeat suction, hospitalization or surgery may be needed. Infection rates are less than 1% for suction curettage, 1.5% for D&E, and 5% for labor induction. Incomplete abortion: F e t a l p a r t s o r o t h e r p r o d u c t s o f p r e g n a n c y m a y n o t b e completely emptied from the uterus, requiring further medical procedures. Incomplete abortion may result in infection and bleeding. The reported rate of such complications is less than 1% after a D&E; whereas, following a labor induction procedure, the rate may be as high as 36%. Blood clots in the uterus: Blood clots that cause severe cramping occur in about 1% of all abortions. The clots usually are removed by a repeat suction curettage. Heavy bleeding: S o m e a m o u n t o f b l e e d i n g i s c o m m o n f o l l o w i n g a n a b o r t i o n. Heavy bleeding (hemorrhaging) is not common and may be treated by repeat suction, medication or, rarely, surgery. Ask the doctor to explain heavy bleeding a n d w h a t t o d o i f i t o c c u r s. Cut or torn cervix: T h e o p e n i n g o f t h e u t e r u s m a y b e t o r n w h i l e i t i s b e i n g s t r e t c h e d o p e n t o a l l o w m e d i c a l i n s t r u m e n t s t o p a s s t h r o u g h a n d i n t o t h e u t e r u s. This happens in less than 1% of first trimester abortions.

19 Perforation of the uterus wall: A medical instrument may go through the wall of t h e u t e r u s. T h e r e p o r t e d r a t e i s 1 o u t o f e v e r y a b o r t i o n s. D e p e n d i n g o n t h e severity, perforation can lead to infection, heavy bleeding or both. Surgery may be required to repair the uterine tissue, and in the most severe cases hysterectomy may be required. Anesthesia-related complications: As with other surgical procedures, anesthesia increases the risk of complications associated with abortion. The reported risks of a n e s t h e s i a - r e l a t e d c o m p l i c a t i o n s i s a r o u n d 1 p e r 5, a b o r t i o n s. Rh Immune Globulin Therapy: Genetic material found on the surface of red blood cells is known as the Rh Factor. If a woman and her fetus have different Rh factors, she must receive medication to prevent the development of antibodies that would endanger future pregnancies. LONG-TERM MEDICAL RISKS Future childbearing: E a r l y a b o r t i o n s t h a t a r e n o t c o m p l i c a t e d b y i n f e c t i o n d o n o t cause infertility or make it more difficult to carry a later pregnancy to term. Complications associated with an abortion or having many abortions may make it difficult to have children. EMOTIONAL REACTIONS Because every person is different, one woman s emotional reaction to an abortion may be different from another s. After an abortion, a woman may have both positive and negative feelings, even at the same time. One woman may feel relief, both that t h e p r o c e d u r e i s o v e r a n d t h a t s h e i s n o l o n g e r p r e g n a n t. Another woman may feel sad that she was in a position where all of her choices were hard ones. She may feel sad about ending the pregnancy. For a while after the abortion she also may feel a sense of emptiness or guilt, wondering whether or not her decision was right. Some women who describe these feelings find they go away with time. Others find them more difficult to overcome. Certain factors can increase the chance that a woman may have a difficult adjustm e n t t o a n a b o r t i o n. O n e o f t h e s e i s n o t h a v i n g a n y c o u n s e l i n g b e f o r e c o n s e n t i n g t o an abortion. When help and support from family and friends are not available, a woman s adjustment to the decision may be more of a problem. 1 7

20 Other reasons why a woman s long-term response to an abortion can be poor may be related to past events in her life. For example, negative feelings could last longer if she has not had much practice making major life decisions or already has s e r i o u s e m o t i o n a l p r o b l e m s. Talking with a professional and objective counselor can help a woman to cons i d e r h e r d e c i s i o n f u l l y b e f o r e s h e t a k e s a n y a c t i o n. MEDICAL RISKS OF CHILDBIRTH C o n t i n u i n g a p r e g n a n c y a n d d e l i v e r i n g a b a b y i s u s u a l l y a s a f e, h e a l t h y p r o c e s s. Based on data from the CDC, the risk of dying as a direct result of pregnancy and c h i l d b i r t h i s l e s s t h a n 1 0 i n 1 0 0, l i v e b i r t h s. T h e r i s k i s h i g h e r f o r A f r i c a n - Americans (22 in 100,000). The most common cause of death of pregnant women are: E m b o l i ( b l o o d c l o t s a f f e c t i n g t h e h e a r t a n d b r a i n ), E c l a m p s i a ( h i g h b l o o d p r e s s u r e c o m p l i c a t i o n s a f f e c t i n g p r e g n a n c y ), Hemorrhage (severe bleeding), Sepsis (severe infection), Cerebral vascular accidents (stroke, bleeding in the brain), and Anesthesia-related deaths. Altogether, these causes account for 80% of all deaths relating to a woman s pregnancy. Unknown or uncommon causes account for the remaining 20% of deaths relating to pregnancy. Women who have chronic severe diseases are at greater risk of d e a t h t h a n a r e h e a l t h y w o m e n. C o n t i n u i n g y o u r p r e g n a n c y a l s o i n c l u d e s a r i s k o f e x p e r i e n c i n g c o m p l i c a t i o n s that are not always life-threatening. A p p r o x i m a t e l y 1 5 t o 2 0 o r e v e r y p r e g n a n t w o m e n r e q u i r e Caesarean delivery. O n e i n 1 0 w o m e n m a y d e v e l o p i n f e c t i o n d u r i n g o r a f t e r d e l i v e r y. A b o u t 1 i n 2 0 p r e g n a n t w o m e n h a s b l o o d p r e s s u r e p r o b l e m s. One in 20 women suffer from excessive blood loss at delivery.

21 PREGNANCY, CHILDBIRTH, AND NEWBORN CARE You may or may not qualify for financial help for prenatal (pregnancy), childbirth and neonatal (newborn) care, depending on your income. If you qualify, programs such as the state s medical assistance program, called Medicaid, will pay or help pay the cost of doctor, clinic, hospital and other related medical expenses to help you with prenatal care, childbirth delivery services and care for your newborn baby. Brochures explaining Louisiana s Maternal and Child Health Program are available. Call for information about eligibility. WHAT ABOUT ADOPTION? W o m e n o r c o u p l e s f a c i n g a n u n t i m e l y p r e g n a n c y w h o c h o o s e n o t t o t a k e o n t h e f u l l r e s p o n s i b i l i t i e s o f p a r e n t h o o d h a v e a n o t h e r o p t i o n : a d o p t i o n. P l a c i n g a c h i l d f o r a d o p t i o n i s r a r e l y a n e a s y d e c i s i o n. C o u n s e l i n g a n d s u p p o r t services are a key part of adoption and are available from a variety of adoption agencies and parent support groups across the state. The services directory that a c c o m p a n i e s t h i s b o o k l e t i n c l u d e s a l i s t o f a d o p t i o n a g e n c i e s s o m e o f w h i c h m a y b e a g e n c i e s i n y o u r p a r i s h. There are many ways to adopt, including through a public or private agency or through a private attorney. One type of adoption, known as an open adoption, perm i t s t h e w o m a n t o c h o o s e t h e a d o p t i v e p a r e n t s. F u l l y a n o n y m o u s a d o p t i o n i s a l s o available. To find out more, please call the Louisiana Department of Health and Hospitals hotline number: THE FATHER S DUTY The father of a child has a legal responsibility to provide for the support, educat i o n a l, m e d i c a l a n d o t h e r n e e d s o f t h a t c h i l d. T h a t d u t y c a n i n c l u d e c h i l d s u p p o r t payments to the child s mother. A child has rights of inheritance from his or her father and may be eligible through him for benefits such as life insurance, Social Security, pension, veteran s or disability benefits. Further, the child will be aware of his or her medical history. Paternity can be established in either of two ways: 1. the father can acknowledge the child by signing the birth certificate and a written declaration before a notary public and two witnesses; or 2. a n a c t i o n c a n b e b r o u g h t i n c o u r t. M o r e i n f o r m a t i o n c o n c e r n i n g p a t e r n i t y e s t a b l i s h m e n t a n d c h i l d s u p p o r t m a y b e obtained from the regional office of the State Department of Social Services, Office 1 9

22 of Family Support, Division of Support Services, that serves your parish. Other information may be obtained from your parish district attorney s office. Telephone numbers for both offices may be found in the accompanying director. INFORMATION DIRECTORY T h e d e c i s i o n t o h a v e a n a b o r t i o n, h a v e a b a b y o r m a k e a n a d o p t i o n p l a n, m u s t b e carefully considered. Listed in the accompanying directory area appropriate state and parish social agencies and organizations. You are encourage to contact them if you need more information so you can make an informed decision. Individuals may call the Louisiana Department of Health and Hospitals toll free at to receive the pamphlet, ABORTION: Making A Decision and the directory of agencies which provide abortion alternative services. Services p r o v i d e r s ( e. g. p h y s i c i a n s, h o s p i t a l s, a b o r t i o n c l i n i c s ) m a y o b t a i n c o p i e s o f t h e pamphlet, directory, and certification form via mail or facsimile to: LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS OFFICE OF PUBLIC HEALTH 325 Loyola Avenue, Room 610 New Orleans, LA (504) Fax (504) T h i s e l e c t r o n i c d o c u m e n t w a s p r o d u c e d i n - h o u s e. T h i s d o c u m e n t w a s p r o d u c e d b y t h e L o u i s i a n a Department of Health and Hospitals, Media & Communications, P.O. Box 3234, Baton Rouge, Louisiana It was printed in accordance with standards for printing by State A g e n c i e s e s t a b l i s h e d p u r s u a n t t o R. S. 4 3 : 3 1.