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» Scarleteen Boards: 2000 - 2014 (Archive) » SCARLETEEN CENTRAL » Sex Basics and Sexual Health » Medical abortion vs. surgical abortion?

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Author Topic: Medical abortion vs. surgical abortion?
libertatissacra
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So, I had a pregnancy scare a few days ago. No worries now - I got my period, and it's a normal period and I'm assured that I'm not pregnant (it was just that I didn't start it until the third day of my Yaz white pills when I normally start it on the first or second day, so I had about two days of being a little freaked out, and then actually noticed that it started when I went to the bathroom right before going out the door to pick up a pregnancy test. Good timing!), but it was my first scare, and really got me thinking more seriously about what I would do if and when I actually do have an unwanted pregnancy.

My boyfriend and I have both agreed that if I were to get pregnant, I would have an abortion. Neither of us want kids any time soon (I'm 18 and he's 21 and we're both barely making ends meet), and I probably never want to have my own children. I'm terrified of being pregnant and giving birth, so abortion is what we both feel the best option for us would be. I've been putting away what money I can spare each month for an "abortion fund" just to be prepared and have saved up about $600 thus far. If I needed a little bit more, I could count on my parents to chip in. So, my mind is definitely more at ease now that I already know what I would do and have the funds to pay for an abortion if I needed one.

But, even though I'm not pregnant, this scare did get me thinking and researching about the actual experience of getting an abortion, and I'm wondering which is better/safer/easier: medical abortion or surgical abortion?

Both have their own pros and cons to me. Personally, medical abortion does seem a little more appealing at the moment. It just seems less invasive, and even though I've read that the cramping tends to be a lot more severe and painful, the idea of being able to have an abortion in the privacy of my own home without someone poking and prodding around my privates seem to have definite benefits. And also, it's extremely unlikely that, should I need an abortion, I would be more than four or so weeks pregnant, since I have no problem buying a pregnancy test if I suspect I'm pregnant, and if I am pregnant, my first call will be to Planned Parenthood. So I would likely be within the time limit for medical abortion to be an option.

But, on the other hand, surgical abortion is faster and apparently can be a lot less painful, and part of me likes the idea of just getting everything over and done with all at once. Also, I read that an IUD can also be put in place at the same time as a surgical abortion is done, and since I've been considering trying to get an IUD sometimes in the future anyway, it seems like if I did need and abortion and get the go-ahead from a medical professional to get an IUD, it would be nice to just do everything all at the same time. And if I ended up pregnant as the result of screwing up with my birth control (and thus needing an abortion), an IUD is definitely something I would want to seriously pursue.

I know it may seem a little silly that I'm trying to plan all this out when I may not even end up needing an abortion (I'm very good with taking my pills, but hey, no method offers 100% reliability), but I'm kind of a planner, and especially when having the possibly of facing situations that I'd really rather not face, it always makes me feel better to know exactly what I would do if "the worst" were to happen. Just the fact that I'd already decided to get an abortion if I got pregnant, that my boyfriend was supportive of that, and that I had the funds to do it made this pregnancy scare easier to deal with, but I'd just feel that much better with more information to really know exactly what I'd do in the case of an unwanted pregnancy.

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"America is the only country that went from barbarism to decadence without civilization in between."
-Oscar Wilde

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pyro_angel
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Good for you for being prepared and evaluating your options!!!
Have you read these articles?
All About Abortion
Abortion: One Woman's Story
And this wonderful thread:
Heather's Abortion Questions thread

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Courtenay

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libertatissacra
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I'd read the first one a while back, but not the second one, or looked at the thread, so thanks for those links.

I have to say, although the second link didn't really answer my question as far as the cut-and-dry process of getting an abortion, it did make me feel very fortunate that my situation is more or less the opposite of the young girl in the clinic. Sometimes I think I take for granted the fact that my boyfriend, parents, and close friends are all people who would support whatever choice I made in the event of an unwanted pregnancy, including abortion. It's definitely an easier decision to make when the people close to you are supportive of that decision.

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"America is the only country that went from barbarism to decadence without civilization in between."
-Oscar Wilde

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Heather
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Hey there, libertatissacra.

I can talk to you in a lot of depth about this, but I do think the one big thing missing from the picture to consider is that medical abortion is around 5% less effective than surgical abortion, so anyone getting one does need to be prepared -- practically, financially, emotionally -- to have to get a surgical procedure as well if the medical doesn't take.

The other factor is that, basically, a medical takes longer: a first-trimester surgical procedure takes but a few minutes, while a medical takes a few days, in terms of the actual abortion.

Also, not all providers will insert IUDs with a first-term procedure. Many will, but plenty don't for a wide array of reasons. And too, some providers just still won't do IUDs for women who have not been pregnant before and either devlivered, or were pregnant for a considerable length of time (over 12 weeks) -- especially with an abortion -- simply because for those women, the risks of expulsion are so much higher, as are the chances of profound discomfort, especially the first couple of months. So, basically, I'd not have the IUD thing be a factor in a choice between a medical and a surgical.

Lastly, even with a medical, you still are likely to have an exam with your first follow-up visit, so medical as a way to avoid a doctor or nurse examining you also isn't so sound. But one of the reasons medicals are commonly chosen are, as you voice, a desire to have most of the abortion be private and in the comfort (even though miscarrying with a medical is not exactly comfortable) of one's own home.

I can talk more if those details don't help, just holler. Just waking up today, but I'm around.

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Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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Heather
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I should also add that it might not actually be so sensible to try and make a very firm decision about having abortion, or what kind of abortion to have in advance of ever being pregnant (or before you even have the experience of viscerally feeling what pregnancy feels like in your body -- that can influence any of these choices, too).

If you choose to abort is one thing, and then if so, what type of abortion you choose will also depend on how you feel at the time, what your life is like then -- like, with a medical, you need to have a support person, days to devote to it, time to go back for all your follow-ups on a strict schedule -- what's available in your area, etc.

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Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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libertatissacra
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Thanks, Heather.

And just for the record, I know full well that a medical abortion would involve medical exams, and it's not the medical exams I have a problem with. I've never had any real issues with doctor's visits/gyno. exams and the like, because I figure that even if some of it may be mentally or physically uncomfortable, hey, at least I leave knowing that everything is in working order. Or not, and have an idea of how to deal with whatever's wrong.

The appeal of a medical abortion, to me, is more or less what you said. I just think I'd feel more comfortable being able to have an abortion in a familiar place (like my apartment). The idea of having what seems to esscentially be a high-tech vaccuum inserted into my cervix and sucking out the contents of my uterus, while in an unfamiliar place surrounded by unfamiliar people just...isn't as appealing to me. But then, as I said, the fact that it's faster and likely less painful (or at least, the pain doesn't last as long) is definitely more appealing to me. Which is why it's still kind of a toss up for me. In the case of medical abortion, however, I would be prepared and willing to have a surgical abortion if need be. But, again, another part of me is saying why not just get the surgical abortion in the first place and not need to risk needing two abortions? Well, yeah. Obviously I'm still on the fence.

I've worked out most of what to do in the case that I would get an abortion. My boyfriend has agreed to both go with me to a clinic, and be around for whatever supervision/emotional support I may need or desire him for, and his friend has a car and would be willing to, at the very least, drive me home from a surgical abortion, as well as to any other exams or follow-ups I may need as a result.

And I know that getting an IUD at the same time as a surgical abortion isn't a done deal, but if it was an option for me, that would likely put getting a surgical abortion in my favour, y'know?

And yeah, it's possible that in the case of an actual pregnancy, I might change my mind. In all honesty, I really don't see that happening given my absolute and utter terror at the idea of pregnancy and giving birth, but if I change my mind, well, then I change my mind, and I'll deal with it if and when I find myself in that situation.

Mostly, I just want to be able to make the most informed decision that I can, and don't want to feel like I'm going into an already scary situation blind. And really, I've been told a lot about pregnancy and childbirth throughout my life, but I've been told very little about the facts of abortion.

And, again, I'm a planner in the face of crisis. I just feel so much more secure if I've already talked myself through what all I'll do and how I'll do it. And, of course, if I decide to change my plans when actually facing said "crisis," then I change my plans and talk myself through another series of events and actions. But I like to be prepared, at the very least, with as much honest information as I can get.

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"America is the only country that went from barbarism to decadence without civilization in between."
-Oscar Wilde

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Heather
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I gotcha.

Still sounds like you're on the fence per what type, which isn't very surprising. Really, I'd say close to half the time at the clinic women come in scheduled for a medical, they're feeling that way even with the appointment. And I'd say that about a third of the time, by the time I've counseled a client for a medical through the process, what they need to do, their follow-ups, the note-taking, etc. they decide they'd like to switch to a surgical.

(Sometimes, mind you, that's because women mistakenly choose medical thinking that's the easier procedure to hide from a partner or family. When they realize they've got it backwards, they'll usually switch. Too, we sometimes have to decline medicals to women who don't have support systems or anyone to be with them or even a phone call away.)

Obviously, too, a lot of this will depend on how soon you find out you're pregnant, and if those funds you've been saving now are available to you then. Same goes with if this happened when you were still with your boyfriend now, or if it happened with a partner in the future who didn't feel like he does who wasn't so supportive.

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Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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libertatissacra
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Yeah, I know that a lot of it will depend on my exact feelings and situation if and when I actually do face an unwanted pregnancy. I was leaning towards medical when I was worried I was pregnant a few days back, when I was in the thick of crisis-planning research mode. Which is interesting, because prior to that, from what I did know of abortion, surgical abortion always seemed more appealing to me. But when actually facing the possibility of getting an abortion, medical started to sound good. I figured...I have video games in my room. And a DVD player. And a Blockbuster down the street. And a cute boyfriend at my beck and call. They don't have that in a clinic recovery room. XD

And I figured, on a more practical level, I was within the time limit for a medical abortion, I had transportation to any and all appointments I might need to have, and I had someone who could stay with me.

And yeah, this "plan" is pretty much only applicable if all this happens with my current boyfriend, who I hope to be with for a very long time, but...y'know, we're young, and crap happens. A different partner might very well require a different plan. Though I will say that I try to avoid being sexually involved with anyone who would not be supportive of whatever choice I would make in the event of an unplanned pregnancy. I actually stopped having sex with my ex-boyfriend because he told me that he wouldn't want me to get an abortion if I got pregnant, and honestly, while people are entitled to their opinions, I don't want to find myself in a situation where I either have to go behind my partner's back, or tell them what I'm going to do and likely either make them very angry or very hurt. Or both. If I do face an unplanned pregnancy, regardless of what option I decide to take, I want my partner to be right there with me, and I don't want to feel like any of my options are ruled out because of what my partner wants. [/rant] Sorry.

The other thing that spurred this frenzied curiosity about abortion is that...well, abortion is the most time-sensitive option, and if I actually am pregnant, the longer I take gathering information and funds and making a decision, the more options start to disappear for me, and I don't want that to become a deciding factor.

Okay, I've written another novel that's mostly just a rant, but I actually do have a specific question for you, Heather (or anyone else who knows). During a surgical abortion, do they tend to put the patient under completely, or just use a local anesthetic, or nothing at all? And if they do two or all three of those, what are some of the pros and cons of each?

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"America is the only country that went from barbarism to decadence without civilization in between."
-Oscar Wilde

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Heather
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When it comes to surgical abortion, what options you have in that regard will depend on a given clinic.

In our clinic, for instance, you can run the gamut from having only a local anasthetic to your cervix (and years and years back, when I had my abortion in Chicago, I expressly asked for only that, and actually had to fight for that right, which was vexing), to that plus a general painkiller and very light sedative, to conscious sedation, to going under general anesthesia. But I know that with the PPs here, they don't offer GA. So, it varies.

The pros and cons are pretty personal there, and I'd say it has mostly to do with if you want to remember your procedure or not, and how clearly you want to remember it, as well as what a given person prefers to do to manage any pain or discomfort (emotional and physical). General anesthesia and IV sedatives do also toss in an extra issue, which is that coming out of them can be confusing and disorientating, so sometimes patients who chose that to try and decrease the ante seem to experience more trauma afterwards than those who chose mostly painkillers instead. Too, what you choose also depends on how far along you are: earlier procedures aren't usually as painful as later ones can be. As well, we usually see more women getting GA's who already feel like they're managing way too much and just can't handle more at the time: rape survivors, women in abusive relationships, genetics cases, very young women, etc.

But in the best clinics, all of this is totally up to the client. Personally, when people ask my personal opinion, I'm of the mind that less is better from an emotional standpoint, but that would also only be if a given person is well-equipped to manage pain and isn't very anxiety-ridden about the whole thing.

(We do have DVDs in some of our recovery rooms, btw. But no cute boyfriends -- especially since a lot of the boyfriends we see are not at all cute in their behavior -- or video games. [Razz] )

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Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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libertatissacra
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Okay, thanks.

I do think that for me, GA would certainly be disorienting after the fact, and that would worry me.

But honestly, local anesthetics kind of freak me out. I had to get stitches when I was 11 because of a mishap with a spooked horse and was given a local, and it was really disconcerting for me to see someone sewing through my skin and yet not really feel any pain...I don't know. It was just weird, and I really didn't like it, and that's made me sort of afraid of locals.

I can see how being fully conscious would probably be better from an emotional standpoint, but...isn't it kind of weird and trippy to be awake and watching this done to you? Do they put up and kind of barrier so to block you from actually seeing all what's going on, or are you free to watch them suck stuff out of your uterus?

Also, another question: Excluding pre and post abortion exams, how long is one generally in a clinic for a surgical abortion? With prep, the procedure itself, recovery, etc?

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"America is the only country that went from barbarism to decadence without civilization in between."
-Oscar Wilde

Posts: 115 | From: San Francisco, CA | Registered: Nov 2007  |  IP: Logged | Report this post to a Moderator
   

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