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Abortion: Making a Decision
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Introduction
Development of An Unborn Child
Description of Growth with Pictures
Abortion Methods and Medical Risks
Emotional Reactions to Abortion
Medical Risks of Childbirth
Information About State Health Care Programs that Pay for Prenatal Care, Childbirth, and Neonatal Care
Directory
INTRODUCTION
The information in this booklet has been developed to give a woman basic information before making a decision about having an abortion.
It illustrates and describes, at two-week intervals, how an unborn child grows during the stages of a woman’s pregnancy. Also provided is information about the chances of a baby’s survival when born at a given gestational age. Survival here is defined as living 28 days after birth.
Information is given about abortion methods and the medical risks and emotional reactions of an abortion. Also described are the medical risks of childbirth. However, it should be emphasized that as technology and medical advances occur, the medical risks associated with abortion and childbirth are diminishing.
State health care programs that pay or help pay for medical bills for prenatal care, childbirth and neonatal care are explained in this publication. A directory of names, addresses and telephone numbers of County Assistance Offices and social service agencies is also available. The directory is broken down by county, so callers can get information and help from places located close to where they live.
By calling or visiting the agencies and offices, a woman can find out about alternatives to abortion, adoption and the kinds of assistance available to help her through pregnancy and childbirth and while she is raising her child.
Furthermore, every woman should know that:
It is unlawful for any individual to coerce a woman to undergo an abortion.
Any physician who performs and abortion upon a woman without obtaining her informed consent or without according her a private medical consultation may be liable to her for damages in a civil action at law.
The father of a child is liable to assist in the support of that child, even in instances where the father has offered to pay for an abortion.
The law permits adoptive parents to pay costs of prenatal care, childbirth and neonatal care.
This booklet is available free of charge upon request by calling the toll free State Health Line at 800-692-7254.
Also available are pamphlets about state health care programs such as the Medical Assistance program for pregnant women called Healthy Beginnings which pays or helps pay the cost of prenatal care, childbirth and neonatal care. Call the Welfare Help Line at 800-692-7462 for information on eligibility.
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DEVELOPMENT OF AN UNBORN CHILD
The age of an unborn child (gestational age) is measured in two different ways. Embryologists (doctors and scientists who study the early stages of pregnancy) measure the age of an unborn child from the etstimated day of conception (the time when you actually become pregnant). This book refers to that measurement of gestational age as “weeks fertilization”.
On the other hand, practicing doctors measure an unborn child’s age from the first day of your lasts menstrual period which usually occurs two weeks before fertilization (conception). This book refers to that measurement as “weeks menstrual”.
On the following pages are pictures and descriptions of how an embryo and fetus grow in a woman’s body.
The dimensions (inches/millimeters and pounds/grams) are based on information presented by Williams Obstetrics, Eighteenth Edition, 1989.
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DESCRIPTION OF GROWTH WITH PICTURES
After fertilization, the egg divides and multiples to form the embryo.
2 Weeks Fertilization
4 Weeks Menstrual
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The developing embryo is about the size of a pinhead and is now inside a protective shell of special cells in the uterus wall. The cells are beginning to grow into groups that will be parts of the embryo.
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3 Weeks Fertilization
5 Weeks Menstrual
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The embryo and first nerve cells have formed.
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4 Weeks Fertilization
6 Weeks Menstrual
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The embryo is about ¼ inch long (5 millimeters. A blood vessel forms which will later develop into the heart and circulatory system. It begins to pump blood. At about the same time, a ridge of tissue forms down the length of the embryo. That tissue will later develop into the brain and spinal cord. Arm and leg buds are present.
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6 Weeks Fertilization
8 Weeks Menstrual
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The embryo is about ¾ inch long (23 millimeters.) Cells of the embryo continue to multiply and start to form the brain. At the other end is a tail bud which will become the end of the spine. Fingers and toes are starting to appear. Cells which also are multiplying in other parts of the embryo are starting to form the eyes, ears, jaws, lungs, stomach, intestines and liver.
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8 Weeks Fertilization
10 Weeks Menstrual
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The embryo is called a fetus. The length of the fetus, measured from the top of the head to the bottom trunk (crown to rump), is about 1½ inches (4 millimeters). The head is large. Structures which will form the eyes, ears, arms and legs are identifiable. Muscles and skeleton are developing.
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10 Weeks Fertilization
12 Weeks Menstrual
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All major external body features have appeared. The fetus from crown to rump is approximately 2 ½ inches long (60millimeters), and weighs roughly ½ ounce (14 grams). The muscles continue to develop. Fingers and toes are distinct and have nails.
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12 Weeks Fertilization
14 Weeks Menstrual
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The fetus measures approximately 3 ½ inches long (87 millimeters), and weighs roughly 1 ½ ounces (45 grams). The head is still the dominant part of the fetus. The eyes are beginning to grow toward the front of the head and 20 buds are present for baby teeth. There are eyelids and the nose is developing a bridge External genitals have been developing so that the sex can be identified.
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14 Weeks Fertilization
16 Weeks Menstrual
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The length of the fetus is approximately 5 inches (120 millimeters), crown to rump, and the weight is roughly 4 ounces (110 grams). Limbs are well developed. The skin appears transparent. The head is large compared to other body structures.
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16 Weeks Fertilization
18 Weeks Menstrual
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The fetus from crown to rump is now roughly 5 ½ inches long (140 millimeters). Weight is almost 8 ounces (200 grams). Skin is pink and transparent.
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18 Weeks Fertilization
20 Weeks Menstrual
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Crown to rump length is about 6 ¼ inches (160 millimeters). Weight is almost ¾ pound (320 grams). Fine, downy hair as well as scalp hair appears on the fetus. Respiratory movements occur, but the lungs have not developed enough to permit survival outside the uterus. By this time the woman can feel the fetus moving.
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20 Weeks Fertilization
22 Weeks Menstrual
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Crown to rump length is about 7 ½ inches (290 millimeters). Weight is about one pound (460 grams). The kidneys are starting to work and the air sacs of the lungs are starting to develop. The fetus is more active turning from side to side. Up to this time, there is very little chance that a baby would survive outside the uterus. Selected Pennsylvania Hospitals report that 1-10% of babies treated in the neonatal intensive care units of those hospitals survived for at least 28 days or to the day when they were discharged from those intensive care units*.
*There are, however, no definitive published studies on survival rates for babies born at this stage.
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22 Weeks Fertilization
24 Weeks Menstrual
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Crown to rump length is about 3¼ inches (210 millimeters) and weight has increased to about 1¼ pounds (630 grams). Head and body hair are evident. The skin is wrinkled and still extremely thing. Eyebrows and eyelashes are more evident. Fat is beginning to form on the fetus and, usually, evidence of the fetal skeleton can be detected. At this time, changes are occurring in lung development so that some babies at this stage may be able to survive outside the uterus, given the technology and intensive care services provided in many hospitals. Still, chances of survival are poor. Selected Pennsylvania hospitals report that for babies born at this time and treated in the neonatal intensive care units of those hospitals, up to 66% survived for at least 28 days or to the day when they were discharged from the neonatal intensive care unit.* If the baby lives, there is a likelihood it will have long term disabilities.
*There are, however, no definitive published studies on survival rates for babies born at this stage.
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24 Weeks Fertilization
26 Weeks Menstrual
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Crown to rump length is about 9 inches (230 millimeters) and the average weight is two pounds (820 grams). Lungs continue to develop. Body movements are stronger. Skin is red and wrinkled and covered with fine soft hare. Selected Pennsylvania hospital report that for babies born at this time and treated in the neonatal intensive care unit of those hospitals, up to 82% survived for at least 28 days or to the day when they were discharged from the neonatal intensive care unit. *
*There are, however, no definitive published studies on survival rates for babies born at this stage.
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26 Weeks Fertilization
28 Weeks Menstrual
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Crown to rump length is about 10 inches (250 millimeters. Weight is about 2 ½ pounds (1,00 grams). The fetus continues to develop and grow. Eyes are partially open. According to national statistics, about 90% of babies born at 28 through 29 weeks menstrual survive.
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28 Weeks Fertilization
30 Weeks Menstrual
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Crown to rump length is about 10 ½ inches (270 millimeters) and weights 1,300 grams or almost 3 pounds. Fat is accumulating and the body is more rounded. Fetus can open and close its eyes, suck its thumbs and cry. National statistics show that about 96% of babies born at 30 through 31 weeks menstrual survive.
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30 Weeks Fertilization
32 Weeks Menstrual
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Crown to rump length is about 11 inches (280 millimeters). Weight is more than 3 pounds (1,700 grams). The fetus continues to develop with wrinkles appearing on the soles of the feet. About 98% of babies born at 32 through 33 weeks menstrual survive (based on national statistics).
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32 Weeks Fertilization
34 Weeks Menstrual
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Crown to rump length is about 12 inches (300 millimeters). Weight is about 4 ½ pounds (2,100 grams). Skin is pink and smooth. Fat continues to accumulate, and the fetus continues to gain weight steadily. About 99% of babies born at 34 through 35 weeks menstrual survive (based on national statistics).
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34 Weeks Fertilization
36 Weeks Menstrual
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Crown to rump length is about 12 ½ inches (320 millimeters). Weight is about 5 ½ pounds (2,500 grams). The fetus is more round and plump and is almost fully developed. The face is less wrinkled. More than 99% of babies born at 36 through 37 weeks menstrual survive (based on national statistics).
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36 Weeks Fertilization
38 Weeks Menstrual
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Crown to rump is about 13 ½ inches (340 millimeters. Weight is 6 ½ pounds (2,900 grams). At this time, in most cases, the fetus is fully developed. More than 99% of babies born at 38 through 39 weeks menstrual survive (based on national statistics).
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ABORTION METHODS AND MEDICAL RISKS
There are three ways a pregnancy can end: a woman can give birth, a woman can have a miscarriage or she can elect to have an abortion. If you make an informed decision to have an abortion, you and your doctor will need to consider how long you have been pregnant before deciding which abortion method to use. Based on data from the Centers for Disease Control and Prevention (CDC), the risk of dying as a direct result of a legally induced abortion is less than one per 100,000.
The First Trimester
Doctors use a vacuum aspiration method during the first trimester (the first three months of pregnancy). The doctor must first check the size of your uterus. Your doctor will ask you to lie on your back and bend your knees. He or she will place on e hand in your vagina and the other on your abdomen (belly). The doctor will look at the opening of your uterus (the cervix) using a speculum (a special instrument). Next, the doctor will spray or inject medicine on your cervix. This prevents you from feeling any pain. Then the doctor will put a catheter (a soft, clear tube similar to a long straw) into your cervix. The catheter is connected to a machine that acts like a vacuum cleaner. The fetus is sucked out of the womb through the catheter.
If more than six weeks have passed since your last normal period, the doctor must first gently open (dilate) the cervix. He or she will use a larger, firmer plastic tube (a curette) to remove (evacuate) the fetus.
Ending a pregnancy in the first trimester is considered minor surgery. However, in one out of every one hundred abortions, the uterus may not be completely emptied or it may become infected. Both problems are treatable. Also, in one out of every 500 abortions the catheter may go through the wall of the uterus by accident. If this happens, the woman would need surgery to fix the tear.
The Second Trimester
Usually during a second trimester (the fourth, fifth, and sixth months of pregnancy), to perform an abortion, the doctor opens (dilates) the cervix and empties (evacuates) the uterus. This method is known as dilation and evacuation (D & E).
When this abortion method is used in the second trimester, the doctor may insert a sponge-like material into the cervix. As the sponge gets wet it becomes larger, opening the mouth of the cervix. The doctor will remove the sponge two to sixteen hours later. The doctor uses forceps to remove the fetus or fetal parts; the doctor may also suction the fetus or fetal parts by vacuum aspiration using a larger catheter than described for the first trimester. The afterbirth is most commonly removed by vacuum aspiration.
Before the doctor will perform this procedure, he or she needs to feel the size of the uterus to determine the gestational age of the fetus. If the age is determined to be late in the second trimester, the doctor may elect to perform the abortion by labor induction.
During labor induction, labor can be started (induced) by injecting medicines or salt water into the fetal bag of waters (amniotic sac). The medicine can be injected into the bag of waters by cleaning the belly (abdomen) to kill germs on the skin; putting numbing medicine (anesthetic) into the skin; and pushing a needle through the skin into the bag of waters. Medicine may also be injected into the women’s bloodstream through her vein to induce labor. Labor will usually begin in two to four hours.
Generally, labor induction requires a longer stay and is not performed in a clinic setting. If the afterbirth is not removed with the fetus during labor induction, the doctor must open the cervix and suction the uterus as described in the vacuum aspiration method.
When an abortion is performed by the D & E method, there is virtually no chance that the fetus will live through the procedure. When an abortion is performed late in the second trimester, the doctor may elect to inject medicine into the fetus to terminate it before doing the vacuum aspiration. If the labor induction method is used, there is minimal chance that a baby could live for a short period of time. The chance of living outside the uterus increases as gestational age increases. In the event the baby removed is alive, any physician or other medical personnel attending the baby is required by law to provide the type and degree of care and treatment which in the good fathe judgment of the physician is commonly provided to any other person under similar conditions and circumstances.
Complications involved in second trimester abortion from D & E are the same as in the first trimester: the uterus may not be completely emptied, an infection may occur or instruments may tear a hole in the uterus. In second trimester abortions, there may also be heavy bleeding for a few days after the pregnancy has ended. These problems do not happen often and can be medically treated.
Complications in abortions are less frequent in the first eight weeks of pregnancy than later. Labor induction abortion carries the highest risk for problems.
Women who end their pregnancies by vacuum aspiration, labor induction or D & E, do not usually have problems getting pregnant later in life. However, it is possible that have many abortions may make it difficult to have children.
Remember, every method used to end a pregnancy may cause problems. Ask your doctor about all possible problems so he or she can provide you with advice.
The Third Trimester
Your physician may advise you to end your pregnancy early between 24 and 38 weeks gestation (weeks menstrual). Should this advice call for the use of any means to end your pregnancy with knowledge that the termination by those means will, with reasonable likelihood, cause the death of the unborn child, then the termination of pregnancy using such means is an abortion. An abortion at this stage your pregnancy may only be done if your physician reasonably believes that it is necessary to prevent either your death or a substantial and irreversible impairment of one of your major bodily functions.
When a pregnancy is ended at this stage, one of two procedures is performed: labor induction or cesarean section.
If pregnancy is ended by labor induction during the third trimester it is quite different from the description above. In the third trimester, labor can be started by injecting medicine directly into the bloodstream (vein) of the pregnant woman. Labor and delivery of the fetus during the third trimester are similar to childbirth. The duration of labor depends on the size of the baby and the “readiness” of the womb.
As with childbirth, the complications of labor induction during the third trimester include: infection, heavy bleeding, stroke and high blood pressure. When medicines are used to start labor, there is a greater risk of rupture of the womb than during normal childbirth.
If labor cannot be started by injecting medicine into the pregnant woman, or if the pregnant woman is too sick to undergo labor, a cesarean section may be done. A cesarean section is surgery to remove the baby from the womb. Generally, the woman is made numb and sleepy and/or by a combination of medicines injected into the vein or spine and/or medicine inhaled into the lungs. Then the belly is prepared by washing with a soapy solution (antiseptic) to kill the germs. The belly and womb are then surgically cut open and the baby removed.
The complications seen with cesarean section are similar to those seen with childbirth and with administration of anesthesia: sepsis (severe infection); emboli (blood clots to the heart and brain); aspiration pneumonia (stomach contents breathed into the lungs); hemorrhage (severe bleeding); and injury to the urinary tract.
The likelihood that your baby will live after it is delivered during this stage of your pregnancy depends on the baby’s gestational age and health at the time of delivery. When an abortion is performed during the third trimester the following steps must be taken:
- The physician who terminates the pregnancy must certify in writing that based upon the physician’s medical examination and medical judgment, the abortion is necessary to prevent either your death or substantial and irreversible impairment to one of your major bodily functions.
- A second physician must also examine you and certify in writing that based upon that physician’s medical examination and medical judgment, the abortion is necessary to prevent either your death or substantial and irreversible impairment of one of your major bodily functions.
- The abortion must take place in a hospital.
- The physician must select a procedure that is most likely to allow the unborn baby to live.
- A second physician must also be present in the room in which the abortion is performed. That physician will take charge of medical care for the baby immediately after it is delivered and must take all reasonable steps necessary to preserve the baby’s life and health.
The physician is not required to use the abortion method that would provide the best opportunity for the baby to live if the physician determines in his or her good faith medical judgment that use of that method poses a significantly greater risk to your life or to the substantial and irreversible impairment of one of your major bodily functions than would another method.
In the case of a medical emergency, a physician is also not required to comply with any condition listed above which, in the physician’s medical judgment, he or she is prevented from satisfying because of the medical emergency.
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EMOTIONAL REACTIONS TO ABORTION
Because every person is different, one woman’s emotional reaction to an abortion may be different from another’s. After an abortion, a woman may have both positive and negative feelings, even at the same time. One woman may feel relief, both that the procedure is over and that she is no longer pregnant.
Another woman may feel sad that she was in a position where all of her choices were hard ones. She may feel sad about ending the pregnancy. For a while after the abortion she also may feel a sense of emptiness or guilt, wondering whether her decision was right. Some women who describe these feelings find they go away with time. Other women find them more difficult to overcome.
Certain factors can increase the chance that a woman may have difficult adjustment to an abortion. One of these is not having any counseling before consenting to an abortion. When help and support from family and friends are not available, a woman’s adjustment to the decision may be more of a problem.
Other reasons why a woman’s long-term response to an abortion can be poor may be related to past events in here life. For example, negative feelings could last longer if she has not had much practice making major life decisions or already has serious emotional problems.
Talking with a professional and objective counselor can help a woman fully consider her decision before she takes any action.
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MEDICAL RISKS OF CHILDBIRTH
Continuing a pregnancy and delivering a baby is usually a safe, healthy process. Based on data from the Centers for Disease Control and Prevention (CDC), the risk of dying as a direct result of pregnancy and childbirth isles than 10 in 100,000 live births. The risk is higher for Blacks (22.0 in 100,000).
The most common causes of death of a pregnant woman are:
- Emboli (blood clots affecting the heart and brain).
- Enclampsia (high blood pressure complications affecting pregnancy).
- Hemorrhage (severe bleeding).
- Sepsis (severe infection).
- Cerebral vascular accidents (stroke, bleeding in the brain.
- Anesthesia-related deaths.
Together, these causes account for 80% of all deaths relating to a woman’s pregnancy. Unknown or uncommon causes account for the remaining 20% of deaths relating to pregnancy. Women who have chronic severe diseases are at greater risk of death than healthy women.
Continuing your pregnancy also includes a risk of experiencing complications that are not always life-threatening.
- Approximately 15 to 20 of every 100 pregnant women require cesarean delivery (delivery by cutting open the abdomen).
- One in 10 women may develop infection during or after delivery.
- Approximately one in 20 pregnant women have blood pressure problems.
- One in 20 women suffer from excessive blood loss at deliver.
Information about State Health Care Programs That Pay for Prenatal Care, Childbirth and Neonatal Care
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INFORMATION ABOUT STATE HEALTH CARE PROGRAMS THAT PAY FOR PRENATAL CARE, CHILDBRITH AND NEONATAL CARE
You may or may not qualify for financial help for prenatal, childbirth and neonatal care, depending on your income. If you qualify, programs such as the state’s Medical Assistance program called Healthy Beginnings, will pay or help pay the cost of doctor, clinic, hospital and other related medical expenses to help you with prenatal care, childbirth delivery services and care for your newborn baby.
Under Healthy Beginnings, a pregnant woman is allowed to have more income to qualify than the income set under the regular Medical Assistance program. You can apply for this financial help at your local County Assistance Office. Your County Assistance Office also can tell you which providers participate in Healthy Beginnings and can answer your questions about other available benefits.
Brochures explaining Healthy Beginnings are available. Call the Welfare Help Line at 800-692-7462 for information about eligibility.
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DIRECTORY
The decision to have an abortion or have a baby must be carefully considered. If you need more help or guidance, a directory is available of county and social service agencies and organizations. You are encouraged to contact them if you need more information so you can make an informed decision. If you want to see the directory, please ask your doctor, nurse or counselor to provide you with it. Or, if you want to obtain a copy of the directory, call the toll free State Health Line at 800-692-7254.
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