How to Get a Safe Abortion

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Medication abortion

It's called the abortion pill, but it's actually two pills: The first, mifepristone, is taken at the clinic — it blocks the hormone progesterone, breaking down the uterine lining. The second, misoprostol, is taken at home 24 to 48 hours later

What to expect

Post pill no. 2, cramping and heavy bleeding will last 24 to 48 hours. You might notice blood clots or the pregnancy tissue — a white-gray meaty material — but it won't look fetus-like, says Pratima Gupta, MD, a fellow at Physicians for Reproductive Health. Wait a week before putting anything into your vagina (a tampon, a penis, even bath water) to avoid infection. You'll have spotting, so stock up on pads. A follow-up within two weeks will check if all pregnancy tissue has been expelled — 97 percent of the time, it has. If not, you may need aspiration.

What it costs

$800 (but often less) without insurance.

Aspiration

The most common in-clinic abortion procedure, aspiration (also called a D&C — dilation and curettage), involves stretching the opening of the cervix and emptying the uterus with a suction device. On a case-by-case basis, the doctor may do a sweep with a curette to ensure all the pregnancy tissue is removed. It takes five to 10 minutes. While it's more invasive than the abortion pill, you can walk out and be D-O-N-E.

What to expect

Pain medication is standard, and providers will offer some form of sedation — ranging from numbing at the cervix to an IV drip to (rarely) general anesthesia. Then the doctor dilates the cervix with medication or a series of progressively larger instruments that push it open. Throughout the procedure, you'll feel pressure. Some women feel painful cramping; others don't. Still, "there shouldn't be extreme pain," says Jennifer Conti, MD. About 10 minutes later, the abortion is complete. If you were sedated, you will feel groggy for a few hours and will need someone to drive you home. You may have to change pads a couple of times a day, says Dr. Conti, and this spotting can last a few days to a couple of weeks. Your doctor may request a follow-up in two to four weeks to make sure you're back to 100 percent.

What it costs

$1,500 (or less) without insurance in the first trimester; costs are generally higher the further along you are.

D&E

Dilation and evacuation is a two-part, sometimes two-day, procedure offered from the second trimester until viability. The cervix must be softened and stretched a few hours or the day beforehand, more so than with aspiration because the pregnancy is further along. The abortion itself, which is similar to aspiration but uses different instruments, lasts 10 to 30 minutes.

What to expect

To open the cervix, your provider will give you misoprostol or insert one or more thin rods made of seaweed (for real) or synthetic material into your vagina, where they gradually expand. It hurts, so you'll get pain meds or possibly something stronger, and antibiotics. After the cervix is soft, you'll probably head to an operating room so you can receive higher levels of pain control as needed, says Dr. Gupta. You will be offered a shot in the abdomen to stop the fetal heartbeat, if that gives you peace of mind. Your doctor will remove the pregnancy tissue in portions with specialized medical instruments, such as forceps. As with aspiration, recovery will include some bleeding and cramping for a few days.

What it costs

$1,500 (or more) without insurance. Prices increase as the pregnancy progresses.

Induction termination

This rare alternative to D&E (aka labor induction) involves delivering the fetus vaginally at a hospital. Women "go through a process similar to labor, with the cervix opening, and possibly pushing to deliver the pregnancy," explains Dr. Gupta. It is a longer and riskier process than a D&E, so is generally only offered from 20 weeks until viability. Dr. Conti notes that induction enables the woman to hold the fetus and allows for a thorough autopsy.

What to expect

Your provider will offer you an optional shot in the belly. Then she'll use medications to soften the cervix and induce contractions. Your water will break, and you'll feel cramping and pain. "You have the option of an epidural," adds Dr. Conti. The process can take several hours or several days. Barring a medical issue, you can go home a few hours after the fetus has passed. Recovery is similar to that of women who've given birth, including vaginal swelling and soreness, spotting, and potentially lactating.

What it costs

$5,000 (approximately). Cost and insurance coverage varies. This is the average cost for an abortion at 20 weeks, according to the Guttmacher Institute.

And afterward...

It's not like ending a pregnancy is fun. But by three years later, 99 percent of women seeking abortions say they made the right choice, according to researchers who interviewed 667 women. Aspen Baker, who runs the after-abortion talk line Exhale, says people report "grief, confusion, relief, ambivalence, confidence, and hope. The main question is, 'Is what I'm feeling normal?'" Answer: Yes. To talk to a counselor, call 1-866-4-EXHALE.

—Caitlin Moscatello

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Getting an abortion in many states is no easy task. Paying for it is often even more difficult and, unfortunately, there is far more expense that goes than just paying for the procedure. There are days off from work or child-care expenses you will incur, especially if your closest clinic available has a mandatory in person waiting period that requires more than one appointment. There are transportation costs like gas, a bus ticket, and sometimes even a plane fair, or a cab to get home if you don't have someone to go to the clinic with you. You might need a hotel in order to get to the appointment early enough, or to stay overnight if it's a long distance and you have multiple visits to make. And at some point, you will need to eat, and even get simple supplies like additional sanitary pads.

Abortion providers and abortion rights activists all across the nation have responded to the increased burdens that anti-abortion legislators have put on accessing care by offering financial assistance, travel assistance, and other resources to try to bridge the gap for those who need services but don't have the means to obtain them. These national organizations are ready to help whomever needs them.

National Abortion Federation (NAF): Unsure where your closest clinic is that offers the procedure you need at your gestation and if you even have the resources to get there once you find it? The NAF Hotline can offer you information on which clinics offering quality care are still open (a constantly changing landscape, thanks to state-based abortion restrictions), and if the best option for you is even in your state at all. They can also potentially assist if funding for your procedure or travel is a barrier, or if additional travel arrangements need to be scheduled, especially if a pregnancy is more advanced or has added complications. You can contact NAF here.

National Network of Abortion Funds (NNAF): NNAF is the first place to contact if you need an abortion but don't think you have the ability to pay for it. Based on location, the group can help you learn if you live one of the 15 states where Medicaid will cover the cost of your abortion, and if you have the ability to access a local, state-based abortion fund for help too. To get started, click on "Get Help."

Women's Reproductive Rights Assistance Project (WRRAP): Located in California, WRRAP is another national funding source if you aren't sure if you can afford a procedure. WRRAP only provides funding to clinics that are in their approved network, so be sure to ask the clinic you schedule with if they work with WRRAP. If they do, the clinic will help you with how to proceed.

Many states have local funds and services that help with cost, transportation, and lodging if you have to stay overnight. Click here to find a full list, state-by-state, of services that can help you.

—Robin Marty

Follow Caitlin on Twitter. Follow Robin on Twitter.

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