Surgical or Medical?

January 31, 2007 4:24 PM

Surgical or Medical abortion?

Today I found out I am pregnant. I am probably about 5 weeks along. I have never been pregnant before. I do not plan on continuing with the pregnancy. I talked to Planned Parenthood today and they inquired as to whether I want to choose a surgical or a medical abortion. I was wondering if anyone had any reasons why one was a better choice than the other. I talked a long while to the woman there, but she was very resistant to give me a recommendation one way or the other. Thanks for your help.

posted by anonymous to health & fitness (29 answers total)

I'm unclear what you mean, about the difference between them. Is she referring to the "abortion pill" rather than a surgical procedure?

Either way, sooner done, the better for you physically.
posted by jokeefe at 4:32 PM on January 31, 2007

Anecdotes are us: a friend (no really) who had a medical one said the cramps were excruciating. I had a surgical one, and although it wasn't pleasant, it wasn't too painful -- just weird -- and it was over quickly.
posted by The corpse in the library at 4:32 PM on January 31, 2007

The sooner the better either way, obviously. I've heard pros and cons for both methods, the best thing would be to ask PP what they perceive as the good and bad of each. To be honest, I've never had the procedure myself, but the vast majority of women I know who have gone through it had no problems at all, regardless of the method. I did a quick web search, and I did find this to be of some interest (it's a debate between doctors):

http://www.aiims.edu/aiims/events/Gynaewebsite/ma_finalsite/report/1_4_1b.html

Either way, take care of yourself.
posted by Dee Xtrovert at 4:38 PM on January 31, 2007

If you read this page, and follow the links about the different types of abortions, they do a good job of describing the pros and cons of each.
posted by jellicle at 4:41 PM on January 31, 2007

From what I've read and from working in gyn/ob (not as a medical provider, although I am related to some), if I'm ever unlucky, I'd go in for an early surgical.

Part of this is because it's a more well-established procedure, and part of it is because I just don't trust hormones to flush the tissue completely from me (but this is me and my experience with massively irregular cycles talking.) But a lot of it is that doctors who provide abortions have likely done more early surgical abortions than any other type, including medical/chemical/hormonal. Additionally, if it fails, one has to go in for a D&C anyway.
posted by cobaltnine at 4:41 PM on January 31, 2007

If there were an obvious answer to your question, we wouldn't have both to choose from, of course. Take a look at the pros and the cons of each.
posted by ikkyu2 at 4:51 PM on January 31, 2007

Is there any particular reason you talked to the undescribed woman at PP and not an OB-GYN? Perhaps you could decide which doctor you want to do the surgery/prescribe the medication, and ask for his/her expertise?
posted by IndigoRain at 4:54 PM on January 31, 2007

There's more sensible advice about making the choice at Netdoctor. Remember when thinking about weeks of gestation, it dates from the time of your last period not the probable time of conception. So if you conceived mid-cycle, three weeks ago, you are five weeks pregnant. If your period is three weeks late, you are actually seven weeks pregnant. (Assuming you have a 28 day cycle).
posted by roofus at 5:03 PM on January 31, 2007

I know someone who had the medical abortion and not only was it painful, but there was still some . . . tissue (?) left and she ended up having to go in for a surgical procedure as well (D&C?). If you are concerned about the price, beware that not only is the medical abortion more expensive but you still may need to pay extra for further procedures.

The surgical abortion, while seemingly more frightening is super quick. The pain level is somewhere between 4-6 on a 1-10 scale (10 being most painful). It is over very quickly. You'll be feeling fine a couple hours later (though you'll bleed for the next week or two).

I hear the medical procedure is very painful and the pain goes on for ever (like birth contractions).
posted by necessitas at 5:05 PM on January 31, 2007

Someone close to me had a surgical one. She said that it was simple, and mostly painless (physically).

Have someone around who can hold your hand, if you can. Good luck.
posted by dirtynumbangelboy at 5:22 PM on January 31, 2007 [2 favorites]

More links: The Planned Parenthood site itself has a fair amount on both procedures. (The links on the left of that page have more info.
posted by occhiblu at 6:09 PM on January 31, 2007

I'd suggest talking to someone at Planned Parenthood. They have people whose job it is, among other things, to help you make that very decision. They can go through the pros and cons with you before you have to decide.
posted by cerebus19 at 6:20 PM on January 31, 2007

I had an early surgical abortion (years ago before medical abortions were available). It hurt like hell, but it was short and then over. And no after-effects. I would probably choose surgical again (though medical can be useful for women who don't have confidential access to the surgery or who have fears of/concerns re surgery).
posted by ClaudiaCenter at 6:57 PM on January 31, 2007

response from someone else via email (not me)

Too bad I can't get a "best answer" award for this one, but I've had both kinds, both done at
Planned Parenthood.

The first one I had was surgical, and they had me wait a certain number of weeks till it was
far enough along that they could be sure to successfully remove all the tissue. (I don't
remember the number of weeks exactly since this was 15 years ago, but probably I was at 8
weeks.) First they do medical background stuff, a pregnancy blood test, and counseling.
After that, the procedure was relatively quick -- set up, laying on the back just like an OB-
Gyn exam, and then maybe a minute total of actual procedure. It was extremely painful for
that one minute. They gave me a shot of local anesthesia to my cervix (just like the dentist
does with your gums, but OW!), and then dilated the cervix with a tool (ow) and insert a
vacuum and aspirate the contents of the uterus. For this part, I actually felt my sphinter
quivering as though I might not be able to keep it closed. But then it was over, and I had a
bit of nausea, and then I recovered my equilibrium. They had me put on a maxi-pad and sit in
recovery with a heating pad for a half-hour or so. (Note: some people get general
anaesthesia and obviously feel nothing. If you think you might want to get general, there
are fasting rules to adhere to.) Later that day I went to a concert and felt fine. I had to
monitor myself for a fever but none came, and there was a little residual nausea for a few
days. There was no bleeding or spotting after the procedure day, until about 3 weeks later.
I was out to dinner and suddenly got a blood gush (not my period). It wasn't much, but it
was surprising and I was unprepared for it. About a week or two after that, I got a normal
period.

The medical one I remember more clearly because it was about 4 years ago. The same medical
background stuff (including an ultrasound where you will see the packet of developing cells
there in the uterus unless you turn away) and counseling, and then they hand you a pill. You
take the pill there in the office, with water, and then go home. This pill basically stops
the cells from dividing, effectively ending the development of the zygote. Sometime later
(maybe about 8 hours?) they have you insert two pills into your vagina. These pills
basically cause your uterus to contract so that you can expel the pregnancy. About an hour
after inserting the pills, the contractions begin. Um, this was very painful. It lasted
about two hours... I was writhing in pain, sweating, etc. (Note: some people take Advil or a
codeine-based pain pill for this part, and I wish I had.) At the end of the cramping, there
is blood and tissue to expel. So you'll head to the toilet and out it'll come, and from that
point on, you just have a regular period. I did bleed or spot daily for about a month
afterwards, until getting my next proper period. And had some residual nausea for a few days
till my body realized it wasn't pregnant anymore. A few weeks afterwards (not sure how
many), you go back to the clinic and they do an ultrasound to make sure your uterus is empty.

If I was advising my identical twin, I'd say go for the medical one, because it's more
private-feeling and more like a miscarriage, but fill the pain prescription too and use it
before starting the contraction pills. But because of the long residual bleeding, I didn't
feel normal again in terms of my cycle for a full month. The surgical one was more
immediately invasive, but easier to forget. These differences could also be because of my
age, though. I was really young (resilient) for the first and less so for the second.
posted by jessamyn at 7:44 PM on January 31, 2007

here's another, similar post from another person:

As someone who was fortunate enough to have had one of each procedure, here is my breakdown:

On the day of my surgery I got up at 5am, drove to the facility, walked past the picketers, and waited in the lounge to be called. In short order, I was given all the appropriate paperwork to sign and then escorted to the back to change into a gown and wait some more with the other girls who were unlucky enough to share my predicament. The time I spent in those waiting rooms is still one of the worst moments of my life. No one made eye contact and although a few girls pretended to read the magazines scattered about, we were all just waiting for the ordeal to be over. There was definitely a...factory feel to whole process as girls shuffled off one by one as they were called. When my name finally came up I was terrified, but also relieved to be out of that waiting room. I came to regret that when I was lying on that table with my legs in the stirrups waiting for the surgeons to come in. The doctors were cordial but distant, I was knocked out in moments and woke up in recovery. I think it was about half an hour before I groggily walked out, shell shocked, to meet my ride. Although there was not too much pain, it was emotionally draining and made even more so by the shared experience. The next morning I was woken up by the incredible pain in my breasts, they hurt so much that I cried. The tenderness lasted for a few days and then things went more or less back to normal. When I got my first period after the surgery I almost fell over from the cramps. When I called the nurse hotline they told me it was perfectly normal and told me to take ibuprofen, which did not help very much. It was 2-3 more months before my cycle returned to almost normal.

Despite swearing that it would never happen again, my world crumpled a few years later when I became a statistic and was pregnant a second time. This time I pushed for the medical termination and faced less resistance. My first time I had inquired about the possibility but was strongly discouraged from that path for many of the same reasons already mentioned in this thread. I was in and out of the facility in much less time and was given the pills and directions for use. I went home and inserted the pills as directed and lied down on my bed waited. I began to experience contractions not long afterwards and felt something pass about 40 minutes later. The contractions continued for a long time, the pain peaking at around an 8 on a scale of 1-10, but nothing else happened and I eventually fell asleep as they continued. I was extremely grateful for the ability to be in my own home, on my own bed, holding someone's hand. There was no pain or discomfort the next morning and I have no memory of anything notable happening after that. Although it was hardly a pleasant experience, it was one that I controlled and it allowed me to cry and grieve in private. I am sure that if I did not have the ability to compare so directly, I would have felt that the pain of contractions for the medical procedure was too much, but for me it was worth it to avoid the helplessness I felt while surrounded by all these girls whose faces were as hollow as I felt. In re-reading, that sounds like such a cliched line, but every girl in that room was filled with grim despair, we were all in the same predicament, and we were all, in that moment, completely alone, and just recalling that feeling brings tears to my eyes.

I am so very sorry that you have to go through this and I hope that I was able to help. You can contact me through Jessamyn if you would like to talk further.
posted by jessamyn at 7:56 PM on January 31, 2007 [2 favorites]

i've also had both. they were the two most painful things that have ever happened to me, but different. for the surgical, the advantage was that it was quick. and you can be knocked out for it, if you want to and can afford it. the disadvantage, where i went, was that my partner was not allowed to be with me, and that it felt more clinical and invasive.

the medical took much longer and was very painful (even with codeine) the entire time, but i was at home with my partner so i prefered that. either way, definitely see if you can get as many painkillers as possible.
posted by lgyre at 7:58 PM on January 31, 2007

More anecdotes: a friend had a surgical abortion with no complications whatsoever. Another friend had a surgical abortion got an infection from leftover tissue, which necessitas says also resulted from a friend's medical abortion. Point being, therefore, is that either way, you could have complications; be careful, and pay attention to your body's responses to whichever procedure you choose.

As a long shot, anonymous, but also to anyone else reading, if you're in Seattle-ish and need moral support or help before, during, after (cup of coffee? booze? ice cream? hand-holding? bring you a book from the library?), let me know.
posted by librarina at 9:01 PM on January 31, 2007

Plenty of helpful answers already. I'd just add that in terms of 'surgical' abortions, a suction abortion is a (statistically) safer procedure than a dilation and cuterage (D&C), although abortions in general - of all types, especially when done early, are fairly safe and next to routine compared to many other surgical procedures.
posted by serazin at 12:29 AM on February 1, 2007

Misoprostol and other chemical prostaglandins used to dilate the cervix (thus causing abortion) are associated with an elevated risk of uterine rupture in women that have had previous uterine surgery. You have not had a c-section, but you may have had other surgeries. If so, definitely take the surgical route.
posted by crazycanuck at 1:27 AM on February 1, 2007

With the fun of a 'blighted ovum' and 'missed miscarriage,' I was offered the choice of Cytotec, or a D&C.

The Cytotec was a lot of cramping and blood. Think many bad periods all at once. And some combination of what was going on, and the medications (I was also taking some good piles of painkillers) made me throw up a fair bit, too. It is not free of side effects.

Things weren't very far along at all; I was surprised at resulting amount of blood and gore.

And it didn't work. I ended up going in for a D&C.

Under general anaesthetic, so -- painless; painful on waking up, but I was physically back to normal in a day or two.

Insist on a good supply of good painkillers whichever route you go.

Reading the other answers here, I get the impression that women with miscarriages are treated differently than women having identical procedures for abortions. This happened in a hospital with an overnight stay, not in-and-out in a clinic with idiots at the door. My sympathies. Is there the option (as there is here) for you to get it done in a hospital setting? I was happy about the overnight stay, and would've done horrible things to a picketer. Again: my sympathies.
posted by kmennie at 4:46 AM on February 1, 2007

I would be more comfortable with surgical. It's more immediately invasive and uncomfortable, but it's more certain. You know exactly when it's going to happen. You know exactly when it's over. I hated running the gauntlet of picketers, but that only lasted a few seconds, and the clinic had escorts to help with that. I think I would have made myself sick waiting for a medical abortion to start, and made myself sicker wondering if it was really, really over. (But, that said, I only had the choice of a surgical abortion when I had mine, so that's probably in part the voice of clinging-to-the-familiar.) Good luck to you, you have my thoughts and sympathies.
posted by headspace at 6:45 AM on February 1, 2007

I, too, have had some experience with this, and although I cannot advise you which to choose (medical terminations were not available to us 20 years ago), I would strongly advise you to make arrangements to have someone physically present with you for 24 hours after the proceedure. While it is unusual for things to go wrong, others above have described the high levels of physical pain involved with either proceedure, and sometimes things do take a turn. Having someone there with you -- even if its just a roommate or a friend to watch movies with or whatever -- even if its someone who doesn't really know what's going on ("I had to have a little medical proceedure done and they advised that I have someone with me for 24 hours just in case there were any nasty after effects") -- can be a big help.
posted by anastasiav at 8:05 AM on February 1, 2007

My good friend says that surgical was far easier on her - over quickly, in the hands of professionals the entire time, etc. The at-home process, for a different friend, was excrutiating, with hours of cramps. But then again, if home would be more comforting to you, I can completely understand going that route. I know I might be more comfortable at home with my husband than at an impersonal clinic.

I'm sorry I don't have more to offer, but I wanted to say good luck to you. You will choose what is right for you and I hope it goes smoothly for you. And thanks to all who've answered the question with actual experiences, instead of just saying, "Figure it out yourself."
posted by agregoli at 8:11 AM on February 1, 2007

Go surgical, and take them up on the offer for xanax.
posted by frecklefaerie at 8:39 AM on February 1, 2007

I am shocked at all the posters above describing having to walk through picket lines. I honestly didn't think that happened very often. What a horror.

I had a surgical abortion years ago. The most difficult part was seeing the beating heart on the ultrasound - but I knew it was the right decision for me. I was under general anesthesia and felt nothing. Some mild cramping and spotting later the same day, but that was it. I could have gone out dancing that night, I felt that fine.

I had mine done in Norway, which I suspect might have something to do with why it was so non-traumatic for me - the doctors treated me with respect; there was no preaching, only a simple 'what are your plans for better birth control from now on'; no picketers - and while I did wait for maybe half an hour with about 5 other women, it wasn't horrible. None of us were happy about being there, but quietly resigned and OK.

If you do go the surgical route, make sure you get general anesthesia. A friend had one done in New Zealand with only local anesthesia and she was awake for the whole thing. It was a horrible experience for her, magnifying the guilt she already was feeling.

My heart goes out to you - it's a bad situation to find yourself in, but it doesn't have to be horrible. Sending you warmth and love.
posted by widdershins at 9:45 AM on February 1, 2007

widdershins, yes, pickets are a reality for some places in the U.S. - that's why sadly things like clinic protection are necessary.

Just wanted to pick up on widdenshins' points regarding general anesthetic. I think this a classic case where YMMV - your milege may vary depending on your pain threshold, previous surgery experiences, etc. but in general you want to avoid any surgeries where general is used, since there can be more complications when you have a general aesthetic than there can be from using a local or nacoleptics (IANAD, obviously). anon, please speak to someone at Planned Parenthood who can advise you.

librarina, that's an incredibly nice offer of moral support. I wonder if a buddy system exists for women - if Planned Parenthood et al do that in real life at all. Anyway, this thread and the comments and support in it is a shining moment for MeFi.
posted by rmm at 10:50 AM on February 1, 2007

Not to argue with widdershins, but to offer a counterpoint- I think I felt better having the local rather than the general. The nurse in the procedure room held my hand and talked to me about other things, and when I was in discomfort the doctor adjusted for that because I could tell him I was in pain. But I have to be honest and say, I felt better having the local because I would have felt very, very out of control to have been unconscious during a gyn procedure of *any* kind. Which I think describes my reaction to the entire procedure from the beginning- surgical because I knew when it would be, when it would be over, local, because I would be aware of it when it was happening. There's only so much control you can eke out of being unintentionally pregnant. Anyway, I hope this helps, and again, I wish you good luck.
posted by headspace at 12:53 PM on February 1, 2007

If you go with the surgical option (which is what I chose, at 7 weeks) you should definitely get twilight anesthesia if at all possible.

And if you need anybody to talk to please email me!

For me, the procedure was not traumatic but the next couple of days I was the saddest I have ever been... even though I knew abortion was the absolute right choice... that's one of the side-effects they don't really tell you about. Don't get mad at yourself for being upset- it's a lot to deal with especially considering the huge hormone shock it puts you through.

Stay strong!
posted by elisabeth r at 1:14 PM on February 1, 2007

anonther anon follow-up:

I had the surgical one about a year ago. I chose it over the "medical" option for several reasons. I trusted the doctor to make sure everything was done correctly more so than myself, as I obviously had messed up with taking pills once already. It's been around longer and so there is more medical research behind the safety. (More women die during actual childbirth than having abortions)

If you do the surgical either have a ride or a taxi so you can get the anesthetic, because yes, it does hurt. (But so will the medical). Remember to breathe.

I didn't have horribly bad cramps afterward, but the pain was noticeable.

At the clinic I went to there were picketers, but they were far from the hospital, they were actually on the driveway into it, so I simply drove past them. The actual office area had a guard who checked my ID and let me and my husband in. We got there at 9 am and did not get to leave until after 9pm. The staff were all very respectful and supportive.
posted by jessamyn at 7:07 AM on February 2, 2007