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 (Medical abortion | Abortion Pill)
is also available early in the first trimester.
All services are outpatient, by appointment only. Please call for available days and times. 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
Surgical abortions 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.
Rh typing is performed in our on-site lab and is included in the fee. 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 given. Additional
pain medication by injection is available for a fee of $60. 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. She/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 she/he can
view the cervix. She/he will clean the cervix with a Betadine
solution, and numb it using Lidocaine. She/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. She/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 or friendly 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, or ask about a pre-counseling
session scheduled on a day previous to your abortion appointment.
Medical Abortion (Abortion Pill)
The medical abortion is a non-surgical option available
to women who are no more than nine 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. Both medications must be taken to complete the abortion process and avoid complications.
The combination of 200mg of oral Mifeprex, followed in
24-48 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 and 63rd 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 24 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. Not all clinics are equipped to offer the surgical procedure to complete a "failed" medical abortion (about 2% of the time). Our facility provides this service to our patients at no additional cost.
If you would like to reduce the amount of time spent at
your appointment, please download the FORMS,
complete and bring them with you, or ask about a pre-counseling
session scheduled on a day previous to your abortion appointment.
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