Abortion Care

Special Information for Women Under 18 Years Old
If a patient is under 18, she must attend the information session with one of her parents (or her legal guardian, if applicable), who will then need to return on the patient’s procedure day to give consent and complete paperwork. For women who cannot involve a parent, or choose not to, the law allows for a judicial bypass. This means that a judge may decide that the patient is mature enough to complete the process herself, without parental consent. Philadelphia Women’s Center phone counselors are trained to help patients through this process, and can explain the necessary steps that will need to be taken if a minor decides that judicial bypass is her best option. There are no additional fees involved for women who choose to obtain a bypass.

Non-surgical Abortion Care
Non-surgical abortion is commonly called or known as “abortion by pill.” It is also referred to as medical abortion. It is a non-invasive procedure for terminating a pregnancy. The name of the abortion pill is Mifeprex, and it has also been called mifepristone and RU-486.

Mifeprex has been available as a legal, early abortion method in the United States since September 2000, although several other countries around the world made mifepristone and RU-486 a legal, early abortion method a decade or two earlier. The FDA has approved one regimen for administration, though studies have shown that various regimens for administering the medications can work effectively and safely. Therefore, some doctor’s offices and clinics may use the FDA approved method, while others may use an alternative method, though they should all have similar success rates. At Philadelphia Women’s Center, we use an alternative method that has been shown to be highly effective. Our counselors and medical staff meet with each patient to explain the entire process.

The non-surgical abortion is known as an early abortion method because the FDA has approved Mifeprex for use up to 7 weeks last menstrual period (LMP), and depending on the facility’s protocols, may be offered to patients until 9 weeks LMP. At Philadelphia Women’s Center, we offer medical abortion to women who are between 5 and 7 weeks by ultrasound. Patients who are between 7 and 8 weeks may be eligible for the pill, and will be evaluated on a case-by-case basis by the physician.

Mifeprex is used with another medication called misoprostol (also called cytotec) to cause a process similar to miscarriage. There are three steps to non-surgical abortion, and the time it takes to complete the abortion varies. The non-surgical abortion usually requires at least 2 visits to the healthcare facility.

• Step 1:

The first step of the non-surgical abortion regimen is to take the Mifeprex pill orally at the healthcare facility. This will stop production of the hormones necessary to sustain the pregnancy, and will cause the pregnancy to detach from the uterus.

• Step 2:

The second step is to take the misoprostol, either orally or inserted vaginally, 6 to 72 hours after taking the first medication. Philadelphia Women’s Center instructs patients to insert 4 misoprostol tablets into the vagina 24-48 hours after taking the Mifeprex. These pills will then dissolve inside the vagina, which will cause the uterus to contract and the patient to bleed, in order to expel all the pregnancy tissue from the uterus. Many women will pass the pregnancy within about 4 hours of inserting these pills. However, bleeding will generally last anywhere from several days to 4 weeks. The bleeding will usually be heavier than a normal period.

• Step 3:

The third step is to return to the facility two weeks after taking the Mifeprex pill. During this visit, the facility staff will run some tests to ensure all the pregnancy tissue has been removed, and that there are no current complications. At Philadelphia Women’s Center this generally involves an ultrasound scan, as well as a screening for anemia.

In the event that all pregnancy tissue is not expelled at the time of the follow-up visit, the healthcare provider may give the patient more misoprostol to try to remove the remaining tissue or perform a surgical abortion. This will depend on the circumstances of the case, as well as the recommendation of the physician and the patient’s preference. Official statistics show that about 5-8 out of 100 women will need a surgical procedure to end the pregnancy. However, many physicians have found in practice that these numbers are much lower, and that only one or two women out of 100 would be likely to need surgery.

Surgical Abortion Care

• First Trimester Abortion (up through 11 weeks 6 days LMP)

A first trimester surgical abortion, which is measured approximately up to 12 weeks from the first day of the last menstrual period (LMP), is completed by a procedure known as dilatation and evacuation.The procedure alone will take approximately 5 minutes, although the visit to our office will take several hours.

The procedure will begin with the physician performing a pelvic exam to determine the size and location of the pregnancy in the uterus. After this exam, anesthesia medication may be given through an IV. This will sedate the patient for the length of the surgery, so that she does not hear or feel anything. It is generally the patient’s decision if she would like sedation or not. Patients who choose not to receive sedation will be given a local anesthetic to numb the cervix, which will make the procedure more comfortable. More information on anesthesia is given below.

After the pelvic exam, the doctor will insert a speculum into the vagina so that he/she can view the cervix. The cervix is the lower end of the uterus, and is located at the top of the vaginal canal. He/she will clean the vaginal canal with an antiseptic. Next, he/she will dilate, or open, the cervix by inserting a series of sterile metal rods, one by one, into the opening of the cervix. These rods, called dilators, gradually increase in width. Dilation for a first trimester abortion is minimal. Once the cervix is opened, the physician will be able to remove the pregnancy from the uterus. The doctor will insert a sterile, plastic, flexible tube called a cannula into the uterus. The cannula is attached by a tube to a machine called a vacuum aspirator, which creates a suction that removes the pregnancy. Once these steps are complete, the surgeon will clean the inside of the uterus with an instrument called a curette to ensure that all pregnancy tissue has been removed. He/she will then remove the speculum. The whole process generally takes about 5 minutes. After surgery, the patient will be monitored in the Recovery Room by the Nursing Team for approximately 45 minutes, or until she is medically cleared to return home.

• Second Trimester Abortion (up through 21 weeks 6 days LMP)

At Philadelphia Women’s Center, a second trimester abortion takes place from about 12 weeks from the first day of the last menstrual period (LMP) through 22 weeks LMP. A second trimester surgical abortion is performed in the same manner as a first trimester abortion; however, after about 14 weeks, the patient’s cervix must be dilated, or opened, prior to her surgery. The length of this dilation depends on the physician’s protocols, as well as the patient’s medical history, pregnancy history, and other factors. In general, patients who are 14 to 18 weeks pregnant at the Philadelphia Women’s Center will need to dilate for 1 to 6 hours before surgery is done. Patients approximately 18 weeks and over will require an overnight dilation, as well as possible continued dilation on the morning of the second day, before surgery is done. Patients do not stay in the facility overnight, and are given specific, strict guidelines and instructions for their home care between day one and day two.

The cervix is dilated through the administration of a medication called misoprostol (cytotec) and/or laminaria/lamicel insertion. The misoprotol is either taken as a pill orally or inserted into the vagina. Laminaria or lamicel must be inserted by the physician into the patient’s cervix. Laminaria are made of sterilized seaweed and look like tiny tampons. Lamicel are similar, but made of a synthetic material. The laminaria/lamicel act like a sponge by absorbing the moisture in the patient’s vagina and expanding. As the laminaria or lamicel expands, the cervix is slowly dilated. Depending on the gestational age of the pregnancy and the patient’s medical history, the physician will decide on the best method of dilation with misoprostol (cytotec) and/or laminaria or lamicel. The physician will perform the surgical abortion after dilation is complete in a manner similar to, but more extensive than, the method described for first trimester abortion.

Types of Anesthesia for Surgical Procedures
Both first and second trimester surgical abortions can be performed with various types of anesthesia – local anesthesia, conscious sedation, or deep sedation. These methods can help to control pain and discomfort during the procedure, and each will have benefits and drawbacks. The doctor and facility staff will aid each patient in determining which method is best for her. Philadelphia Women’s Center routinely offers local anesthesia or deep sedation to our patients. Women who are not ideal candidates for deep sedation (women over 250 pounds, or women with certain medical conditions, for example) may be evaluated on a case-by-case basis for conscious sedation. However, this form of anesthesia is not routinely available to most patients.

If the procedure is performed under local anesthesia, the patient will be awake and conscious as normal during the procedure. Patients will be able to see and hear as usual during the procedure, and will be able to remember everything that happened during the surgery after it is over. While local anesthetics can be administered differently, generally speaking the physician will inject the anesthetic into the patient’s cervix. This will lessen the pain, but the patient will still experience cramping and discomfort during the procedure. Sometimes medications, such as ibuprofen, are also offered both before and after the surgery to ease pain. Breathing exercises may also be used in conjunction with local anesthetic to minimize discomfort. Local anesthesia allows women to remain alert during the process, which may be more empowering for some individuals. In addition, this method allows women to avoid some of the side effects and risks often associated with sedation methods of twilight anesthesia and general anesthesia explained below.

Anesthesia will be administered by a certified registered nurse anesthetist, or CRNA. This anesthesia may contain a combination of medications, usually given through an intravenous (IV) needle inserted into the hand or arm. The anesthesia will relax and partially sedate the patient. She will have no memory of the procedure, but may appear conscious or partially asleep, and will usually be able to respond to simple requests. The patient will remain in this state for a couple of minutes up to a few hours depending on how much medication is administered. Many patients will be completely sedated, and will not see, hear or feel any part of the surgery and will not remember anything about the surgery afterwards.  As a typical abortion procedure usually lasts from 3 to 20 minutes, the patient will only be sedated for this time. However, anesthesia often causes grogginess, so many patients will sleep off and on for the rest of the day.

Sedation is optimal for women who wish to decrease pain, though it may not be appropriate for obese women or women with certain medical conditions. Sedation may also cause side effects such as nausea, dizziness, and feeling cold. The anesthesia also takes longer time to wear off entirely and the patient will feel drowsy for several hours or a full day. This means the patient will be required to have a friend or family member escort her home after surgery. Patients who are 16 weeks or more into the pregnancy will be required to undergo anesthesia, and must meet certain guidelines for sedation.

Follow-Up
Philadelphia Women’s Center believes that it is important for patients to have medical care available after an abortion procedure, and provides a 24-hour hotline for patients experiencing medical difficulties. Patients are also scheduled for a routine follow-up exam, usually 2-3 weeks after the procedure. There is no additional charge for this check up, or for any follow-up care at Philadelphia Women’s Center. The follow up time allows patients an opportunity to bring any problems to the practitioner’s attention, to discuss birth control, and to obtain a referral for ongoing healthcare. Testing for sexually transmitted infections can also be performed free of charge during the abortion procedure, and results are usually available at the follow-up appointment.

Scheduling an Abortion
Philadelphia Women’s Center generally sees patients for abortion services on Tuesdays, Thursdays, Fridays, and Saturdays. The choice between local anesthesia and sedation is usually available on every procedure day. However, our phone counselors will advise patients of the exact schedule each week. Phone counselors are available Monday through Saturday to answer all of your questions and to schedule an appointment.

When a patient calls to make an appointment, she will be asked for some information. Below are some of the usual questions a patient will be asked

• Name
• Age
• Date of birth
• Phone number (this is required, though the office generally does not need to contact patients, and we will NOT identify ourselves if you do not want us to).
• Approximate height and weight
• First day of last menstrual period
• Medical history questions – any illnesses, allergies, current medications, etc.
• Pregnancy history
• Insurance information (if any)

Some of these questions may seem very personal, or not necessary. However, our phone counselors require a range of information in order to create a full picture of each patient’s medical history, and any special needs she may have. Philadelphia Women’s Center strives to make every patient’s experience as personalized, smooth and streamlined as possible, and will make every effort to identify any potential problems prior to the patient’s arrival at the office. In order to achieve this goal, it is important for a patient to be as honest and complete as possible when discussing her medical history and other information. Remember, all information is kept confidential, and is used to ensure the safest care possible.

After taking down this information, the phone counselor will schedule the patient for at least two appointments. The first is for a state-required information session, lasting about 45 minutes, where you will receive written and verbal instructions. The second is for the abortion procedure itself. As mentioned above, this appointment may actually be scheduled over the course of two consecutive days (Thursday and Friday, or Friday and Saturday), depending on the length of pregnancy. In general, Tuesday appointments are reserved for patients under 16 weeks by ultrasound. Patients up to 21.6 weeks may be seen on Thursdays and Fridays. Patients scheduled on Saturdays must be less than 18 weeks and 4 days.

For more information on abortion care at Philadelphia Women’s Center, or to schedule an appointment, please call the office at 215.574.3590 or 800.869.2330.  For more information on abortion care, you can also visit AbortionUSA.com.