When the pregnant person’s life is in danger

Some preexisting health conditions as well as some pregnancy complications can put your pregnancy health and safety at risk. Expert provider can help manage many of these conditions to allow a pregnancy to progress long enough that the baby is viable (able to survive outside of the womb). But some health conditions and pregnancy complications cannot be managed safely long enough to reach this point. Continuing the pregnancy in these cases would mean certain or high likelihood of death, loss of uterus, or other long-term medical complications — like stroke and other permanent disabilities for the parent. 

Recent federal legislation aims to secure abortion rights in all cases when a parent’s life is in danger, but it is in dispute in several states. Even a delay in care in these situations can have devastating short and long-term health impacts. 

Before we explain the conditions and complications you should be aware of, there are some steps you can take before you become pregnant to support your health. 

Understand the laws in your state

Abortion access varies depending on your state — and in many places your pregnancy trimester, your provider, and your age. In some states, if you’re a minor, you’ll need one or both of your parents’ consent. You can find a state by state breakdown here.

Schedule a preconception visit with your provider 

A pre-pregnancy checkup helps your healthcare provider make sure that your body is ready for pregnancy and often includes some health screenings. During this appointment, you can ask your provider any questions you have about your general and fertility health. 

Consider pre-pregnancy carrier screening

You may discuss this at your pre-pregnancy appointment. A carrier screen is a genetic test that can help you understand your risk of having a baby with a genetic disorder. And you can request it before you’re pregnant. Carrier screening is one of many tools to help you go into starting or growing your family with more information about your risks and options. 

Let’s review conditions and complications that can happen during pregnancy. If you experience one of these, then your state abortion laws could impact your care.

Ectopic pregnancy 

Ectopic pregnancies are early pregnancies that implant and grow in the wrong part of the body — outside of the uterus. The most common location of an ectopic pregnancy is in a fallopian tube, but can happen anywhere within the abdomen, including on the liver or bowel. 

Ectopic pregnancies can never result in a healthy pregnancy and lead to severe internal bleeding and death if left to grow. The only medical treatment available is abortion. The earlier these pregnancies are identified by ultrasound, and treated, the safer it is. If you live in a highly restrictive state, it’s important to know how your provider treats this type of situation. Will you have early ultrasounds? Will you have to travel if you need an abortion? Is there a local hospital that has experience navigating the legal difficulties of this situation? 

Severe hypertensive disorders 

Severe hypertensive disorders of pregnancy most commonly occur later in pregnancy. But, when they happen before viability (around 24 weeks), they are incredibly dangerous for parents. If the pregnancy is not ended, it can result in seizure, stroke, bleeding, and death. The only “cure” for these disorders is immediate delivery. There is no known long-term management option to safely allow the pregnancy to reach viability. Especially for parents with any history or high risk of hypertensive disorders, it’s important to discuss an emergency plan with your provider and any possible preventative steps.

Sepsis and bleeding 

Sepsis and bleeding are two other life threatening complications that can happen in early pregnancy where your body starts to miscarry or labor before about 24 weeks. In these situations, a pregnant person can experience their water breaking or heavy bleeding while their baby is still alive. The treatment for these conditions is delivery.

In states that don’t recognize the life of the parent as a valid reason for abortion, this can end in the death of the parent and the fetus. Even delaying care can increase the risk of serious infection (sepsis), need for blood transfusions and surgery, and death. Again, discussing your options with your provider early in pregnancy can help you feel at ease or make a necessary emergency plan.

When the fetus is at-risk or will not survive after birth

Finding out your baby has a complication or severe illness is one of the most devastating pieces of news to receive as a parent. Modern medicine has made enormous strides to treat certain conditions during pregnancy and work miracles for some people. However, there are chromosomal and genetic conditions that make it more likely for a fetus to die during the pregnancy or immediately after birth. There are also complex fetal differences that may survive birth, but not all parents feel they have the capacity to manage medically, emotionally, financially, or physically. Many people choose to end a pregnancy in these circumstances to reduce suffering for everyone and potential medical complications for the pregnant parent. 

The impact of abortion bans and restrictions

The abortion bans in many states do not have exceptions for these situations. These laws can be confusing and cause delays in care of the pregnant person. Knowing your state’s guidelines, and where you can travel to safely get the care you need is essential. In some states, specialized OBGYNs, called MFMs (Maternal Fetal Medicine specialists), will help identify and explain what is happening with your fetus, but they may be limited in discussing options. They may be able to refer you for a virtual appointment with an MFM out of state to have a more open discussion inclusive of more care options. Early genetic testing and counseling can leave more options open in states that only restrict abortion after a certain gestational age. 

If you find yourself in need of support or information after a devastating diagnosis here are some resources to explore: 

• Empty Arms
• Rare Disease information
• Neonatal donation
• Medical Ethics and Decision Making

Reviewed by the Ovia Health Clinical Team

Ovia’s goal is to support the health and wellness of our members throughout their reproductive health journeys. Ovia cannot, however, encourage or discourage the very personal decision of whether to have an abortion or counsel on whether and how an abortion may be performed in a particular case. Abortion may or may not be legal in your state and in your particular personal situation. None of the information made available through Ovia is intended to provide you with legal advice regarding abortion. Ovia may refer you to third-party websites or publications for additional information on reproductive health issues, including abortion. Ovia is not affiliated with these third parties and is not responsible for any information that they make available to you.

The first days

The type of care you will receive and what you can expect after an abortion depends on how far along your pregnancy is and if you plan to have a medical abortion (taking pills) or a surgical abortion. Surgical abortions are also called D&C or D&E. D&C is dilation and curettage, D&E is dilation and evacuation. They are two distinct procedures done depending upon gestation age at the time of termination.

Surgical abortions take place at a hospital or clinic, while the abortion pill can be taken at home (though some people will take part of the treatment with a provider). As you plan, make sure to pick up pads in various absorbencies (including the heaviest flow), Ibuprofen, and a heating pad.

Most people who take pills for an abortion will have 1-2 days of heavy bleeding and cramping. This may be accompanied by nausea, vomiting and/or diarrhea. It’s likely you’ll pass tissue and clots in addition to bleeding during this time.

The day of a surgical abortion, you will need a ride home because the sedation you’ll receive will make it unsafe to drive. Most people feel sleepy and some feel nauseous. A few hours after, most of the sedation will have worn off, and you’ll feel tired and crampy. 

After the first 1-2 days, most recoveries look similar whether you had a medical or surgical abortion. Most people describe bleeding like a period, with cramping that is usually managed well by medications like Ibuprofen and warmth (warm drinks and a heating pad both help). Try to rest for 1-2 days if possible, as lots of activity will generally cause heavier bleeding and cramping. 

Weeks one-two

Expect bleeding to slow down over about 1 week, with some discharge or spotting lasting 1 week more. This discharge can be black, brown, pink or mucousy. Sometimes discharge or spotting can last for a few weeks, although this is less common.

If your abortion was performed later in pregnancy, you may have breast/chest changes — this can range from soreness to severe engorgement and milk production. Wearing a supportive bra and icing your chest will help (so will the Ibuprofen you’re already taking for cramps). Some people also add Cabocreme or cabbage leaves to their care. If you are having pain for more than 1-2 days, reach out to your provider for support. If you can’t talk to your provider, monitor for signs of a breast infection. 

After week two

Many people find their menstrual cycle takes 1-3 months to get back to their normal, though it is possible to ovulate right away (before your next period), so take steps to prevent pregnancy or try again depending on your situation. 

If your abortion happened later in pregnancy, then it’s more common to experience longer amounts of bleeding, discharge and cramping. 

Your emotions

The range of emotions after abortion varies as much as the reasons for needing one. You could be feeling immense relief, sadness or just be ready to move on. Whatever your experience is, your feelings are valid. There are also significant hormonal changes at play, knowing that you can expect some ups and downs can help you prepare for them. 

It may feel taboo to talk about your abortion and — depending on where you live — it may not feel like a safe option. If you’re able, talking to a trusted partner or friend can be validating and can help you process your experience. If you’re unable to talk to someone, writing in a journal or doing other activities like meditation can help.

If you need some more support, there are after-abortion hotlines to call, including https://exhaleprovoice.org/resources/. 

What to avoid after an abortion

Until you stop bleeding, you should generally avoid:

• Tampons or anything else in the vagina (if you took pills, you can use tampons or a menstrual cup after the first few days when you’re sure your bleeding has slowed down)
• Swimming or baths
• Intercourse 
• Vigorous exercise
• Breast/nipple stimulation like touch or warm water (for abortions that happened later in pregnancy)

Your provider may have given you more relaxed instructions, and that’s okay too! Be sure to follow their recommendations and take medication they may have prescribed for you.

Warning signs

Be on the lookout for any of these symptoms, each of which are a reason to call your provider right away.

• Heavy bleeding that soaks through a pad in one hour. If you’ve been very active, try rest and a heating pad to see if this helps slow the flow, but continued heavy bleeding needs attention.
• Fever over 100.3F
• Pain that doesn’t get better with medication, warmth and rest
• Clots larger than a lemon 
• Fainting
• Discharge that smells bad or looks like pus
• Still feeling pregnant 2 weeks after your abortion
• Nausea, vomiting or diarrhea that lasts more than 1-2 days

It’s not common to have a complication after an abortion, but watching for warning signs and getting medical help if needed is important to take care of yourself. 

Make a plan that includes where you’ll get care if you need it and who you can rely on for support and transportation. Remember that if you need to seek urgent care for bleeding, or any of the other warning signs above, you do not need to tell medical providers that you had an abortion. The medical care for complications after an abortion is the same as after a miscarriage. 

Reviewed by the Ovia Health Clinical Team

Read more:

• What is a medical abortion and how to access one
• How to find abortion care

Ovia’s goal is to support the health and wellness of our members throughout their reproductive health journeys. Ovia cannot, however, encourage or discourage the very personal decision of whether to have an abortion or counsel on whether and how an abortion may be performed in a particular case. Abortion may or may not be legal in your state and in your particular personal situation. None of the information made available through Ovia is intended to provide you with legal advice regarding abortion. Ovia may refer you to third-party websites or publications for additional information on reproductive health issues, including abortion. Ovia is not affiliated with these third parties and is not responsible for any information that they make available to you.

What exactly is the abortion pill and how does it work?

The “abortion pill” is a bit of a misnomer as it isn’t a single pill. The most common “abortion pill” is a combination of Oral mifepristone (Mifeprex) and oral misoprostol (Cytotec). The former is used to prevent the embryo from growing, and the latter is used to release the embryo from your body. 

Those who get the abortion pill from a provider will likely take Mifeprex in their provider’s office and the Cytotec later at home. You may be asked to return to your provider’s office after about a week so they can confirm the abortion is complete.

Can I purchase the abortion pill online?

Yes. Some opt to purchase abortion pills from legitimate sources online and take them at home. While this is a safe option for most people, it’s a good idea to take a couple steps to make sure you’re safe: preselect a provider that you can contact if you experience side effects and plan to have someone you trust nearby. 

Additionally, the combination of Oral mifepristone (Mifeprex) and oral misoprostol (Cytotec) is not the right abortion method if you’re experiencing an ectopic pregnancy. If you haven’t had an ultrasound, there is a chance that you could be experiencing an ectopic pregnancy without knowing it. It’s always a good idea to check with your provider if possible before taking any medication. Medical abortion is only an option for those who are less than 10 weeks pregnant. If you’re not sure how far along you are, you’ll also need to check with a provider.

If it’s not possible to check in with a provider, serious side effects to look out for are severe stomach pain, fainting or lightheadedness, or sudden shoulder pain. If you notice these symptoms, go to a hospital right away — they will be able to treat you even if abortion is not legal in your state. 

What are normal side effects?

While side effects can vary from person to person, everyone will experience cramping and bleeding. Some more serious side effects, like nausea, vomiting, chills, headache, and diarrhea are also possible. 

Where can I access a medical abortion?

Through your provider or online from sites like https://www.abortionfinder.org. 

How much does it cost?

The abortion pill can cost several hundred dollars, or much less, depending on where you get it and if your insurance covers it. There are abortion funds that can help you cover the cost — learn more here. 

Are there risks?

There may be legal risks to purchasing and taking the abortion pill, depending on where you live. You can find more information about legal risks here. 

And, as with any medication, there are medical risks and side effects associated with the abortion pill (including those cited above). That said, it is a safe, effective, and FDA approved method.

Reviewed by the Ovia Health Clinical Team

Read more:

• What to expect after an abortion
• How to find abortion care

Sources

• Mayo Clinic Staff. “Medical abortion.” Mayo Clinic. Mayo Clinic. July 29, 2022. https://www.mayoclinic.org/tests-procedures/medical-abortion/about/pac-20394687. 
• Lauren Cross and others. “Medication Abortion Now Accounts for More Than Half of All US Abortions.” The Guttmacher Institute. The Guttmacher Institute. February 24, 2022. https://www.guttmacher.org/article/2022/02/medication-abortion-now-accounts-more-half-all-us-abortions. 
• “How much does the abortion pill cost?” Planned Parenthood. Planned Parenthood. 
• https://www.plannedparenthood.org/learn/abortion/the-abortion-pill/how-much-does-abortion-pill-cost.
• “Second-Trimester Abortion.” American College of Obstetricians and Gynecologists (ACOG). ACOG. June 2013. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2013/06/second-trimester-abortion.

Ovia’s goal is to support the health and wellness of our members throughout their reproductive health journeys. Ovia cannot, however, encourage or discourage the very personal decision of whether to have an abortion or counsel on whether and how an abortion may be performed in a particular case. Abortion may or may not be legal in your state and in your particular personal situation. None of the information made available through Ovia is intended to provide you with legal advice regarding abortion. Ovia may refer you to third-party websites or publications for additional information on reproductive health issues, including abortion. Ovia is not affiliated with these third parties and is not responsible for any information that they make available to you.