• Am I considering self-induced abortion due to financial reasons? Organizations in the United States that may provide financial assistance for clinical abortion are listed in the Resources section.
What methods are used in self-induced abortion?
Medical abortion - A pharmaceutical drug-induced abortion, termed ‘medical abortion’ is increasingly recognized as an effective and safe self-induced abortion method. Medical abortion is believed to be safest when used with physician oversight, however when physician oversight is unavailable, medical abortion is regarded as the “best and safest way a woman can do an abortion herself.”[68] In countries where abortion is restricted or illegal, Womenonwaves.org offers medical abortion prescriptions from foreign doctors and online physician advice. (See Resources).
Menstrual extraction – Menstrual extraction is a modified form of the clinical technique of manual vacuum aspiration. Menstrual extraction groups, sometimes called self-help or friendship groups, form a close community of women who educate each other on proper sterile techniques. They share skills and train by seeing and doing. A simple device called a Del-EM™ is traditionally used. The Del-EM™, consisting of a suction syringe, a check valve, tubing, a glass jar, and a sterile flexible plastic tube called a cannula, is used to extract the menstrual fluids from the uterus. Through the careful use of this method by trained women’s self-help groups, many women are finding menstrual extraction to be a safe and effective self-induced abortion option early in a pregnancy.
Herbal abortion – Herbs have been used since ancient times by women to induce abortion.
Homeopathy - Homeopathic remedies (based on herbal abortives) are used in some areas of the world to induce abortion.
Acupuncture – The application of needles inserted and stimulated at specific points on the body has long been used in China for abortive purposes. The development of electronic acupuncture point locators has made this abortion method available to more women.
Massage - The physical manipulation of the body is probably the oldest form of self-induced abortion and still remains popular. The United Nations estimates over 300,000 massage abortions are performed annually in Thailand alone.[69]
Hyperthermia - The application of heat is also an ancient form of abortion. The Greek physician, Soranus, who lived in AD 98-138, prescribed hot baths along with abortive herbs.[70]
Yoga – Yoga, as a menstrual promoting method, is a new discovery. Modern female yoga enthusiasts have learned through experience that some yoga postures and processes have the added benefit of influencing fertility.
Psychic abortion - The use of psychic communication as a fertility regulation method is reported by some women for self-induced abortion.
What steps should a woman take before self-induced abortion?
• Administer a Pregnancy Test
For a woman who has missed her period and suspects she might be pregnant, the first step in making a decision regarding pregnancy is to find out whether or not she is pregnant. Home pregnancy tests, available at a pharmacy, test the urine for the hormone human chorionic gonadotropin (hCG), a hormone secreted in a pregnant woman’s ovary. Some pregnancy tests claim to accurately test on the day of expected menstruation, approximately fourteen days after ovulation. Quantitative hCG blood tests can be accurate 6 – 8 days after ovulation, but are usually only available at a doctor’s office.
• Get a Sonogram
A sonogram (ultrasound) at a clinic after the sixth week will help determine if there is an ectopic pregnancy. It is not possible to safely abort an ectopic pregnancy without physician supervision. Ectopic pregnancies are the leading cause of maternal mortality in the first trimester.
In an ectopic pregnancy the embryo implants outside the womb. The most common site for an ectopic pregnancy is the fallopian tube. Ectopic pregnancies can be fatal if the fallopian tube bursts and the woman bleeds to death before emergency attention can be secured. Sometimes the pain of an ectopic pregnancy can seem heavier than normal cramping pains. On average, the symptoms of an ectopic pregnancy appear 7 - 8 weeks LMP. An ectopic pregnancy may feel a lot like a miscarriage, but if the fallopian tube has ruptured the pain will often become so severe that a woman will have trouble standing up. Pain may be on one side of the pelvis or possibly referred to the shoulder. If an ectopic pregnancy is caught early enough, a doctor can administer methotrexate, a drug that inhibits the metabolism of folic acid, to cause an abortion; and surgery can be avoided.
A woman may be at a greater risk for an ectopic pregnancy if she smokes, has had her tubes tied, has an IUD, has had pelvic surgery, endometriosis, pelvic inflammatory disease, a previous ectopic pregnancy, or if her mother took diethylstilbestrol (DES) while she was in the womb. Ectopic pregnancies occur in one of 3,885 pregnancies in the United States.
• Calculate Gestational Age
A woman can have some idea of what she might expect in an abortion if she calculates the gestational age, the time in weeks that the pregnancy has progressed. Since the exact time of conception is unlikely to be known, the first day of the last menstrual period is used to measure how old the fetus is. The fertile time of ovulation is the time when the majority of women conceive. Knowledge of the gestational age of the pregnancy and fetus is a valuable tool when making decisions and knowing what to expect regarding self-induced abortion methods.
To calculate the gestational age: Take the first day of the last normal menstrual period (LMP) and count forward the number of days that the pregnancy has progressed.
• Review Options
Review available abortion and contraception options (see Resources). Clinical abortion services are usually safer and more effective than self-induced abortion options. Utilize professional clinical abortion services, if possible. Plan to use contraception immediately after abortion, if pregnancy is not desired.
How does a woman care for herself during an abortion?
1. Secure clinical abortion services, if possible.
2. Secure a telephone, be within one hour’s drive of emergency medical services, have transportation, antibiotics, and a support person before considering self-induced abortion.
3. Breastfeeding women have special concerns (see Appendix B and Appendix I).
4. Regularly monitor blood loss and body temperature during and after an abortion. A temperature of 101˚F (38˚C) or above or filling three thick pads in three hours or less requires immediate emergency medical care.
5. Utilize regular uterine massage to help prevent hematometra. Hematometra is when the uterus becomes painfully swollen with blood and clots. The clots can obstruct the release of the uterine contents through the cervical os and prevent the uterus from clamping down to finish the abortion. Hematometra may require uterine aspiration (menstrual extraction). Uterine massage is performed by regularly pressing with force directly above the pubic bone to place pressure on the uterus and help to release clots. Passing clots during uterine massage is normal.
68
Women on Waves Foundation, Amsterdam, Netherlands. http://www.womenonwaves.org/index.php (accessed July 18, 2008).
69
United Nations, “Thailand Population Policy Data Bank,” Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. http://www.un.org/esa/population/publications/abortion/doc/thaila nd.doc (accessed July 21, 2008).
70
Soranus,