Q. I just had an abortion and it has been more than 24 hours, and I have not yet started bleeding. What does that mean ?
A. Well, my love, I hope it means you haven’t Googled the phrase “after abortion side effects” and clicked on the very first two results, aka, Afterabortion.org. The site, which bills itself with a tagline that asks, “Were You Deceived? The Rights of Women and How You Can Help to Enforce Them” and statistics which include death as one of the most common side-effects of an abortion, a statistic I tend to agree with, if it is the type of abortion done in back alleys, with little sanitation or care for the life of the woman on the table, self-induced, and quite possibly the worst, done after the passing of Roe v. Wade, but in such a horrendous and exploitative fashion, that you think the law had never even passed. Coincidentally, afterabortion.org does not mention that their mother organization, The Elliot Institute, regards its purpose as getting rid of abortion completely, as well as exposing “the effects of eugenics, abortion, population control, and sexual attitudes and practices on individuals and society at large.” The site, which includes tabs like “Modern Mad Scientists” and “Lies and Deception,” is the brain child of David Reardon, who also happens to be the director. Reardon is an advocate “in favor of legislating strict barriers to abortion, has authored of a number of articles and five books examining the controversial issue of mental health effects associated with abortion, and was described in the New York Times Magazine as the “Moses” of the “post-abortion movement.” I don’t mean to dissuade you from Googling “abortion,” only to say, proceed with caution, as the said well-meaning information seas out there are quite choppy and misinformed.
Before we can talk about what you should or should not be experiencing post-abortion, we need to know what which abortion you had, and what is considered “normal,” post-procedure. There are two different methods of abortion: the abortion pill (RU 486, aka Mifepristone), and in-clinic abortions, which are sub-housed in two different medical procedures, aspiration and dilation and evacuation. (Please note: all information resources on both abortion types will come from PlannedParenthood.org.)
RU486 is “a medicine that ends an early pregnancy. In general, it can be used up to 63 days – 9 weeks – after the first day of a woman’s last period.” The pill is part of a three-step process, which breaks down to the following:
- The Abortion Pill: This pill works by blocking the hormone progesterone. Progesterone is what causes the lining of the uterus to stay intact, so without it, the lining breaks down, and pregnancy cannot continue. Often this pill is given with an antibiotic, since the shedding of uterine lining, whether through abortion or your period, always leaves the uterus vulnerable to bacteria.
- Misoprostol: This causes to uterus to expel whatever is inside, thus, where the cramping and bleeding comes into play. “Some women may begin bleeding before taking the second medicine. But for most, the bleeding and cramping begin after taking it. It usually lasts a few hours. You may see large blood clots or tissue at the time of the abortion. More than half of women abort within four or five hours after taking the second medicine. For others, it takes longer. But most women abort within a few days. It’s normal to have some bleeding or spotting for up to four weeks after the abortion.” Side-effects include heavy cramping, bleeding, headaches, vomiting, similar side-effects you have on your period, but amplified.
- Follow-up: This is the check-out period, where your doctor will make sure that everything is okay and that the RU486 did its job. Normally a blood test or an ultrasound is part of the final check-up, to ensure that there is nothing left inside your uterus that might end up harming you later on.
What’s notable about Planned Parenthood’s site is that they acknowledge that side-effects are different. Some people take a few hours before they begin bleeding, some begin almost immediately. Some begin in a few days. There isn’t a one-size-fits-all formula, even for this medical procedure. Physical side-effects are different for each person, though we can safely say that if you are experiencing heavier than normal bleeding (soaking through multiple pads in a short amount of time), uncontrollable vomiting, a high fever, or vaginal odor, then you should consider it an emergency, and contact your doctor ASAP.
If you are past nine weeks, in-clinic abortions are the standard procedure and will either be aspiration or dilation and evacuation. Each procedure has its own intricacies and side-effects, though both are more invasive procedures than RU486.
- Aspiration: Vacuum aspiration is available up to sixteen weeks of pregnancy and involves the numbing and opening of the cervix, normally done with dilators.The dilators absorb fluid inside the vaginal canal, and stretch the cervix open. After the cervix has opened, either a hand-held suction device or a suction machine gently empties your uterus, finishing off with a curette, which is a tool that ensures that nothing has been left behind in the uterus. While the aspiration itself takes five to ten minutes, it is the dilation period that normally takes the longest, which is also dependent on how your body reacts to the dilators.
- Dilation and Evacuation: A similar procedure to aspiration, D&E is a procedure done after sixteen weeks of pregnancy. It is the most invasive of the procedures and depending on how far along the pregnancy is (often second-trimester pregnancy), can be accompanied with a shot to end fetal heartbeat. A vacuum aspirator is inserted into the cervix, as well as a variety of medical instruments, since there is more fetal tissue to breakdown. The procedure takes ten to twenty minutes and requires sedation, though, like aspiration,the dilation period is normally what takes the longest.
Local anesthetics, general anesthesia, pain reliever, and antibiotics are all considered standard with in-clinic procedures, though local anesthesia is more common than general. Side effects can include heavy bleeding for the first few days post-abortion, spotting that can last up to six weeks, and no bleeding at all. It varies from person to person, and again, it is best to call your doctor if you are experiencing heavier than normal bleeding (soaking through multiple pads in a short amount of time), uncontrollable vomiting, a high fever, vaginal odor, and heavy abdominal cramping.
So are your symptoms normal? While it’s hard to tell what is and isn’t over the divide of the vast Internet, and the fact that I am just a naked lady on the Internet and not a doctor, I fall into the assumption that what you are experiencing is normal. The best bet of feeling like something “not normal” is if you feel like there is a serious cause for concern. There is no harm in calling your doctor, just to ask if what you are experiencing is normal, even if it is only for your own peace of mind.
There is one more thing I’d like to talk about, concerning “normal” side effects, post-abortion: how you feel. Not physically, not intellectually, but emotionally. It’s a pretty taboo subject: having an abortion is already so loaded with inflamed rhetoric and the sheer need to just defend the procedure itself, so there isn’t always space offered to have mixed emotions over having an abortion. You might be relieved, but depressed. You might be sad, but know it was the best decision. You might be emotionally drained, you might throw a goddamn party. The emotional playing field after an abortion is unfortunately not as cut and dry as the procedure itself, but what you feel is worthy of being talked about, whatever it is that you are feeling. There really isn’t one way to feel after an abortion and there certainly is no “wrong” emotion, though there are ways of why you might feel that need to be further looked into. PP recommends Exhale, a pro-choice post abortion support network that recognizes that abortion is a deeply personal decision and that while we all come from different places, many of us are united by one of the most commonly performed gynecological procedures in the U.S. What is more normal than that?
Got a question to ask, subject you’d like us to discuss, or myth you’d like us to bust? Keep “˜em coming! You can send us an anonymous message via the Ask Us! feature here.
Exhale offers a free, national talkline that provides emotional support, resources and information. All calls are completely confidential and counselors offer support and respect without judgment. The service is available in multiple languages, including English, Spanish, Cantonese, Mandarin, and Vietnamese. The Exhale talkline is available to women and girls who have had abortions, and to their partners, friends, allies, and family members.