Contraception I: Abortion and Birth Control Pills
Author: Michael Castleman, M.A.
<b>ABORTION</b> <p>Pregnancy termination is very controversial, but currently about 1 million legal abortions are performed in the U.S. each year. <p>Abortion is the deliberate removal of an embryo before it can survive outside the womb. Abortion decisions are often difficult. They should be made carefully and if possible, the woman should discuss her decision with her lover, her family, trusted friends, a counselor, a member of the clergy or her doctor. <p>Currently, during the first three months of pregnancy, abortion decisions are entirely up to women and their physicians. During months four through six, states may impose restrictions. For example, requiring that abortions be performed in hospitals. Beyond six months, abortion is performed only rarely because current technology allows fetuses to survive outside the womb. <p>Most women (and often their lovers as well) experience mixed emotions about abortion decisions. For some, the main feeling is relief. For others, it's profound loss. Studies show that first-trimester abortions cause the fewest psychological and medical problems. <p>Some unplanned pregnancies occur truly accidentally. But many -- perhaps most -- occur because the lovers failed to use a reliable method of birth control properly every time they made love. Lovers should always discuss birth control and never risk an unplanned pregnancy. Once they decide on the best method for them, they should use it properly every time they have vaginal intercourse. No single contraceptive is "best" and no single method is best for any couple all the time or throughout life. But options abound and today there's a reliable method to suit just about every couple's needs and sexual tastes. For more information on birth control, listen to the other tapes in this collection or consult your physician or a family planning clinic. <p>The vast majority of women learn they are pregnant sometime during their third to eighth week of pregnancy. First-trimester abortions can be obtained until the end of the 12th week, so most women can consider abortion decisions for several weeks without jeopardizing their ability to obtain the simplest, safest, most private type of abortion. Abortions absolutely require experienced doctors. Never attempt an abortion on yourself or have an abortion performed by anyone other than a qualified medical professional. Never take herbs to trigger abortion. Some plant oils trigger uterine contractions, but the doses that do this are also lethal. Many women have died shortly after swallowing even small amounts of plant oils in hopes of triggering abortion. <p>Although pregnancy can now be detected as early as 10 days after conception, most clinicians advise women to wait until two weeks after a missed period or about six to eight weeks after their last menstrual period to ensure that the abortion is successful. Early abortions are best, but abortions performed within six weeks of the last menstrual period may not terminate the pregnancy. <p>Several kinds of abortion are currently available: <p><b>Vacuum Curettage</b> is the most widely used procedure. It's also called "suction curettage" or "suction C." Up to 16 weeks, it can be performed in a doctor's office. Most women receive a local anesthetic and pain medication, but in some cases, especially if the abortion takes place in a hospital, general anesthesia may be used. The clinician places a clamp on the cervix to hold it steady and then opens it by inserting a series of metal rods with increasing diameters. Some clinicians prefer to open the cervix with sterilized plant material called "laminaria," which is inserted six to 24 hours before the abortion. The plant material absorbs body fluid and swells, gently enlarging the cervix. <p>Once the cervix has been opened sufficiently, the doctor removes the contents of the uterus with a small vaccuum tube. Then the physician inserts a scraping instrument called a "curette" to make sure all the fetal tissue has been removed. <p>After vacuum curettage, some women experience cramping. Others feel nauseous. With local anesthetic, most women are able to leave the medical facility within two hours. General anesthesia requires longer recovery. <p><b>Dilation and Curettage (D&C).</b> This method uses only a curette. The physician scrapes the uterus to loosen the fetal tissue and then removes it with a forceps. Until the 1960s, D&C was the method of choice for first-trimester abortions. Today it has largely been replaced by vacuum curettage, which is quicker and causes fewer complications. <p><b>Dilation and Evacuation (D&E).</b> D&E is a second-trimester abortion procedure. Some clinicians use it through the 20th week. Performed much like a D&C, the D&E uses special instruments to remove the larger volume of fetal and uterine tissue. Because the cervix must be dilated more than in a vaccum or D&C procedure, most clinicians use laminaria the day before the surgery. Under regional or general anesthesia, the physician removes the fetal tissue with a vacuum tube and other instruments. Most clinicians also adminster a drug called Pitocin, which stimulates uterine contractions and helps limit blood loss. <p><b>Saline Abortion.</b> "Saline" means salt water. After removing some amniotic fluid, the physician injects it into the uterine cavity through the anesthesized skin of the abdominal wall. After six to eight hours, labor begins and the fetus and placenta are generally expelled within 36 hours. Sometimes the placenta must be removed through curettage. Possible complications include hemorrhage, retained placenta and infection. <p>Regardless of the type of abortion, a woman should follow her clinician's recommendations: <ul> <li type="disc">Rest for at least one day after the procedure. <li type="disc">Avoid strenuous activity for 72 hours. <li type="disc">Take any antibiotics as directed and take the full course to reduce the risk of postabortion infection. <li type="disc">Don't have intercourse for at least two weeks. <li type="disc">Don't use tampons for three weeks. <li type="disc">Have a follow-up exam two weeks after the abortion. <li type="disc">Start using an effective method of birth control and use it properly during every sexual encounter. </ul> <p>Consult a physician immediately if any of the following develop: <ul> <li type="disc">Fever <li type="disc">Chills <li type="disc">Muscle aches <li type="disc">Persistent fatigue after 72 hours <li type="disc">Severe abdominal pain, cramping or backache <li type="disc">Abdominal tenderness when you press on the lower abdomen above the pubic bone <li type="disc">Prolonged or heavy vaginal bleeding <li type="disc">No menstrual period within six weeks, especially if you still feel pregnant </ul> <p><b>BIRTH CONTROL PILLS </b> <p>Birth control pills are also known as "oral contraceptives" or simply as "the Pill." Birth control pills contain female sex hormones that prevent pregnancy by stopping the release of eggs from women's ovaries. The Pill is available by prescription only and regular clinic visits are necessary. <p>Birth control pills are theoretically 99% effective, with an actual effectiveness of 97%. To learn what contraceptive effectiveness statistics mean and to see how the Pill compares with the other methods, see the Overview discussion. <p>A woman on the Pill must take one a day, every day. If she misses one pill, she can take two the next day. If she forgets two pills, she can take two each day until she has caught up. But it's wise, in such cases, to use a backup method as well. If she misses three or more days in a row, she should stop taking the Pill and use another type of contraception until her next period, when she may return to taking her birth control pills. <p>Birth control pills come in three varieties: combination pills, minipills and triphasic combination pills. Combination pills contain both estrogen and progestin. Minipills contain only progestin. Minipills are slightly less effective than combination pills, but they can be used by women who, for medical reasons, cannot take estrogen. Triphasic combination pills contain a different hormonal mix than regular combination pills. Women considering birth control pills should discuss the various options with a family planning counselor or physician. <p>Some women should not take birth control pills -- women who suspect they might be pregnant and women with any of the following ailments: <ul> <li type="disc">Liver disease, including, hepatitis, cirrhosis or benign liver tumors. <li type="disc">A history of heart disease, stroke or angina. <li type="disc">A history of breast cancer. </ul> <p>In addition, your physician may advise against using the Pill: <ul> <li type="disc">If you're a teenager. <li type="disc">If you smoke. <li type="disc">If you're breastfeeding. <li type="disc">If you're over 35. <li type="disc">If you have varicose veins. </ul> <p>You may also be advised not to use the Pill if you have any of the following: migraines, high blood pressure, high cholesterol, gallbladder disease, diabetes, uterine growths called fibroids, sickle cell anemia, a high risk of breast cancer or a family history of death from heart disease before age 50. <p>The Pill has some advantages including convenience and regularization of irregular menstrual periods. Birth control pills typically decrease menstrual flow and cramping. They often help relieve acne, endometriosis and ovarian cysts. Studies show that birth control pills also reduce the risk of ovarian and uterine cancer, ectopic pregnancy and infection of women's reproductive organs (pelvic inflammatory disease). However oral contraceptives increase risk of stroke, heart attack, high blood pressure and abnormal blood clotting. <p>Does the Pill increase risk of breast cancer? Estrogen, a major component of combination birth control pills, stimulates the growth of many breast tumors. Some studies have shown an increased breast cancer risk in Pill users. However, others have not. At this writing, it appears that Pill use starting during a woman's teens increases breast cancer risk slightly, but starting the Pill later in life does not. And any increased risk declines when you go off the Pill. Women with a family history of breast cancer should discuss it with their doctors. <p>Some women gain weight while taking birth control pills, which most women consider a disadvantage. Others notice an increase in breast size. Depending on the woman, this may be an advantage or disadvantage. <p>Other common Pill effects include decreased sex drive, nausea, headaches, breast tenderness, depression, fatigue, irritability and bleeding between periods (spotting). <p>Birth control pills provide no protection against sexually transmitted diseases. <p>Finally, birth control pills are a relatively expensive form of contraception. <p>Women who stop using birth control pills typically return to ovulating normally within one to three months, but in some cases, ovulation does not return for up to six months. <p>If you decide to use the Pill, you'll need to have it prescribed by a physician and have annual physical exams while taking it. Never share or borrow birth control pills. Women taking the Pill should contact a physician immediately if they develop any of these symptoms: <ul> <li type="disc">Severe abdominal pain <li type="disc">Chest pain <li type="disc">Shortness of breath <li type="disc">Severe headaches <li type="disc">Blurred vision or vision loss <li type="disc">Severe leg pain </ul>