Pregnancy can happen when you, your partner, or both of you were unprepared for a spontaneous moment; but what happens afterwards, when you are left with the possibility of conception? Years ago, for other generations, this would have been a “wait and see” situation. Today you have the option of emergency contraception that can stop pregnancy before it happens.
Emergency contraception can be used if you have had unprotected sex or if you feel that the birth control you used may be ineffective. The key to this type of contraception is that it must be used as soon as you suspect that may get pregnant (within 72 hours after unprotected sex). The emergency contraception pills (ECP) are designed to stop pregnancy, not terminate one that has already occurred.
The ECP is often called “the morning after” pill. Please remember that it is just a name, and not when it is to be taken. This is not meant to be a form of regular birth control. If you feel that you need something more permanent, speak with your healthcare provider to get a prescription.
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So, you think you could be in a situation where your birth control did not work during your last sexual intercourse about a week ago. It may be because you did not get your period on the day it was supposed to start, or you are just questioning the protection that you and your partner used.
Don’t be alarmed! You may still have time to stop pregnancy. If you are within five days of the sexual intercourse that you are worried about, you can take an ECP to avoid this. If you are beyond this five-day window, you may need to look at other options available to stop pregnancy.
The best way to stop pregnancy at this point is a medication that can be used to end an early pregnancy. In many cases, it can be taken as soon as you miss a period and have confirmed that you are pregnant. One good thing is that you have some time to make this decision. However, the first day of your last period has to be less than 9 weeks ago in order to use this medication. (some medications are usually taken within seven weeks of the first day of your last period).
So, how do you calculate how far along you are in a pregnancy? In the United States, this is typically done by calculating how long it has been since your last normal menstrual period.
This is how you calculate gestational age:
- Grab a calendar.
- Look for the date that corresponds to the first day of your last menstrual period.
- Count the number of full weeks that have passed from the date (Step 1) to today's date.
For example, if your last menstrual period started on October 1st and today's date is November 1st, then the gestational age is 4 weeks. That means that it has been four weeks since the first day of your last normal period.
This information can be very helpful if you are looking at your possible options to stop a pregnancy. If in doubt, always speak to a medical care provider about the best way to end the pregnancy based on your gestational age.
A medical abortion is the one that occurs after one week beyond the unprotected sexual encounter in question up to 9 weeks since the first day of your last period (gestational age). Some medications are usually taken within seven weeks of the first day of your last period.
This means that if you find out you’re pregnant at this stage, you are still within the first trimester of the pregnancy. This is still within the legal limits for terminating a pregnancy.
This form of abortion is performed by taking medication that will terminate the pregnancy. One good thing is that you have some time to determine if this is the best option for you; it is also a non-surgical choice. Your healthcare provider will do several things before you begin to take the prescribed medications.
The actions may include:
- Physical exam
- Review of medical history
- Pregnancy test or ultrasound
- Lab tests (blood and urine)
- Explain what a medical abortion is
- Have you sign for consent
Your medical care provider will give you two different medications to take. One will be taken in the office at the time of the visit. This medication is designed to stop the hormone progesterone from working and cause the uterine lining to break down. The second will be given to you to take at home and is usually to be taken within 6 to 72 hours after the first. This medication will cause the uterus to contract and shed the lining.
Most women will experience pain, cramping and heavy bleeding (more than a normal period) within about 1-4 hours after the second medication. This is normal, and it means that it is working.
You may experience some side effects from the procedure:
Your healthcare provider can advise you on what to take to help alleviate these symptoms.
You'll need to visit your doctor again about a week later to make sure the abortion is complete.
Your periods should return to normal after about 4-8 weeks.
After an abortion, you can usually have sex as soon as you feel ready.
But you may experience some discomfort and vaginal bleeding for a wee or two, so you may want to wait until this stops before having sex again.
Use contraception if you don't want to get pregnant, as you may be fertile immediately after the abortion.
One important thing to remember is that once you begin taking the prescribed medications, you should not stop taking it. It is not safe to stop the medicines once you have started taking them. Doing this creates an extremely high risk for severe birth defects if the pregnancy is not terminated.
A surgical abortion is just as it sounds, a surgical procedure to terminate a pregnancy. This surgical procedure is performed during the first trimester of pregnancy (up to 12 weeks gestational age) to terminate an unwanted pregnancy or when certain medical reasons warrant it.
Before a surgical abortion is performed, your medical care provider will perform an ultrasound. This is done to determine if it is a normal uterine pregnancy and to determine the gestational age. During a surgical abortion, you will be in an outpatient setting with surgical bays and monitoring during the procedure. You will be sedated during the procedure and then a local anesthetic will be administered into the cervix. There are several types of surgical abortion techniques available and they tend to be used according to gestational age. They are as follows:
Aspiration (6-16 weeks gestation), also called suction aspiration, suction curettage or vacuum aspiration. Once positioned, the cervix is numbed, and rods are inserted to dilate the cervix. A tube connected to suction is then inserted into the uterus and the fetus and placenta are removed. The procedure takes about 10-15 minutes. In-clinic recovery for several hours may be necessary. The patient is prescribed pain medication and antibiotics.
Dilation and Evacuation (D&E) (after 16 weeks). This procedure may begin with your medical provider inserting laminaria or a synthetic dilator into the cervix 24 hours prior to surgery. An injection may also be given to ensure fetal death prior to the surgery. During the procedure, the cervix is dilated as with the aspiration procedure. The same type of tube is inserted to begin the process of removing the uterine lining. A curette (a surgical instrument that resembles a large spoon) is used to scrape the lining to be suctioned away. The procedure usually takes about 15-30 minutes. Antibiotics will be given to help prevent infection.
Dilation and Extraction (after 21 weeks) also known as D&X, Intact D&X, Intrauterine Cranial Decompression or Partial Birth Abortion. This is a procedure that doctors usually reserve for when there is a serious problem with the fetus or medical complications related to the mother.
With this procedure, laminaria is placed in the cervix two days prior to surgery. By the third day, the cervix should be dilated, and the amniotic sac will break. The procedure starts with forceps being inserted into the uterus in order to rotate the fetus and then pull the legs, arms and body down through the birth canal. A small incision is then made in the base of the skull and the cranial contents are evacuated until the skull of the fetus collapses. The fetus is then completely removed from the uterus and birth canal.
One of the medical reasons that would require a surgical abortion is an ectopic pregnancy. An ectopic pregnancy happens when the fertilized egg implants in the fallopian tube or other areas (ovary, cervix, abdomen) instead of the uterus. If this happens, it does require hospitalization. With an ectopic pregnancy, you may have a positive pregnancy test, but the hormone levels are typically lower than normal. You may also experience cramping and spotting as if your period is about to start. If you experience these symptoms, it is advisable to contact your medical care provider immediately for additional testing and evaluation.
If you are diagnosed with an ectopic pregnancy, the pregnancy will, unfortunately, need to be terminated. It is not a viable pregnancy and can lead to serious health issues for the woman. Termination is done for several reasons. An embryo growing in a fallopian tube will not receive the necessary nutrients to continue to survive, there is not enough room for a fetus to grow, and there is a high risk of bleeding and infection if the fallopian tube ruptures.
If your fallopian tube hasn’t ruptured and your pregnancy hasn’t progressed very far, your doctor can give you an injection of methotrexate. It stops the cells from growing, and your body will simply absorb them.
In other cases, the pregnancy will need to be ended by surgery. The procedure is done by laparoscopy to remove the fertilized egg. During the surgery, most doctors will try whatever they can to save the tube, but sometimes it is just not possible. If severe bleeding occurs and it needs to be stopped quickly, an abdominal incision may be necessary.
For many couples, this can be a difficult time. The woman especially, as you experience not only the emotional loss but the physical stress due to hormonal changes. Fortunately, even if there are complications that the fallopian tube is lost it is still likely you can conceive with just one tube.
Many people believe that there are foods to stop pregnancy. The questions are, what are they and do they work? Some of these foods include parsley, dried apricots, papaya, ginger root, buckwheat and more. After an extensive literature review, there just isn’t any evidence that supports the idea that eating certain foods can prevent pregnancy. Much of the medical literature today provides evidence of foods that should be eaten during pregnancy to support a healthy pregnancy as well as those that should be avoided.
There are many myths about preventing pregnancy and this is one of them. Women should know that taking a hot bath after sex does not prevent pregnancy nor does it diminish your chances of getting pregnant.
There is evidence that temperature changes can affect sperm. However, this is only when applied directly to the sperm. So, you might ask, what if I were to douche with warmer water? This is NOT recommended! It will not do anything to affect the sperm and it could cause internal burns, leading to scar tissue.
This might be a great option if you have an active sex partner, but it is probably the worst way to prevent pregnancy. This too is one of the myths about contraception and conceiving. Many people have been told that having sex less frequently is better when trying to get pregnant. This would then lead you to believe that having sex more frequently would be good for preventing pregnancy. Unfortunately, this is wrong for both circumstances.
If you are trying to conceive, you and your partner should have sex as often as possible. This does not lower the sperm count; in fact, it ensures that the sperm is healthy. For those women trying to prevent pregnancy, the best way is to see your medical care provider and have a conversation about the healthiest way for you and your partner to assure proper protection. For more information about contraception and birth control, check out our interview with a renowned European doctor, Prof. em. Johannes Bitzer.
The only time a “home abortion” is safe is when a medical care provider has performed all of the necessary steps to complete a medical abortion. The final step of a medical abortion is actually done at home when you take the medication that has been prescribed to complete the abortion process. Studies in the United States have evaluated the preferences of women related to medical abortion. A large percentage of the women that were interviewed, would prefer to take the second medication in the privacy of their own home. The researchers also found that the outcome (success rate) related to the choice to take the medication at the medical facility or at home did not change the final outcome of the procedure. All the other ways of performing abortions outside of certified medical facilities can result in serious damage to female health.
Chong, E., Frye, L. J., Castle, J., Dean, G., Kuehl, L., & Winikoff, B. (2015). A prospective, non-randomized study of home use of mifepristone for medical abortion in the US. Contraception, 92(3), 215-219. https://doi.org/10.1016/j.contraception.2015.06.026
Fox, M. C., & Krajewski, C. M. (2014). Cervical preparation for second-trimester surgical abortion prior to 20 weeks' gestation. Contraception, 89(2), 75-84. https://doi.org/10.1016/j.contraception.2013.11.001
Ireland, L. D., Gatter, M., & Chen, A. Y. (2015). Medical compared with surgical abortion for effective pregnancy termination in the first trimester. Obstetrics & Gynecology, 126(1), 22-28. doi: 10.1097/AOG.0000000000000910
Rao, M., Zhao, X. L., Yang, J., Hu, S. F., Lei, H., Xia, W., & Zhu, C. H. (2015). Effect of transient scrotal hyperthermia on sperm parameters, seminal plasma biochemical markers, and oxidative stress in men. Asian Journal of Andrology, 17(4), 668. doi:10.4103/1008-682X.146967
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Whitehouse, C. (2018). Frequent sex – not abstinence – is better for sperm quality. BioNews (Online). Retrieved from https://www.bionews.org.uk/page_138566