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a) Use of drugs. This is used as an alternative to the curettage method and is used mainly in private clinics but may be more widely used in the future. Mifepristone (RU 486) is given only to women who are less than nine weeks pregnant (i.e. about 60 days pregnant). Three or four visits to the doctor are necessary. On the first visit tablets of the drug are given. This is followed up 36-48 hours later when a vaginal pessary is inserted. The abortion usually follows as heavy vaginal bleeding within 4-6 hours. It is complete in 95% of women. A follow up visit is made 8-12 days later to ensure bleeding has stopped. Pain and heavy bleeding can occur and the drug should not be given to women over 35.
b) Suction Curettage. This is the usual method carried out up to about 12 to 14 weeks of pregnancy (i.e. about 100 days maximum). The operation is usually performed under general anaesthetic in an operating theatre. The neck of the womb is slowly stretched open to allow the insertion of a suction tube. The contents of the womb, including the foetus, are then sucked out. The woman is usually discharged from the clinic on the same day. Pain similar to period cramps and some bleeding may occur afterwards. If the bleeding persists and all the contents of the womb have not been removed, a second operation may be required. There is some evidence that the neck of the womb may become weakened by being forced open prematurely. This would mean that in a future pregnancy she may miscarry or go into premature labour. This risk is highest in teenagers and women experiencing their first pregnancy. As a result of the abortion operation, a small percentage of women suffer from an infection of the womb and Fallopian tubes. Even though this can be treated with antibiotics, the damage is sometimes permanent and it may be more difficult for her to conceive at a later date.
c)Premature Labour Inducement. After 14 weeks of pregnancy the baby is larger and abortion more difficult because the above two methods cannot be used. Inducement of premature labour is carried out in hospitals although the woman usually remains awake during the procedure which, like normal labour, is quite painful and can last many hours. She will usually stay overnight in the hospital afterwards. Pessaries are inserted into the vagina at intervals. Occasionally drugs are given by a drip into the arm of via a catheter into the womb to induce the premature labour. The afterbirth does not always come away completely so a further operation called Dilation and Curettage (D & C) may be necessary to complete the abortion. In some later abortions surgery is used, this method is called a Dilation and Evacuation (D & E). Damage to the womb is more common with the D & E method and it may cause infertility or affect the success of a subsequent pregnancy.
d) Possible Emotional Effects following Abortions. Immediately after an abortion there is often a great sense of relief. Tensions have been high ever since pregnancy was suspected and now it is over. However, as the mothers body has already begun to react to the babys development, strong feelings are often felt after an abortion, even when the decision was carefully thought out and discussed with family and friends. Painful emotions frequently surface, mostly soon after the abortion, but sometimes years afterwards, which have to be dealt with.
i) Guilt and grief are common reactions to the loss of a child and are often experienced following an abortion. Recurrent nightmares of the operation and a sense of loss and mourning are common. The sight of a pregnant woman and babies can be upsetting. Emotionally a woman can become detached, unloving or sexually cold towards her partner, and this can put pressure on their relationship.
ii) Often there is a sense of anger to be dealt with, reactions such as "Why didnt anyone tell me it would be like this?" and "Why didnt I get the support I needed?". Particularly difficult times are the date the baby was due and the anniversary of the abortion.
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