The Doctor Is In: Understanding Abortions

Q: I have been thinking a lot about abortion lately. Not because I’m about to have one, but because I wonder what I’ll decide if the situation ever presents itself. Is it true that abortions can make it harder to get pregnant down the road? Can you explain any other risks in getting one?

A: You are so not alone in having concerns about abortion, honey. Obviously, it’s always better when you can plan a pregnancy, make sure your body is in optimal condition, choose the perfect partner, and time it brilliantly so that pregnancy and parenting fits into your life. But alas, life doesn’t always work this way. You’re smart to be asking the right questions.

First, let me say that I’m delighted you’re asking before you find yourself with an unwanted pregnancy. For those of you who are being careful and taking birth control precautions to protect you against unplanned pregnancy, please don’t forget the morning after pill. You can get Plan B over the counter in some states or by prescription anywhere, and it’s pretty effective for those broken condoms, skipped pills, or sexual encounters that just happen when a passionate moment you weren’t expecting strikes.  So don’t forget Plan B. The sooner you use it, the better, but it’s effective up to 72 hours after the “accident.”  Not a bad idea to keep Plan B on hand in your bathroom- just in case.

Assuming birth control efforts fail, and you find yourself faced with the choice of an abortion, there are some important things to know. First off- not to get all political on you- but as an OB/GYN, founder of www.owningpink.com (a gutsy guide to getting your mojo back) and an avid supporter of women’s rights, I have to say this. Remember, you have the right to choose. It is your body, your life, your pregnancy. ‘Nuff said.  

If you choose to abort a pregnancy and decide early enough, you’ll have a choice between surgical abortion and medical abortion.  What can you expect from a surgical abortion? The procedure, when done in the first trimester, is the exact same procedure we do when someone miscarries but the baby doesn’t pass. Basically, the doctor dilates open the cervix with blunt-tipped dilators, inserts a suction catheter that’s attached to a sucking machine, and vacuums out the uterus.  The whole thing takes about 5 minutes at the most, if all goes smoothly.  Not that it isn’t totally traumatic emotionally (and for most women and even the doctors performing these procedures, it is).  But the procedure itself isn’t that big a deal.

What are the risks? The biggest risk is perforation of the uterus. Because the procedure is blind (we can’t see inside the uterus), the doctor is poking sharp objects somewhere she can’t see. So there’s always a risk that the sharp object could poke through the uterus and possibly damage something on the other side, like the bladder or the bowel (not good, but very rare).  There’s also a risk of bleeding, infection, and missing the pregnancy, which can require a second surgery.

What about medical abortion? For this procedure, medications like mifepristone (RU-486) and misoprostol are given to help you pass the baby on your own. Usually, you go in for the medication, then follow up a few days later to make sure it passed. If it didn’t, another dose of medication may be given, or your doctor may choose to proceed with surgical abortion. What are the risks?  The biggest risks are hemorrhage, infection, and retained products of conception, requiring surgery to remove what doesn’t come out.  The upside is that no sharp objects are poked blindly in dark places, so there’s no risk of perforation of the uterus, and the cervix doesn’t have to be manually dilated, which can put you at risk of complications down the road.

So what about that? Does having an abortion affect getting pregnant later? Almost never. Uncomplicated abortions rarely affect future fertility or pregnancy. But if you suffer a complication or undergo multiple surgical abortions, you may have a small risk of trouble down the road.  The biggest concern when your cervix is manipulated surgically is something called “incompetent cervix,” which means the cervix can be weakened, leading to pregnancy loss, usually in the second trimester. Multiple surgeries on the cervix can also predispose you to preterm labor and delivering a preemie. The other risk is scarring of the uterus (Asherman’s syndrome) and scarring of the cervix (cervical stenosis), which can lead to infertility or pregnancy loss.  Medical abortion has fewer of these long-term risks.

So yes, you have reason to be concerned about the effects of abortion. But these effects are very rare. Nevertheless, abortion should never be used as birth control. There are much better ways to protect yourself.  And the risks are something to keep in mind when you find yourself with an unplanned pregnancy and you’re making your choice.

So please, take care of yourself. Protect yourself with birth control. Have Plan B in the bathroom, just in case. But if you find yourself choosing to have an abortion, find a skilled, compassionate doctor, forgive yourself, surrender to the choice, release your fear, and let go.

[Dr. Lissa Rankin is an OB/GYN and founder of Owning Pink. If you have something you'd like to ask, send it over and we'll pass it along. No question is too big or too small, so ask away!]