• In Ohio, at least two visits are necessary to have an abortion. The first visit will consist of paperwork, some blood work, and an ultrasound, as well as a meeting with our physician. By state law, our physician is required to discuss certain information with you in person at least 24 hours before your procedure. This information includes the risks of abortion and full-term pregnancy, as well as information on alternatives to abortion.

• In the first trimester, surgical abortion is called vacuum aspiration. This is a relatively quick two-step process. The first step to the surgery is dilating the cervix. The doctor does this by numbing the cervix, and then using plastic dilators to open the cervix to the appropriate width, usually a few millimeters.  The second step is to remove the contents of the uterus by suction. The entire process usually takes less than 5 minutes and can be performed using only local anesthetic, although we have additional anesthesia options available.
• In the second trimester (14 weeks and up), surgical abortion is called dilation and evacuation, or D&E. Because the pregnancy is more developed than in the first trimester, additional steps are taken to dilate the cervix. We do this several ways. Starting at 14 weeks, the doctor inserts dilators called laminaria into the cervix the day before the procedure. Laminaria are small dilators made from natural seaweed, and they expand slowly as they absorb moisture inside the vagina. The laminaria help to dilate the cervix slowly over time, which causes less stress to the cervix and decreases the likelihood of complications, such as a tear.  Depending on your gestation, more than one day of laminaria may be necessary. We also use a medication called Cytotec on the morning of your surgery to help soften the cervix and make it more elastic. Cytotec is given in the form of tablets that dissolve inside your cheek while you wait for surgery.  The procedure itself tends to last longer (5 to 15 minutes) than in the first trimester, and can be more painful.  Additional anesthesia to help you relax and reduce pain is usually recommended.
• A medical abortion (also known as the “pill method”) is an alternative to having surgery if you are less than 9 ½ weeks pregnant.  Medical abortion uses two medications to cause you to pass the pregnancy like a miscarriage.  The first medication is called Mifeprex, and it works to stop the growth of the pregnancy by blocking the action of progesterone, the pregnancy hormone.  You must take this pill at the office in the presence of the doctor.  There are not very many side effects from the Mifeprex, and you can usually return to work or school shortly after taking it.  The second medication is called misoprostol.  Misoprostol consists of four pills that you insert vaginally at home, between 6 and 72 hours after taking the Mifeprex.  Once inserted, the misoprostol causes the uterus to begin contracting, so that you pass the pregnancy over a period of several hours like a miscarriage.  Because this step involves some heavy period-type bleeding and cramping as well as passing some larger blood clots, we recommend that you spend the day resting at home.  Other side effects from the misoprostol can include nausea, a slight fever, headache, or other flu-like symptoms.  These should go away after a day or two, as the medication leaves your system.  The medical abortion is safe and effective, but it does occasionally fail.  For this reason, it is important that you follow up with us after a medical abortion by taking a pregnancy test three weeks later and contacting us with the results.  (For more information on a failed medical abortion, see “What if I choose…?”

• Below, we have listed the most common risk factors for both surgical and medical abortion.  An important thing to remember is that you can help to reduce your risk of complications by sharing your full medical history with us, including any allergies to medications, and by following instructions given by our medical staff.  Also, keep in mind that while there are always some risks involved, abortion is statistically safer than a full-term pregnancy and childbirth.  Please see your provider for a complete list of possible complications.
• Surgical Abortion is one of the safest surgical procedures performed in the United States, especially if it is done early or in the first trimester.  As with any medical procedure, there are some risks involved.  The most common complication with an abortion procedure is infection, which occurs in about 3% of cases.  Infection is very easily preventable, however.  We take several steps in preventing infection, which we will discuss with you as part of your initial consultation.  Other risks from a surgical procedure include a tear in the cervix or wall of the uterus.  These risks are very minimal and occur in about ½ of 1%, or .5% of cases. 
• Medical Abortion (Non-surgical; the Pill) is also a safe option, and can be used as an alternative to surgery early in pregnancy.  Again, the most common risk factor is infection (3%), as with the surgical procedure.  Another risk factor with the medical abortion is the possibility of a failed or incomplete abortion.  This occurs in 5 to 7% of cases nationwide, although our facilities have a 95% success rate with the procedure.  This increased failure rate makes it extremely important that you follow-up with us by taking a pregnancy test about three weeks after your procedure.

• The medical abortion is usually about 95% effective.  However, there are some cases in which the abortion is incomplete or fails.  Usually, this means that you could still have some tissue or blood clots in your uterus.  Occasionally, it could mean that the pregnancy has continued growing.  If you choose the medical abortion, we ask that you follow up with us three weeks after the procedure by taking a pregnancy test and contacting us with the results.  A negative pregnancy test indicates that the abortion was complete.  A positive pregnancy test may be an indication of an incomplete or failed abortion.  In the case of a positive pregnancy test, we would most likely perform an ultrasound to make sure that the uterus is empty.  If an ultrasound reveals that the abortion failed, we would perform a surgical abortion to remove any excess tissue.  It is very important that you agree to have surgery if it is necessary after a medical abortion.  If surgery is necessary after a failed medical abortion, it is at no additional cost to you.

• Surgical Abortion: Usually, pain during a first trimester surgical procedure consists mainly of abdominal cramping similar to your heaviest period cramps.  Local sedation (numbing the cervix in addition to prescription-strength Ibuprofen) is included in the cost of a first trimester procedure, and is the most commonly used level of pain medication.  However, many women feel more comfortable using additional medication to help them relax and lessen pain.  We offer a variety of different pain medication options, so be sure to ask your provider for more information.  Second trimester surgical abortions can be more painful and last longer than earlier surgeries.  Therefore, additional pain medication is often included in the price.
• Medical Abortion: Abdominal cramping is also the main source of discomfort associated with the medical abortion.  On the day that you insert the misoprostol (the second medication), you will most likely experience some moderate to heavy abdominal cramping for several hours while your uterus contracts.  For most women, this is similar to a heavy period day.  Prescription-strength Ibuprofen (800 mg) is often sufficient for this level of cramping, but you can discuss different prescription pain options with the physician.  Some women, however, experience cramping that is heavier, and is associated with abdominal pain during labor.  It is impossible to predict exactly what the medical abortion will be like for you, but there are some medical conditions that could make the procedure more painful, such as Pelvic Inflammatory Disease (P.I.D.), Inflammatory Bowel Syndrome (I.B.S.), or Endometriosis.  Be sure to share any medical conditions you may have with the doctor prior to taking the medication.

• Because of the cost and additional risks involved, we do not offer a full, unconscious I.V. sedation at our facilities.  However, we do offer a conscious I.V. sedation that helps considerably with pain and anxiety during a surgical procedure.  The I.V. contains a pain medication that offers a high level of pain relief, and a powerful sedative that puts you in a more relaxed, sometimes dreamlike state.  For many patients, the I.V. also acts as a memory inhibitor, leaving them with a “patchy” memory of the procedure.  It is important to remember that the I.V. works differently on everyone, so it may be more or less effective for you depending on your body mass index, or BMI, and your tolerance to pain medications.

• In Ohio, the legal limit for abortion is 24 weeks, or the start of the 6th month.  Some states (Georgia and Kansas) provide abortions up to 26 weeks.  At our facilities, we perform abortions up to 19 weeks 6 days.  Keep in mind, however, that it is always better to have an abortion sooner rather than later.  The price usually increases weekly in the second trimester (starting at 12 weeks), and the procedure becomes more involved because additional steps need to be taken to dilate the cervix.  This can mean additional visits to the office before your actual surgery.

• The cost of an abortion varies somewhat depending on the provider.  At our facilities, the prices also vary depending on location, but are usually between $300 and $400 for a first trimester surgical abortion and between $350 and $500 for a medical abortion.  These prices typically include post-procedure medications to prevent infection and a local anesthetic for the surgical abortion. Prices for surgery in the second trimester (starting at 12 weeks) increase weekly, so be sure to contact the nearest office for more complete pricing information.  At our facilities, the first $100 of the total procedure cost is due at the initial consultation, and the balance is due the day of the procedure.  

• In Ohio, unemancipated minors do need parental consent to have an abortion.  However, there is an option called Judicial Bypass for women under 18 who choose to have an abortion and feel that it is unsafe to tell their parents.  Judicial Bypass is a process where the minor meets with a judge, and the judge grants the bypass in place of parental consent.  The rules for Judicial Bypass differ by county, but most require that your parents DO NOT KNOW that you are pregnant.  The following is a list of possible scenarios where you may be able to obtain a bypass:
• You feel that your parents may become violent, or force you to leave your home, if they know about the pregnancy/abortion.
• You think that your parents might coerce you into a decision about whether to continue the pregnancy or have an abortion.
• Your parents have a religious opposition to abortion.

For more information on getting a Judicial Bypass, contact your local provider.  They will be able to provide the number and location of the courthouse and go over any additional information.  Minors who are emancipated (married or emancipated by the courts) do not need parental consent as long as they can provide documentation.

• There is nothing about the abortion procedure itself that should prevent you from having children in the future.  There is a small risk of complications, as with any gynecological procedure, that may have an effect on your future fertility, such as a tear in the cervix or wall of the uterus, or an untreated infection that, if severe enough, spread to the uterus.  The risk of these complications is very low.  For more information about the risks of abortion, see “Is abortion safe?”  Some women also have pre-existing conditions that may put them at greater risk for complication, such as Pelvic Inflammatory Disease (P.I.D.) or Endometriosis.  Please make sure to share your full medical history with us in order to reduce your risk of complications.

• Many women undergo more than one abortion in their lifetime.  Most of them are still able to carry a pregnancy to term when they want to.  The main risk factor with multiple abortions is due to the cervix being dilated multiple times.  After being dilated several times, the cervix may start to lose elasticity, or the ability to close all the way after the procedure, making it more difficult to carry a pregnancy to term.  This is more likely to occur after later-term abortions where the cervix is dilated further, or after multiple vaginal deliveries.  For most women, having 2 or 3 first trimester abortions with no complications will probably not have a substantial effect on future fertility.

• The morning-after pill is actually a medication taken after unprotected sex in order to prevent pregnancy.  It is usually sold under the brand name Plan B.  Sometimes, Plan B is referred to as an “abortion pill,” but this is incorrect.  Plan B can be taken up to 72 hours after unprotected sex, but it works the same way that normal birth control pills work.  It prevents pregnancy three ways:
• Preventing ovulation: if you haven’t already ovulated in your cycle (usually about 14 days after you started your last period), Plan B contains hormones that can prevent your body from releasing an egg for that cycle.
• Preventing fertilization: if you have already ovulated (your body has produced an egg or ovum), Plan B can also prevent sperm from fertilizing the egg.
• Preventing implantation: if you have already ovulated and the egg has already been fertilized, Plan B can create changes to the lining of your uterus, which helps prevent the fertilized egg from implanting on the uterine wall.  The egg would then pass from your body the next time you have a period.  *Because pregnancy does not begin until the fertilized egg implants itself on the uterine wall, this action is not considered an abortion, except by a small minority in the medical community.  It is this minority who is also religiously opposed to hormonal forms of birth control (like the pill) for the same reason.

• The medication that is used as part of a medical abortion is called Mifeprex.  Unlike Plan B, which is taken just after unprotected sex to prevent pregnancy, Mifeprex is used after the pregnancy has begun.  It works by stopping the growth of the pregnancy by blocking the action of progesterone, the pregnancy hormone.  After taking Mifeprex, a second medication is inserted vaginally (misoprostol or the brand-name Cytotec) to cause the uterus to contract and expel the tissue.  The two medications together work like a miscarriage.  A woman who chooses to have a medical abortion passes the pregnancy over the course of several hours after insertion of the misoprostol.

• In the state of Ohio, we are required to see you at least 2 times.  The first visit is your initial consultation, where the doctor meets state law requirements with you, and the second is the actual procedure.  Depending on what type of procedure you choose to have, or how far along you are, you may need more than 2 visits.