Abortion Procedures + Risks

Abortion

Jan 5

Abortion Procedures & Risks

Getting an abortion is a serious decision to make and should not be taken lightly or be done out of pressure or fear. If you are seriously considering an abortion, getting all of the facts concerning your available options is an excellent first step. We hope that the information below is helpful to you.

The Abortion Pill

The abortion pill [1], (medication abortion) is also known as RU-486 and is a duo of medications: mifepristone (Mifeprex) and misoprostol (Cytotec). It is taken up to 10 weeks LMP [2] (that is, measuring from the first day of the last period that you had).

On day one, mifepristone is given and taken orally. This drug works by cutting off the supply of progesterone and results in separating the developing embryo from the uterus lining, causing it to die. A second pill (misoprostol) is then taken (usually 24-48 hours later), which starts contractions. The induced cramping then expels the baby through the vagina [3].

Follow-up with the healthcare provider is usually recommended 1-2 weeks after taking the first pill to check for complications [4], however, additional office visits are up to the abortion provider’s discretion [5].

Side effects may include: [6]

• Abdominal pain

• Severe cramping

• Bleeding

• Nausea

• Vomiting

• Diarrhea

• Headaches

• Dizziness

• Fever and chills

Risks Include: [7]

Abortion Health & Safety Checklist

Surgical Abortion

Suction (or Vacuum) Aspiration: [14]

Suction/Aspiration is a surgical procedure that is used up to 14 weeks LMP. The night before the procedure, the cervix is sometimes softened using laminaria and/or vaginal medication [15]. On the day of the procedure, local anesthetic is injected in the cervix, which is then stretched open using metal dilating rods. A plastic tube is then inserted in the uterus and connected to an electric or manual vacuum device that pulls the baby’s body apart and out. After the suction has completed, a curette may be used to scrape any remaining fetal parts out of the uterus. The removed tissue is then examined to verify completeness.

Risks Include: Serious complications are infrequent [16] but may be associated with long-term health risks [17].

Later-Term Abortions

Dilation & Evacuation (D&E): [24]

Dilation & Evacuation is a surgical procedure that is done 15 weeks LMP and up. For 2 days before the procedure, the cervix is softened using laminaria and/or vaginal medication. Local anesthetic and sedation are given and, in some cases, general anesthesia, if available. The cervix is further stretched open with metal dilating rods, and forceps are used to pull fetal parts out through the cervix. This is followed by an account for all the parts of the baby: skull, spine, ribcage, and four limbs. If there is any remaining tissue, a curette or suction is used to remove it along with any blood clots.

Risks Include:

• Incomplete abortion with retained tissue

• Heavy bleeding

• Reactions to anesthesia

• Infection

• Organ damage

[25]

D&E After Viability: [26]

From 23 weeks LMP and up, lethal injections may be given to stop the baby’s heart [27]. The cervix is softened and dilated for 3 days prior to the procedure, using laminaria and vaginal medication. IV sedation and local anesthetic may be used. During the procedure, surgical instruments are used to grasp and pull fetal parts out through the opened cervix.

An alternative procedure, called an “intact D&E”, attempts to remove the baby in one piece, which reduces the risk to the mother. This procedure usually requires the fetal skull to be crushed before removal.

Risks Include:

• Increased risk to the life and health of the mother

[28]

• Anesthesia complications

• Heavy bleeding

[29]

• Infection

• Organ damage

Labor Induction: [30]

Labor Induction is performed during the 2nd and 3rd trimesters. Lethal injections may be given to end the fetus’ life, and laminaria and/or vaginal medications are used to soften the cervix for 2-3 days. Medications are then given to induce labor and reduce pain through the process of labor and delivery of the deceased baby.

Side effects may include:

• Abdominal pain

• Severe cramping

• Nausea Vomiting

• Diarrhea

• Headaches

• Dizziness

• Fever and Chills

Risks include:

• Hemorrhage

• Need for a blood transfusion

• D&C for retained placenta

• Uterine rupture

What should I do first?

If you are considering an abortion, your first step is to get an ultrasound. Most abortion procedures require a confirmation ultrasound to determine pregnancy and gestational age (which determines what kind of abortion the abortion clinic can offer you and the cost of that abortion procedure).

Thrive Medical Clinic provides a confirmation ultrasound by a licensed medical professional at no charge with no insurance needed. It is important to us to provide you with a safe place to gather medically accurate information about your pregnancy and pregnancy options (abortion, adoption or parenting), from a source that does not profit from your abortion, adoption plan, or any of your pregnancy decisions.

We are not an abortion clinic or an abortion referral service, but we are here as a team of fellow women to serve and support you, without pressure or judgment.

Get An ultrasound

Could abortion affect me later?

The data about the long-term effects of abortion is currently incomplete [31]. However, we encourage you to consider the potential risks of both medical and surgical abortion in their entirety, and how that may impact you in the future.

Emotional:

After abortion, some women say they initially felt relief and looked forward to their lives returning to normal. Other women report negative emotions after abortion that linger, and for some, problems related to their abortion emerge months or even years later [32].

In line with the best available evidence, women should be informed that abortion may significantly increase risks for:

Physical:

The long-term physical risks associated with abortion are not yet fully known or agreed upon by medical experts. Immediate risks that could lead to lasting results include [38]:

• Infection of the womb

• Part of the pregnancy stays in the womb

• Continued pregnancy

• Excessive bleeding

• Damage to the cervix

• Damage to the womb

Future pregnancies may also be affected by other long-term physical risks after an abortion, including:

[39]

[40]

Relational:

Early pregnancy is usually a very private scenario, and not all women feel comfortable discussing their abortion experience later on. Often, it is the most important relationships in a woman’s life that are most keenly affected down the road. Some couples choose abortion to preserve their relationship. Unfortunately, many have experienced an increase of relationship problems after choosing abortion [41].

Pregnancy (no matter the outcome) can have major and lasting effects; it is important to understand that there is no “eraser”. It may also be beneficial to discuss with someone you trust what abortion, adoption, or parenting would entail. Isolation is seldom the best route – neither before nor after your pregnancy outcome.

*Note: No one has the legal right to decide your pregnancy outcome or force you into an abortion, even if you are a minor [42]. If you are feeling pressured or uneasy about your pregnancy decision, please contact us at (231)929-3488.

More help can be reached at: National Domestic Violence Hotline: (800)799-7233 | https://www.thehotline.org | National Human Trafficking Hotline: (888)373-7888 | https://humantraffickinghotline.org

Call us now for help

Spiritual:

As most people consider themselves to be spiritual, it is helpful to consider what personal impact abortion may have on you individually. It is also important to note that spiritual impacts of abortion may be felt at any stage of pregnancy or after an abortion procedure is completed.

Am I at risk?

You may be at risk [43] for emotional or psychological problems following an abortion if any of the following are true for you:

• Being pressured or coerced to abort

• Have, or previously had, mental health problems before abortion

• Feeling very uncertain or having difficulty making the decision

• Have past childhood sexual abuse or unresolved traumatic experiences

• Lack of emotional/social support

• Want the pregnancy

• Believe abortion is against your values

• Have religious beliefs against abortion

• Feel the need to keep the abortion a secret

• Feel attached to the pregnancy

If you can relate to any of the above, you are at increased risk of having mental health problems after abortion [44]. Evidence suggests that abortion does not reduce mental health risks for women pregnant unexpectedly and may increase those risks [44].

Your Legal Rights

As a patient, you should always be treated in a valued and respectful manner by those who are providing you with care. Being equipped with the knowledge and understanding of your legal rights is important. You have the right to:

Talk beforehand to the doctor performing or prescribing your abortion
A full and accurate description of the abortion procedure you are about to undergo
Know all the potential risks and complications of the abortion procedure/prescription – i.e. bleeding, pain, perforation, and other side effects
Know information about the doctor performing the abortion – i.e. current license, hospital privileges, history of malpractice claims or suspended licenses
Be treated with dignity in a safe and sanitary environment
Obtain a second opinion
Ask questions and to change your mind, even at the last minute
Get a copy of your medical records
Ask what hospital you would be sent to if a complication arises
Confidentiality and privacy

What if I change my mind?

During a medication abortion, some women regret their choice after taking the first pill and want to reverse it. This may still be possible [46], and that is where abortion pill reversal comes in.

If you are in doubt concerning your abortion decision, call the 24/7 HELPLINE: (877)558-0333, or visit: abortionpillreversal.com/ for more information.

Women should not attempt to counteract the abortion pill without the assistance of a medical professional.

Before an Abortion Procedure:

There are some things that are essential to do and learn before scheduling your abortion procedure. This includes finding out:

If you are actually pregnant — This cannot be done through a pregnancy test alone. A confirmation ultrasound can medically verify your pregnancy test results and help you determine if there is a viable pregnancy to terminate.
How far along you are — Abortion options and costs vary significantly depending on the gestational age of the fetus; measuring from your last period will not always give you an accurate estimate, especially if your periods are irregular. Surgical abortion and abortion pill costs can range anywhere from about $600-3,000 – depending on how far along you are. A confirmation ultrasound is the best tool to gather this information.
If yours is an ectopic (or tubal) pregnancy — An ectopic pregnancy is where the pregnancy implants outside of the uterus and is a life-threatening situation. Early detection is essential, and a confirmation ultrasound can help rule this out and determine the location of the pregnancy for you. A medical abortion (abortion pill) only terminates a pregnancy inside the uterus and would not eliminate an ectopic pregnancy.
If you are in the early stages of miscarriage — Because there is a chance that your pregnancy may end naturally, you should receive pregnancy confirmation before your abortion (it’s possible to get a positive pregnancy test, even while in the early stages of miscarriage).

If you haven’t already had your pregnancy medically confirmed, we provide confirmation ultrasounds by a licensed medical professional at no charge with no insurance needed. It’s our goal to equip you with the support and services that you need to thrive, in a safe and non-judgmental environment that does not profit from any of your pregnancy decisions.

Schedule a No-Cost Confirmation Ultrasound

Already confirmed?

If you have already confirmed your pregnancy through an ultrasound and are seeking more information, or would just like to have a no-pressure sit-down with a professional Patient Care Assistant and fellow woman, you can contact us for a free and confidential Pregnancy Options Consult, no insurance needed.

We are not an abortion provider, and we don’t refer for abortions. No matter what option you choose, we leave it up to you to select a provider that you trust and feel comfortable with.

Make a Confidential Appointment

Patient Review: “The services provided to me today were extremely helpful. I am grateful that there is a place like this for women in situations like mine. The generosity and kindness I was shown today is remarkable. Thank you.” Read More Reviews

A bit more info about section:

[1.1] American College of Obstetricians & Gynecologists (2014). Practice Bulletin: Medical Management of First-Trimester Abortion (143).

[1.2] U.S. Food and Drug Administration. (2018, February 5). Mifeprex (mifepristone) Information. To view source: CLICK HERE

[1.3] Paul, M., Lichtenberg, S., Borgatta, L., Grimes, D., Stubblefield, P., Creinin, M. (2009). Medical abortion in early pregnancy. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 122-29). Chichester, UK: Wiley-Blackwell.

[2] Typical use is up to 10 weeks LMP, but is used throughout first trimester and beyond. Dickinison, J. E., Jennings, B. J., & Doherty, D. A. (2014). Mifepristone and oral, vaginal, or sublingual misoprostol for second-trimester abortion: a randomized controlled trial. Obstetrics & Gynecology, 123(6), 1162-68. doi:10.1097/AOG.0000000000000290.

[3] Davenport, M. L., Delgado, G., Harrison, M. P., & Khauv, V. (2017). Embryo Survival after Mifepristone: A Systematic Review of the Literature. Issues in Law & Medicine, 32(1).

[4] U.S. Food and Drug Administration. (2016, March). Mifeprex highlights of prescribing information. To view source: CLICK HERE

[5.1.] Foster, A. M. (n.d.). Medication Abortion: A Guide for Health Professionals. Retrieved from IBIS Reproductive Health website. To view source: CLICK HERE

[5.2.] Physician’s Desk Reference (2019). Cytotec | Drug Summary | PDR.net. Retrieved from http://www.pdr.net/drug-summary/cytotec?druglabelid=1044

[5.3.] U.S. Food and Drug Administration, Postmarket Drug Safety Information for Patients and Providers. (2018, February 5). Mifeprex TM (mifepristone) information. To view source: CLICK HERE

[6.1] Center for Drug Evaluation and Research. (2019, April 12). Questions and Answers on Mifeprex. Retrieved from https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifeprex

[6.2] Ibis Reproductive Health. (2005). Medication abortion: A guide for health professionals[Brochure]. Angel M. Foster. To view source: CLICK HERE

[7.1] Ibid

[7.2] U.S. Food and Drug Administration (2018, December 31). Mifepristone U.S. Postmarketing Adverse Events Summary. Retrieved from https://www.fda.gov/media/112118/download

[7.3] American College of Obstetricians & Gynecologists (2014). Practice Bulletin: Medical Management of First-Trimester Abortion (143).

[7.4] Guttmacher Institute (2019, September). Induced Abortion in the United States. Retrieved from https://www.guttmacher.org/fact-sheet/induced-abortion-united-states

[8] Slade, P., Heke, S., Fletcher, J., & Stewart, P. (1998). A comparison of medical and surgical termination of pregnancy: choice, emotional impact and satisfaction with care. Bjog-an International Journal of Obstetrics and Gynaecology, 105(12), 1288-95. doi:10.1111/j.1471-0528.1998.tb10007.x

[9]U.S. Food and Drug Administration, Postmarket Drug Safety Information for Patients and Providers. (2011). Mifeprex TM questions and answers: Retrieved from website: https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifeprex

[10.1] Spitz, I., Bardin, W., Benton, L., Robbins, A. (1998). Early pregnancy termination with mifepristone and misoprostol in the United States. The New England Journal of Medicine, 338(18), 1241–47. To view source: CLICK HERE

[10.2] American College of Obstetricians & Gynecologists (2014). Practice Bulletin: Medical Management of First-Trimester Abortion (143).

[10.3] Food & Drug Administration. (2016, March). Mifeprex clinical studies. To view source: CLICK HERE

[11]U.S. Food and Drug Administration, (2016, March). Mifeprex TM patient agreement. To view source: CLICK HERE

[12] Center for Drug Evaluation and Research. (2019, April 12). Questions and Answers on Mifeprex. To view source: CLICK HERE

[13.1] U.S. Food and Drug Administration (2018, December 31). Mifepristone U.S. Postmarketing Adverse Events Summary. To view source: CLICK HERE

[13.2] U.S. Food & Drug Administration. (2016, March). Mifeprex black box warning. To view source: CLICK HERE

[14.1] Paul, M., Lichtenberg, E. S., Borgatta, L., Grimes, D. A., Stubblefield, P. G., & Creinin, M. D. (2009). First Trimester Aspiration Abortion. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 135-156). Chichester, UK: Wiley-Blackwell.

[14.2] Pfenninger, J. L., & Fowler, G. C. (2011). Pregnancy Termination First-Trimester Suction Aspiration. In Pfenninger and Fowler’s Procedures for Primary Care (3rd ed., pp. 863-872). Mosby, Inc, an affiliate of Elsevier Inc.

[14.3] Planned Parenthood Federation of America Inc. (2019). In-Clinic Abortion Procedures : Planned Parenthood. To view source: CLICK HERE

[15] Fox, M. (2007). Cervical preparation for second trimester surgical abortion prior to 20 weeks. Contraception, 76(6), 486–95.

[16.1] Paul, M., Lichtenberg, E. S., Borgatta, L., Grimes, D. A., Stubblefield, P. G., & Creinin, M. D. (2009). Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 111-92). Chichester, UK: Wiley-Blackwell.

[16.2] Guttmacher Institute. (2019, September). Fact sheet: Induced Abortion in the United States. Retrieved from https://www.guttmacher.org/fact-sheet/induced-abortion-united-states

[16.3] Paul, M., Lichtenberg, E. S., Borgatta, L., Grimes, D. A., Stubblefield, P. G., & Creinin, M. D. (2009). Surgical complications: Prevention and management. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 224-51). Chichester, UK: Wiley-Blackwell.

[16.4] Yang-Kauh, C. (2013). Complications of Gynecologic Procedures, Abortion, and Assisted Reproductive Technology. In Emergency Medicine (2nd ed., pp. 1079-96). Saunders, an imprint of Elsevier Inc.

[17.1] Thorp, J. M., Hartmann, K. E., & Shadigian, E. (2003). Long-Term Physical and Psychological Health Consequences of Induced Abortion: Review of the Evidence. Obstet Gynecol Surv, 58(1), 67-79.

[17.2] Centers for Disease Control and Prevention. (2013, November 29). Abortion Surveillance — United States, 2010. To view source: CLICK HERE

[17.3] Guttmacher Institute. (2019, November 1). State policies in brief: Abortion reporting requirements. To view source: CLICK HERE

[18] Paul, M., Lichtenberg, E. S., Borgatta, L., Grimes, D. A., Stubblefield, P. G., & Creinin, M. D. (2009). Surgical complications: Prevention and management. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 228-32). Chichester, UK: Wiley-Blackwell.

[19.1] Paul, M., Lichtenberg, E. S., Borgatta, L., Grimes, D. A., Stubblefield, P. G., & Creinin, M. D. (2009). Surgical complications: Prevention and management. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 239-44). Chichester, UK: Wiley-Blackwell.

[19.2] American College of Obstetricians and Gynecologists. (2011). FAQs: Pelvic inflammatory disease (077).

[20] Ibid.

[21]Paul, M., Lichtenberg, E. S., Borgatta, L., Grimes, D. A., Stubblefield, P. G., & Creinin, M. D. (2009). Pain management. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 95-97). Chichester, UK: Wiley-Blackwell.

[22] Paul, M., Lichtenberg, Grimes, D. A. (2009). Surgical complications: Prevention and management. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 234-39). Chichester, UK: Wiley-Blackwell.

[23.1] Lichtenberg, E. S., Grimes, D. A.(2009). Surgical complications: Prevention and management. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (p. 224-25). Chichester, UK: Wiley-Blackwell.

[23.2] Guttmacher Institute. (2019, September). Fact sheet: Induced Abortion in the United States. Retrieved from https://www.guttmacher.org/fact-sheet/induced-abortion-united-states

[23.3] Iowa Department of Public Health. (n.d.). Pregnancy Mortality. Retrieved November 18, 2019 - To view source: CLICK HERE

[23.4] Note: the 2017 version of the Guttmacher Fact Sheet included the information to substantiate the text. The 2019 version no longer lists information about abortion mortality. Guttmacher Institute. (2017,Oct). Fact sheet: Induced Abortion in the United States. Retrieved from https://www.guttmacher.org/fact-sheet/induced-abortion-united-states

[24.1] Planned Parenthood Federation of America Inc. (2019). In-Clinic Abortion Procedures: Planned Parenthood. Retrieved from http://www.plannedparenthood.org/health-info/abortion/in-clinic-abortion-procedures

[24.2] Paul, M., Lichtenberg, E. S., Borgatta, L., Grimes, D. A., Stubblefield, P. G., & Creinin, M. D. (2009). Dilation and Evacuation. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 157-74). Chichester, UK: Wiley-Blackwell.

[24.3] Stubblefield, P. G., Carr-Ellis, S., & Borgatta, L. G. (2004). Methods for Induced Abortion. Obstetrics & Gynecology, 104(1), 174-85. doi:10.1097/01.AOG.0000130842.21897.53.

[24.4] American College of Obstetrics and Gynecology. (2013). Practice Bulletin: Second-Trimester Abortion (135).

[24.5] World Health Organization. (2014). Clinical practice handbook for safe abortion. To view source: CLICK HERE

[25.1] Lichtenberg, E. S., Grimes, D. A.(2009). Surgical complications: Prevention and management. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (p. 224-25). Chichester, UK: Wiley-Blackwell.

[25.2] Iowa Department of Public Health. (n.d.). Pregnancy Mortality. Retrieved November 18, 2019 - to view source: CLICK HERE

[25.3] Note: the 2017 version of the Guttmacher Fact Sheet included the information to substantiate the text. The 2019 version no longer lists information about abortion mortality. Guttmacher Institute. (2017,Oct). Fact sheet: Induced Abortion in the United States. Retrieved from https://www.guttmacher.org/fact-sheet/induced-abortion-united-states

[26.1] Paul, M., Lichtenberg, E. S., Borgatta, L., Grimes, D. A., Stubblefield, P. G., & Creinin, M. D. (2009). Dilation and Evacuation. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 157-74). Chichester, UK: Wiley-Blackwell.

[26.2] American College of Obstetrics and Gynecology. (2013). Practice Bulletin: Second-Trimester Abortion (135).

[27] Pasquini, L., et al. Intracardiac injection of potassium chloride as method for feticide: Experience from a single U.K. tertiary centre. Br J Obstet Gynaecol. 2008;115(4):528–31.

[28.1] Iowa Department of Public Health. (n.d.). Pregnancy Mortality. Retrieved November 18, 2019 - to view source: CLICK HERE

[28.2] Note: the 2017 version of the Guttmacher Fact Sheet included the information to substantiate the text. The 2019 version no longer lists information about abortion mortality. Guttmacher Institute. (2017,Oct). Fact sheet: Induced Abortion in the United States. To view source: CLICK HERE

[29] Paul, M., Lichtenberg, E. S., Borgatta, L., Grimes, D. A., Stubblefield, P. G., & Creinin, M. D. (2009). Surgical complications: Prevention and management. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 244-45). Chichester, UK: Wiley-Blackwell.

[30.1] Kapp, N., von Hertzen, H. (2009). Medical Methods to Induce Abortion in the Second Trimester. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 178-88). Chichester, UK: Wiley-Blackwell.

[30.2] American College of Obstetricians and Gynecologists (2013). Practice Bulletin: Second-trimester abortion (135).

[30.3] Perry, R., & Harwood, B. (2013). Options for second-trimester termination. Contemporary OB/GYN, 60-68.

[30.4] Dickinison, J. E., Jennings, B. J., & Doherty, D. A. (2014). Mifepristone and oral, vaginal, or sublingual misoprostol for second-trimester abortion: a randomized controlled trial. Obstetrics & Gynecology, 123(6), 1162-68. doi:10.1097/AOG.0000000000000290.

[31.1] Guttmacher Institute. (2019, November 1). State policies in brief: Abortion reporting requirements. To view source: CLICK HERE

[31.2] Centers for Disease Control and Prevention. (2013, November 29). Abortion Surveillance — United States, 2010. To view source: CLICK HERE

[32.1] Silent No More Awareness. (n.d.). Welcome to our Testimony Directory. To view source: CLICK HERE

[32.2] Roberts, J. (2003, June 20). ‘Roe’ Wants Abortion Case Reversed. AP. To view source: CLICK HERE

[33A.1] Coleman, P.K. (2011). Abortion and mental health: Quantitative synthesis and analysis of research published 1995–2009. The British Journal of Psychiatry, 199, 180–86. doi: 10.1192/bjp.bp.110.077230.

[33A.2] Thorp, J.M., Hartmann, K.E., Shadigian, E. (2003). Long-term physical and psychological health consequences of induced abortion: Review of the evidence. Obstet Gynecol Surv.58(1):67–79.

[33A.3 Fergusson, D. M., Horwood, L. J., & Boden, J. M. (2008). Abortion and mental health disorders: evidence from a 30-year longitudinal study. British Journal of Psychiatry,193, 444-51. doi:10.1192/bjp.bp.108.056499. http://bjp.rcpsych.org/content/193/6/444.full

[33B.1] Cougle J., Reardon, D.C, & Coleman, P. K. (2003). Depression associated with abortion and childbirth: A long-term analysis of the NLSY cohort. Medical Science Monitor, 9 (4), CR105-112.

[33B.2] Fergusson, D. M., Horwood, J., Ridder, E. M. (2006). Abortion in young women and subsequent mental health. Journal of Child Psychology and Psychiatry, 47, 16-24.

[33B.3] Pedersen W. (2008). Abortion and depression: A population-based longitudinal study of young women. Scandinavian Journal of Public Health, 36 (4):424-8.

[33B.4] Rees,D.I. & Sabia,J.J. (2007) The relationship between abortion and depression: New evidence from the Fragile Families and Child Wellbeing Study. Medical Science Monitor, 13 (10), 430-436.

[33B.5] Cougle, J., Reardon, D.C., Coleman, P. K. (2005). Generalized anxiety associated with unintended pregnancy: A cohort study of the 1995 National Survey of Family Growth. Journal of Anxiety Disorders, 19 (10), 137-142.

[33B.6] Mota, N. P., Burnett, M., & Sareen, J. (2010). Associations Between Abortion, Mental Disorders, and Suicidal Behaviour in a Nationally Representative Sample. Can J Psychiatry, 55(4), 239-47.

[34.1] Fergusson, D. M., Horwood, J., Ridder, E. M. (2006). Abortion in young women and subsequent mental health. Journal of Child Psychology and Psychiatry, 47, 16-24.

[34.2] Coleman,P.K.(2006).Resolution of unwanted pregnancy during adolescence through abortion versus childbirth: Individual and family predictors and psychological consequences. Journal of Youth and Adolescence, 35, 903-911.

[34.3] Pedersen, W. (2007). Childbirth, abortion and subsequent substance use in young women: a population-based longitudinal study. Addiction, 102 (12), 1971-78.

[34.4] Coleman, P.K. (2005) Induced abortion and increased risk of substance abuse: a review of the evidence. Current Women’s Health Reviews, 1(21), 21-34.

[34.5] Reardon, D. C., Coleman, P. K., & Cougle, J. (2004) Substance use associated with prior history of abortion and unintended birth: A national cross sectional cohort study. American Journal of Drug and Alcohol Abuse, 26, 369-383.

[34.6] Coleman, P.K., Reardon, D.C., & Cougle, J. (2005b). Substance use among pregnant women in the context of previous reproductive loss and desire for current pregnancy. British Journal of Health Psychology, 10(2), 255-268.

[34.7] Reardon, D.C., & Ney, P. (2000). Abortion and subsequent substance abuse. American Journal of Drug & Alcohol Abuse, 26, 61-75.

[35.1] Curley, M., Johnston, C. (2013). The characteristics and severity of psychological distress after abortion among university students. The Journal of Behavioral Health Services & Research, doi: 10.1007/s11414-013-9328-0.

[35.2] Coleman, P.K., Coyle, C., Rue, V. (2010). Late-term elective abortion and susceptibility to posttraumatic stress symptoms. Journal of Pregnancy, Retrieved from http://dx.doi.org/10.1155/2010/130519

[35.3] Coyle, C.T., Coleman, P.K. & Rue, V.M. (2010). Inadequate preabortion counseling and decision conflict as predictors of subsequent relationship difficulties and psychological stress in men and women. Traumatology, 16 (1), 16-30. DOI: 10.1177/1534765609347550.

[35.4] Suliman S, Ericksen T, Labuschgne T, de Wit R, Stein D, Seedat S. (2007). Comparison of pain, cortisol levels, and psychological distress in women undergoing surgical termination of pregnancy under local anaesthesia versus intravenous sedation. BMC Psychiatry, 7:24 doi:10.1186/1471-244X-7-24.

[35.5] Rue, V.M., et al. Induced abortion and traumatic stress: A preliminary comparison of American and Russian women. Med Sci Monit. 2004;10:5–16.

[36.1] Mota, N. P., Burnett, M., & Sareen, J. (2010). Associations Between Abortion, Mental Disorders, and Suicidal Behaviour in a Nationally Representative Sample. Can J Psychiatry, 55(4), 239-47.

[36.2] Fergusson, D. M., Horwood, J., Ridder, E. M. (2006). Abortion in young women and subsequent mental health. Journal of Child Psychology and Psychiatry, 47, 16-24.

[36.3] Gissler, M., et al. (2005). Injury deaths, suicides and homicides associated with pregnancy, Finland 1987-2000. European Journal of Public Health, 15, 459-463.

[36.4] Shadigian, E.M., et al. (2005). Pregnancy-associated death: A qualitative systematic review of homicide and suicide. Obstet Gynecol Surv.60(3),183.

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