Disclaimer: I will be talking about abortion this week, so if that’s a topic you’d rather not read about, feel free to avert your eyes elsewhere.
As an unofficial sequel to last week’s column, today I will be discussing what happens when the stars align, contraception fails and egg meets sperm in that ancient little fertilization dance. I’ll be focusing on the experience of the pregnant person rather than the impregnator, as usually the burden of decision falls mainly in the hands of the former. So you’re pregnant. Or you’re worried you could be. Despite a political war for the contrary, a host of options still exist if you decide that birthing a child isn’t in your best interest right now. I won’t discuss alternatives to parenting after birth, like adoption, though it should be said that choosing to have a child does not mean that you’re choosing to be a parent. This week, I’ll discuss emergency contraception and abortion options.
Emergency contraception prevents fertilization of the egg by the sperm, which is much different from an abortion, which removes an already fertilized egg. Emergency contraception prevents pregnancy, while abortion terminates pregnancy. Emergency contraceptive pills like Plan B and ella work by preventing ovulation until after any sperm has exited the body. Sperm can remain in the fallopian tubes for up to six days after ejaculation, which means that “yes!” you can get pregnant up to six days after you have unprotected sex. As we discussed last week, ovulation occurs when the egg is released from the ovary into the fallopian tube, where fertilization occurs if sperm is present. Plan B uses a synthetic progesterone-like hormone called levonorgestrel to delay ovulation until any sperm has been flushed from the fallopian tubes. Plan B is most effective if taken within 12 hours of unprotected sex, but can be taken up to 72 hours after intercourse. Its effectiveness decreases the later you take it, but it has been shown to successfully prevent pregnancy in about 87 percent of cases. The other type of emergency contraceptive pill, ella, uses ulipristal acetate to delay ovulation which increases its duration of efficacy to up to 120 hours after unprotected sex. Neither pill requires a prescription and Macalester Health and Wellness offers emergency contraception options starting at just $15.00.
The most effective form of emergency contraception is actually the copper Paragard IUD. If inserted within five days of intercourse, it has a 99.9 percent success rate at preventing pregnancy. Sperm hates copper and it won’t make the effort to swim past all that metal in an attempt at fertilization. Unlike either of the pills, Paragard has the same efficacy no matter the weight of the person with the uterus. It’s also the only non-hormonal emergency contraceptive option. However, Paragard is generally the least popular of the IUD options because of its tendency to cause extremely heavy menstrual cycles. Hey, at least it’s not childbirth!
If all else fails and that pregnancy test still insists on displaying the unexpected, now comes the time for abortive options. In 2000, the “abortion pill,” as non-surgical abortion is often called, became available for use in the United States. Non-surgical, or medical abortion, involves the combination of mifepristone and misoprostol to end a pregnancy up to ten weeks after the start of the person’s last period. Mifepristone, taken first, often in a clinic or other professional setting, blocks production and release of progesterone, thus breaking down the lining of the uterus. 24 to 48 hours later, misoprostol is taken to empty the contents of the uterus which usually takes between four and five hours but can last up to a few days. The person will often experience vertigo, cramping, nausea and flu-like symptoms. The prescribing clinic often requires a follow-up appointment one to two weeks post-abortion to ensure the health of the client. Many people choose the “abortion pill” if in early stages of pregnancy because it is less invasive, often cheaper than surgical options and can be done in the comforts of one’s home.
Surgical abortion occurs in-clinic and usually involves aspiration or dilation and evacuation (D&E) depending on stage of pregnancy. Aspiration, performed earlier than 16 weeks after a person’s last period, terminates pregnancy by ejecting the contents of the uterus with suction. The doctor will numb the cervix with local anaesthetic, dilate the cervix to the necessary width, and insert a cannula (tube) into the uterus which is then connected to a handheld suction device. The person may experience cramping and feelings of contraction during the procedure. After ensuring that the uterus has been successfully emptied, the procedure is complete and the pregnancy has been terminated. Fewer than one in 200 people experience complications requiring hospitalizations during aspiration abortions, which is lower than the risk of carrying a pregnancy to full-term and giving birth.
D&E occurs after the first-trimester of pregnancy or later than 16 weeks after a person’s last period. It is procedurally similar to aspiration abortion, but the cervix must be dilated to a greater degree, using either osmotic dilator rods, misoprostol (see above) or a combination of each. The cervix is dilated before the in-clinic procedure, which follows the same steps as the aspiration abortion described above. Heavier sedation may be used in this case, as the pain can be more severe. Abortion providers use suction, forceps and curettes to empty the contents of the uterus. In some cases, the doctor may inject digoxin into the uterus to ensure fetal demise before the procedure takes place. Contrary to popular rhetoric, the fetus does not have the ability to feel pain before the third trimester of pregnancy.
About 30 percent of people with uteri will terminate a pregnancy in their lifetimes in the United States. People feel happy after their abortion; people grieve after their abortion; people feel nothing after their abortion. People who have had abortions will go on to have children or will never have children. They will decide to have large families or small families or no families. They are gay and straight and trans and queer. They are black and white and brown and Christian and Jewish and atheist. There is no one “abortion narrative” because there is no one human narrative. I hope you learned something this week.
Questions? Comments? Insults? Email me, but remember that it won’t be anonymous.