We did a Q&A with a local OBGYN. Here’s what they had to say about abortion:
Q: Will getting an abortion affect future fertility?
A: No.
Any time you get pregnant, there is a small risk of complications from pregnancy that could lead to major health issues or infertility in the future. However, you are more likely to suffer complications that affect your future fertility if you carry a pregnancy to term and give birth than if you have an abortion at any stage of pregnancy.
Q: If I take an abortion pill, will I need to take off from work? What about a surgical option?
A: Most people prefer to take a short time off from work with any type of abortion, but you don't specifically have to. With the abortion pill, you will experience heavy cramping and bleeding within 1-2 days of taking the medication. It may be uncomfortable to experience these symptoms while working, so some people choose to take the pills when they are able to take a day or two off and be in the comfort of their own home or another supportive setting. It is safe to return to work as soon as you feel comfortable to do so, usually the day after the heaviest bleeding.
If you have a surgical abortion, you will need to take off the day of your procedure. Usually this is a whole day; however, depending on when your procedure is scheduled and what medications you are given (especially pain medications or anesthesia), you may be able to work part of the day. It is safe to return to work the day after a surgical abortion, although some people prefer to have a day or two to rest without the physical and emotional stress of work.
Q: Can abortions increase cancer risk?
A: No.
Carrying a pregnancy to term and breastfeeding does decrease your breast cancer risk. However, having an abortion does not increase your risk; it leaves you with the exact same risk for breast cancer in your life as if you had never been pregnant.
Q: Does it hurt? What does the process feel like?
A: Yes, most people do experience some pain with abortion.
A medical abortion is physically similar to a miscarriage. After you take the pills for a medication abortion, you will experience heavy cramping and bleeding. Depending on many factors, including your medical history and how advanced the pregnancy was, these cramps can vary from moderate "period-like" cramps to more intense pain. Scheduled extra-strength ibuprofen can significantly decrease the discomfort you feel from cramping. Depending on your situation, your doctor might recommend or prescribe additional medications for pain. Other comfort measures that can help with pain can include heat from a heating pad or warm bath, distraction from support people or a favorite book/movie/show, and relaxation exercises. The most intense cramping lasts a few hours, although many people have mild cramping for an additional few days.
With a surgical abortion, the pain is mostly limited to the procedure itself. You will likely take some medication before the procedure, often extra-strength ibuprofen, sometimes additional medication for pain or anxiety. During the procedure itself, most providers place a nerve block which is an injection of numbing medication around the cervix. Because of how sensation works around the cervix, this usually doesn't feel like a sharp injection but more like a few strong cramps. Once the nerve block is placed, it dulls the discomfort from opening the cervix. Again depending on your history and the specifics of your pregnancy, the amount of pain varies from very little after the oral and injected pain meds, to more intense cramping. The abortion procedure itself is very quick, usually 5-10 minutes. For most people, the pain improves as soon as the procedure ends, although many people have mild cramping for an additional few days.
Q: If I have a surgical abortion, what should I expect in the conversation with my doctor, procedure, and recovery?
A: Prior to your appointment, you may be given some information by phone about consent for abortion. In North Carolina, the state requires that you have this information 72 hours before your procedure. Some clinics do this with two visits, 72 hours apart; some clinics are able to do counseling by phone, video, or at another site.
When you come for your appointment, your doctor or their office staff will review your medical history, including information about your current pregnancy and any past pregnancies. They may ask you about your plans for contraception, as some types of birth control can be placed or started at the time of an abortion if you wish. Your doctor will perform an ultrasound to look at your uterus and at the pregnancy in order to plan how to safely perform your abortion. Early pregnancies are not always seen well on an external ultrasound, with the probe or "camera" on your skin looking through your abdomen, and so they may recommend a vaginal ultrasound where a thin probe is inserted into the vagina to get a close-up view of the uterus. In North Carolina, your doctor is required by law to offer for you to see the images and hear the fetal heartbeat if it is detectable, but you are not required to look or listen. Your doctor will talk with you about the surgical procedure and answer any questions you may have.
When it comes time for your procedure, you will be in a procedure room, and lay down with your feet in footrests. You make take or be given different types of pain medication prior to starting, depending on your situation. Your doctor will place a speculum in the vagina in order to see the cervix, the same as if setting up for a pap smear. They will clean the cervix to prevent infection, and place injections of numbing medication around the cervix which can feel like 2-3 strong cramps. Then they will use surgical tools called dilators to gently stretch the cervix open, until they can place a tube that is connected to suction into the uterus to remove the pregnancy tissue. Once the procedure is completed, all the tools will be removed and you'll be assisted to a regular lying-down position. The whole procedure typically takes less than 10 minutes.
You may stay in the clinic for a short period of time (an hour or so) for monitoring, although sometimes it is safe to leave right away. When you are ready, you will need a trusted driver to take you home. Light bleeding and mild cramping are normal after an abortion; the cramping usually lasts for a few days, light bleeding can last for 1-2 weeks. It will be safe to resume normal activity including work and exercise as tolerated, but you will be instructed not to have anything in the vagina (no tampons, no swimming, no sex) for at least 2 weeks while you are healing internally. Your doctor's office will give you instructions about after care and who to contact with any concerns.
If there are no complications during your procedure, it is often not necessary to have a follow up appointment. However, you can schedule a follow up with your abortion provider or your regular doctor if needed at any time.
Q: If I want an abortion, what questions should I ask my doctor?
A: Due to complex legal restrictions, many doctors end up either doing only abortion care, or not doing abortion care at all. Therefore, it is possible that the first provider you talk with about your pregnancy will not be the doctor performing your abortion.
If you are talking to your family doctor, general OBGYN, midwife, or other provider, it can be helpful to let them know how you are feeling about the pregnancy and what your desires are. You may want to get more information about the pregnancy, especially confirmation of your gestational age or "how far along" you are. You can ask whether there are any issues in this pregnancy or in your medical history that could affect your abortion care, so you should remember to discuss them with your abortion provider (common issues may be medications you're on that affect pain or bleeding, history of bleeding disorders, abnormalities of the uterus like fibroids or uterine shape). It is ok to ask if they have an abortion provider or clinic that they recommend, although it is not unusual or a "bad sign" if they do not (there is limited communication between abortion clinics and other medical offices for legal and political reasons, not medical reasons). Ask about options for follow up if you need support from your regular doctor's office after your abortion.
When you speak with your abortion provider, the conversation will be more specific to abortion. You may speak with a nurse who can answer some of your questions before you meet with your doctor. You can ask or they may offer information about the different types of abortion available (medication vs surgery) including risks, benefits, and what to expect. Be specific if you have any factors in your personal or medical history that could affect your care (medications, medical conditions, prior surgeries, but also anxiety, depression, trauma, or other factors). This information enables your doctor and their staff to make more personalized recommendations and take better care of you.
If you have any concerns that weigh on you, ask directly. If you're worried about pain, ask about the pain management options available and when they are typically used or not used (some medications are much more expensive for you or have a lot of side effects while making only a small difference in pain, for example, depending on the situation). If you're concerned about feeling exposed, ask who will be in the room for your procedure and what their roles are. If you can't stop thinking about someone else's experience with abortion, good or bad, ask about it - "would playing music during the abortion be an option to help me feel more comfortable?" or "do we need to worry about it taking longer than average in my case?"
Once you feel comfortable with your abortion plan, ask about recommended follow up appointments and how they can be completed. For example, it is recommended to have a follow up appointment after a medication abortion to confirm that all of the pregnancy tissue came out, but you may be able to follow up with your regular doctor instead of your abortion doctor if travel or logistics are an issue. Finally, you can ask or they may offer information about symptoms to look out for after your abortion that could be a sign of complications.