Surgical:
The surgical procedure is available from six weeks to 14 weeks (dated from the first day of the last monthly period). First trimester abortions are very safe (about ten times safer than childbirth) and the procedure takes about 5 minutes to complete. As with any surgery there are risks and complications involved. During your office visit we will go over these risks and possible complications with you and answer any questions that you may have. Listed below are some of these risks and complications:

Infection - infection occurs less than 1% of the time and as a preventative all patients receive oral antibiotics.
Incomplete procedure - occurs less than 1% of the time.
Heavy bleeding - less than ½ of 1%
Uterine perforation or damage to internal structures - less than ½ of 1%
Continued pregnancy - less than 1%

Again, a counselor will review these risks and complications with you. If you would like further information prior to your appointment please call us.

Medical:
The medical procedure, also called RU-486 or abortion by pill, is available starting at about 4 ½ weeks and up until the 7th week, dated from the first day of the last monthly period. The medical procedure works with two medications. The first medication, Mifepristone, blocks the pregnancy hormone and prevents the pregnancy from growing. You take this first medication during your appointment at the clinic. The second medication, Misopristol, is inserted vaginally approximately 48 hours after you take the first medication. The Misoprostol will make your uterus cramp and bleed and you will therefore expel the pregnancy.

RU-486 is a very safe and effective procedure. It is an FDA approved treatment and it has been safely used to end pregnancy in the United States and Europe for many years. At Bread and Roses we only offer this procedure if you are less than seven weeks from your last menstrual period as RU-486 is most effective during that time. As with the surgical abortion, there are risks involved including incomplete procedure, retained products of conception, and infection. On the day of your appointment an information counselor will go over all of the risks associated with RU-486 and answer any and all questions you may have. Because there is a small chance that RU-486 will not end your pregnancy, you must be willing to have a surgical procedure if the treatment fails.




What to expect on the day of your appointment:

Before your surgical appointment:
- do not eat anything one hour before your appointment time. You may drink clear liquids (water, Sprite, gingerale, etc) up until your appointment.
- wear a comfortable, two piece outfit
- if you choose to use Valium or IV sedation you must have a driver with you or a ride home.
- we do not allow children in our office.

Generally your appointment will last 3-4 hours. We understand that your time is important and we will do everything we can to get you home safely and quickly. On the day of the procedure you will fill out paperwork, give us a urine sample so we can confirm your pregnancy, have some lab work done, meet with an information counselor to discuss the procedure, anesthesia options, risks, options, birth control, aftercare instructions, and to address any and all concerns that you may have.

Once your pre-processing is complete you will meet with the Doctor and have the procedure. When the procedure is over you will be escorted into a recovery room. You must stay in the recovery room for a short amount of time so that we may observe your vital signs and make sure you are feeling okay. Before you leave we will go over your aftercare instructions again and make sure you have all of your take home medications. If you are using the RU-486 you will meet with the doctor, take the Mifepristone medication, and then you are ready to go.



LAB WORK
You will have your temperature taken and your blood pressure and pulse checked. We will take a small sample of blood from your finger to test your iron and to determine if you have a negative or positive blood type. We will also do a sonogram to determine how far into the pregnancy you are.

BLOOD TYPE/RH FACTOR
Women who have a negative blood type/are Rh negative will need an injection of Rhogam after an abortion. Rhogam will prevent antibodies from forming in your blood that would cause problems with future pregnancies or blood transfusions. There is an additional charge for this injection.

SONOGRAM
It is very important for us to know how far into the pregnancy you are so that we can provide a safe and effective procedure. Every patient will receive an ultra sound or sonogram. A sonogram uses sound waves to view the pelvic area and does not hurt.

If you are unsure about the first day of your last period or are concerned about how far into the pregnancy you are we can schedule an appointment for a sonogram to determine the gestational dating of your pregnancy.

Pregnancy is usually dated from the first day of the last menstrual period rather than conception. So if you think you conceived six weeks ago then your last period would have been about eight weeks ago and therefore, by clinical practice, you would be considered 8 weeks pregnant.

INFORMATION COUNSELING
Your information counselor is there to make sure you are informed about the abortion, risks associated with the procedure, how to care for yourself after the procedure, and to make sure all of your questions are answered. The information counseling is done on a one to one basis to ensure privacy and individual attention.

ANESTHESIA OPTIONS:
Local anesthesia - every patient receives this. The Doctor will inject pain preventing medication (Lidocaine, Novocaine - the same medication you may receive when you go to the dentist) into your cervix to numb it. Many women have their procedure only using the local anesthesia. If you only use the local, you should expect to feel moderate to heavy cramping during the procedure

Oral sedation - You may choose to have a dose of Valium. Valium by property is an anti anxiety medication and will help you feel relaxed and calm. If you choose this option you must have someone with you to drive you home. Using Valium helps you to relax and the more relaxed you feel, the easier the procedure will be. Valium by property is not a pain reliever but most women who use Valium state that it makes the procedure less painful.

IV sedation - Intravenous sedation will not put you to sleep but will make you extremely relaxed. If you choose this option you must have someone with you to drive you home. The medication in the IV sedation is not, by property, a pain killer but most women say that the IV sedation makes the procedure less painful.

PROCEDURE
The surgical procedure starts with a internal exam very much like what you experience during a pap exam. When the physical exam is complete a speculum will be inserted into your vagina to keep the walls of the vagina open and so that the Doctor can see your cervix. You will then receive a local anesthesia to numb your cervix. Once your cervix is numb, the Doctor will begin to gently dilate your cervix with a series of instruments: the Doctor will begin with a very small dilator and then progress to a slightly larger one and so on, until your cervix is dilated to the appropriate width. Once you are dilated the Doctor will insert a rounded plastic tube called a cannula into your uterus and then use suction to remove the pregnancy. Once this part is complete, the procedure is over. You will then be escorted into the recovery room so that you may relax until you are ready to leave.

AFTER CARE
It is very important to take care of yourself after the procedure. We will give you very specific instructions to take home with you and in addition, we are always available to answer any questions. Listed below are a few of the after care instructions:

- Make sure you take all of the medication you are sent home with.
- Do not insert anything into your vagina and do not have intercourse until after your post operative follow up exam.
- Take you temperature twice per day for at least five days following your procedure.
- We do not want you to do heavy lifting or rigorous activity until after your post operative exam.

PAYMENT OPTIONS
We accept Visa, MasterCard, bank drafts or cash. We do not accept personal checks.

ADDITIONAL FEES
Occasionally you will be given a prescription for medication or be referred for additional testing.