The Knoxville Center for Reproductive Health provides abortion services in both the first and early second trimesters of pregnancy. In addition to surgical abortion, a non-surgical option (a medical abortion or abortion by pill) is also available early in the first trimester. All services are outpatient, by appointment only. Abortion services are provided every Tuesday, Friday, and two Saturdays a month. In order to meet all the needs of our patients, private appointments outside of our regular clinic hours are available on a limited basis, for an additional fee. Please call for more information. Which is best for me? Medical vs. Surgical Abortion Chart Surgical Abortion Abortions performed during the first 16 weeks of pregnancy (dated back to the first day of the last normal menstrual period) are performed by vacuum aspiration. This procedure is the safest method available today. All services can be provided in one day. Patients should expect to be in the office for three to five hours, and will undergo lab tests, an ultrasound, explanation of the procedure, informed consent, the abortion procedure, and a recovery period. Patients may opt to schedule an appointment for the pre-abortion lab tests, ultrasound, and informed consent prior to the day of the abortion, minimizing the amount of time spent at the Center on the day of the procedure, and maximizing the amount of time and individual attention given to the patient. In the first trimester, the surgical abortion generally takes a total of five to seven minutes. A second trimester abortion usually lasts for ten to fifteen minutes. Local anesthesia and prescription strength pain medication is used. An anti-anxiety medication is also available by request. You must have a driver to get this medication. During the abortion procedure, a female surgery technician will assist you and the doctor. You may also request that a counselor accompany you during the procedure. Friends and family are not allowed in the surgery suite, but will be kept informed of your progress. The Surgical Abortion Procedure The doctor will begin the abortion procedure by performing a pelvic exam. He will insert two gloved fingers into the vagina, pushing the cervix and uterus towards the top of the abdomen, while pressing on the outside of the abdomen with his other hand. The pelvic exam allows the doctor to determine how far along the pregnancy is, and how your uterus is positioned. Next, the doctor will insert a speculum into the vagina, opening it so that he can view the cervix. He will clean the cervix with a Betadine solution, and numb it using Lidocaine. He will then begin to dilate the cervix using a series of dilators, beginning with a very small one, and working up to one that is about the size of your little finger. Since the cervix is a muscle, you may experience some cramping (similar to menstrual cramps) at this time. Once the cervix is dilated, the doctor will insert a hollow plastic tube into the uterus. This tube is attached to the vacuum aspiration machine, which will then be turned on, and the contents of the uterus will be removed by suction. You may feel a tugging or pulling sensation in your abdominal area at this time. Cramping may also occur as the uterus is beginning to contract. The doctor will use another instrument, a curette, to check the walls of the uterus, and to ensure that the procedure is complete. He will briefly suction again, and then remove all of the instruments. You will spend a short amount of time in recovery following the abortion. The nursing staff will monitor your condition, review your aftercare instructions with you, and provide you with your post-op medications, a prescription for pain medication and your selected birth control method. Safety and Risks As with any surgical procedure, there are potential risks and complications that may occur. In comparison to other surgical procedures, the rate of complications following an abortion is very low. Fewer than 1 in 200 patients have serious complications following this surgery. In order to minimize the chance of complications, it is very important that you provide us with a complete and accurate medical history, that you follow all of the aftercare instructions we provide you with, and that you have a check-up three weeks after your abortion. We are committed to safely and completely terminating your pregnancy. If there are problems or complications that arise, we prefer that you call us directly so that we can provide you with the care and treatment necessary to successfully terminate your pregnancy. As a facility that specializes in abortion care, we are uniquely equipped to diagnose and treat complications that may arise. Should you choose to seek treatment elsewhere, you may incur additional costs and be treated by providers who are less familiar with abortion care. A safe, legal, first trimester vacuum aspiration abortion performed by a board certified gynecologist should not affect a woman's ability to conceive a pregnancy and carry it to term in the future. Statistics are inconclusive concerning women who have multiple (more than three) abortions. More information is available from the Alan Guttmacher Institute (www.agi-usa.org), the leading reproductive health research institute in the United States. If you would like to reduce the amount of time spent at your appointment, please download the FORMS, complete and bring them with you. Medical Abortion (Abortion by pill) The medical abortion is a non-surgical option available to women who are no more than eight weeks into the pregnancy (dating from the first day of the last normal menstrual period). It is a safe and effective method of ending pregnancy using a combination of medications. The Knoxville Center for Reproductive Health offers Mifeprex (mifepristone) in combination with Misoprostol. Mifeprex (previously known as RU-486) is a progesterone hormone blocker that causes changes in the uterine lining, and stops the development of the pregnancy. Misoprostol causes the uterus to contract and expel the pregnancy. The combination of 200mg of oral Mifeprex, followed in 12-48 hours by 800mcg of Misoprostol bucally, is an evidence-based treatment regimen that has been proven more effective and to cause fewer side effects than the regimen approved by the FDA. Studies show this regimen to be approximately 98% effective up to the 49th day of pregnancy, and approximately 95% effective up to the 56th day of pregnancy. Medical abortions beyond 49 days may be associated with a slightly higher rate of complications such as excessive bleeding, incomplete abortions, and ongoing pregnancy. The Medical Abortion Procedure The physician administers the first medication, a 200mg tablet of Mifeprex, which you take by mouth at the Center. You may or may not develop bleeding and/or nausea after taking this medication. Mifeprex can cause nausea. You may already be nauseous from your pregnancy. We encourage you to bring a driver with you so you can receive Phenergan, a medicine for nausea, while you are here at the clinic. You will receive a packet of four Misoprostol tablets to take home with you for later use. You will also be provided with Phenergan tablets (for nausea) and a prescription for pain medication as well as a packet of antibiotics. You will take the Misoprostol tablets bucally (between your gum and cheek) at home, as early as twelve hours after taking the Mifeprex, and no later than 48 hours after taking the Mifeprex. Once you have inserted the Misoprostol tablets, you should plan to be at home with no responsibilities for at least 24 hours. You will likely begin to experience bleeding, passing of blood clots, and cramping within a few hours of taking the Misoprostol. The amount of bleeding and cramping varies greatly from one patient to the next. The heaviest bleeding usually begins as the pregnancy is moving out of the body, and lasts for two to three hours. Typically this bleeding exceeds that of a normal menstrual period, but will subside to a flow similar to a normal menstrual period after the pregnancy has been passed from the body. The average duration of bleeding is 9 to 16 days, though you may experience some bleeding for four to five weeks. Cramping can be quite painful at times. You can expect to pass blood clots that range in size from very small to quite large (the size of golf balls or oranges). Although the pregnancy is very small at this stage, you may see tissue, including the pregnancy and the lining from the uterus, passing from your vagina. Most women will pass the pregnancy from their body within 24 hours of taking the Misoprostol tablets. In a small number of cases, it can take weeks for the pregnancy to be expelled. A follow-up exam is required three to four weeks following treatment, to ensure that the abortion is complete. Occasionally, additional treatment and testing is required either at the time of the follow-up, or after the follow-up exam. Heavy bleeding and the passage of blood clots may be experienced after the follow-up exam. In addition, your next menstrual period may be heavier than normal, and include passing more blood clots. Each of your visits to the Center are extremely important. Failure to complete any part of the treatment can endanger your health. If you fail to return for your follow-up or fail to provide follow-up documentation from another physician, we will contact you by phone or mail. Safety and Risks The medical abortion is very safe and effective. However, as with any medical treatment, some risks are involved. The Center is committed to safely and completely terminating your pregnancy. We encourage all of our patients to follow their aftercare instructions and return for their follow-up exam. If there are problems or complications that arise, we prefer that you call us directly so that we can provide you with the care and treatment necessary to successfully terminate your pregnancy. If you would like to reduce the amount of time spent at your appointment, please download the FORMS, complete and bring them with you. <return to the top>