Day 1
Patient should receive necessary blood tests and a sonogram to confirm the pregnancy and its gestational age. She is given Methotrexate orally or by injection.

Day 3-7
Patient inserts Misoprostol tablets into her vagina three days after receiving Methotrexate. Bleeding usually begins within the first 24 hours after inserting Misoprostol. Contractions may begin up to 2 days later.

Week 2

Day 8
Patient receives a sonogram one week later to determine whether the baby is still present there and attached to the uterine wall. If so, a second dose of Misoprostol is given.

Week 3

Day 15
A week later, a repeat sonogram is needed to verify that the abortion is complete. If not the patient will need a D&C. Sometimes the abortion clinic will elect to observe the patient several weeks before performing the surgical abortion.

Any Complications or Side Effects?

May require a surgical abortion:

• 5% of pregnancies at 7 weeks gestational age are not complete after this procedure and require a D&C.
• Up to 16% of pregnancies between 7 and 8 weeks gestational age are not complete after this procedure and require a D&C.
• 12% to 35% of women may experience a delay in abortion for up to 1 month.

Pain
Up to 90% of women may require a pain reliever, sometimes codeine for cramping and abdominal pain

Bleeding
Vaginal bleeding can last up to 3 weeks with the passage of blood clots. Anemic women are not candidates for this procedure.

Nausea, Vomiting, and Diarrhea
Women experiencing these symptoms may require medication to stop the vomiting and diarrhea.

Infection
May result from retained pregnancy products, undiagnosed STD or possible destruction of the body's white blood cells (neutropenia, 4%).

Sources: Hatcher RA, Nelson AL, Zeiman M et al. A Pocket Guide to Managing Contraception. Tiger, Georgia: Bridging the Gap Foundation, 2001.

Scott JR, Di Saia PJ, Hammond CB and Spellacy WN. Danforth's Obstetrics and Gynecology, 8th edition-Philadelphia: Lippincott Williams & Wilkins, 1999

RU-486 (Mifepristone)/Mifeprex combined with Misoprotol Technique

When Used?
RU-486, also known as the "Abortion Pill" was approved for use in a pregnancy that is no older than 49 days old (7 weeks after the beginning of the last menstrual period).

Procedure Description: Week 1
Day1
Patient should have a pelvic examination, blood tests and a sonogram. The sonogram will document the viability and gestational age of the pregnancy. RU-486 is given to cause the destruction of the baby's nutritional support, and eventually the baby itself. 60-80% of women will abort after using Mifepristone alone.

Day 3
Within 48 hours after receiving RU-486, Misoprotol is given vaginally or orally to start uterine contractions. Up to 70% of women will abort within 4 hours of receiving misoprotol.

Week 2

Day 14 or 15
Patient will return for a sonogram. Up to 98% of women will have completed the abortion after receiving both mifepristone and misoprotol. If the abortion is not complete, she will need a surgical abortion (D&C).

Any Complications or Side Effects?

May need a surgical abortion
Incomplete abortions occur in about 2% of the women and continued pregnancy in about 1%.

Bleeding
Sometimes, a woman may have excessive bleeding or hemorrhaging that requires surgical intervention (<1%) with rarely needed blood transfusions.

Nausea, Vomiting and Diarrhea
These symptoms may require medications to stop vomiting and diarrhea.

Tubal Pregnancy
There is a possibility of maternal death in the case of an undiagnosed ectopic pregnancy.

Sources: Hatcher RA, Nelson AL, Zieman M et al. A Pocket Guide to Managing Contraception. Tiger, Georgia: Bridging the Gap Foundation, 2001.

HHS News. Department of Health and Human Services. September 28, 2000.

New England Journal of Medicine, 338: 18. April 30, 1998.

Surgical Abortion

Surgical Abortion What is it? This procedure involves the use of a mechanical device (suction or vacuum aspirator), surgical instruments (forceps, sharp curette and cervical dilator) and/or long needles (for injecting a deadly concentration of saline). Surgical abortions are performed on babies at any stage of their human development (1st through 3rd trimesters). The specific technique selected depends upon the baby's gestational age. Although the baby and the pregnancy are destroyed, major maternal complications occur in about 1% of 1st trimester abortions. Because this is a surgical procedure, proper blood tests must be performed and informed consent must be given. How Much Does It Cost? The charges for surgical abortions vary. The prices depend upon: the trimester in which the abortion is performed the high risk nature of the pregnancy whether the procedure is performed in an outpatient (clinic) or inpatient (hospital) setting Generally, the abortion is more expensive when: the pregnancy is further along (late 1st, 2nd and 3rd trimesters) there are maternal medical complications it is performed during hospitalization How is each Surgical Techniques Performed? There are several surgical techniques used in performing abortion. The following section discusses the techniques according to the gestational age of the developing baby and trimester of pregnancy. Some surgical techniques may be used in combination with each other, or with medical techniques (e.g., complications related to a medical abortion). First trimester - procedures performed up to 14 weeks (3 months, 2 weeks) Suction Aspiration Dilation and Curettage (D&C) Second trimester - procedures performed between 12 and 24 weeks (3-6 months) Dilation and Evacuation (D&E) Saline Injection or Salt Poisoning Third trimester - procedures performed from 20 weeks (5 months) up to full term Partial Birth Abortion (D&X) Suction or Vacuum Aspiration Technique When Used? Suction Aspiration is the most common 1st trimester technique. It is used to terminate a pregnancy up to 14 weeks old. Procedure Description The woman lies on her back with her feet in stirrups. The cervix is cleaned. Local cervical pain killer may be given. A clamp (tenaculum) is placed on part of the cervix. A dilator is used to open the cervix wide enough for the suction tube to fit inside. The doctor guides the tube inside the uterus and turns on the suction machine. The placenta as well as the baby's head, limbs and organs are removed in pieces small enough to fit through the suction tubing and into a container. The nurse (or assistant) reassembles the baby making certain that all of it has been suctioned from the uterus. Any Complications or Side Effects? During this procedure, the doctor cannot see inside the uterus. He or she uses the tip of the suction tube as a means sensing (feeling) how much of the uterine lining has removed with the placenta and the baby. Major complications can occur in about 1% of women having a surgical abortion. These may include: Infection Retained pregnancy components or an undiagnosed STD may cause an infection requiring outpatient PID treatment, or hospitalization for intravenous antibiotics. If pregnancy components are retained, the woman will need another aspiration procedure. Persistent or excessive bleeding Abnormal bleeding may result from uterine muscles not contracting or blood vessels not constricting to stop the bleeding. Also, blood clots may develop inside the uterus after the procedure. The women will need repeat suction and medication to stop bleeding. The uterus and/or intestine may have been perforated (a wall punched through with the suction tube or other instrument inserted within the uterus). On occasion with hemorrhaging, a woman may require abdominal surgery and/or a blood transfusion to replace large blood losses. The cervix may be lacerated (cut or torn) requiring suture repair in order to stop significant bleeding. Failed Abortion Sometimes, when this procedure is performed during the earliest stages of human development, the suction device may miss the baby. In such cases, the pregnancy continues; a sonogram is performed to locate the baby for repeat suction if there is no ectopic pregnancy. Dilation and Curettage (D&C) Technique When Used? Dilation and Curettage abortion technique is used up to 14 weeks gestational age, or when there are complications resulting from other procedures (such as, an incomplete abortion, a failed abortion or retained components of the pregnancy after suction). This technique is also used following a miscarriage. Procedure Description The woman lies on her back with feet in stirrups. The cervix may be dilated mechanically or with medication before the procedure (if the pregnancy is greater than 12 weeks gestational age). Otherwise, it is dilated during the procedure. The cervix is cleaned and a local pain killer may be given. A clamp (tenaculum) is attached to part of the cervix. If the cervix is dilated, a curette (a steel loop-shaped surgical knife) is used to scrape out the placenta and the baby. This scraping process is called curettage. Any Complications or Side Effects? During this procedure, the doctor cannot see inside the uterus. He or she uses the tip of a surgical instrument as a means of sensing (feeling) how much of the uterine lining has been removed with the placenta and the baby. Major complications can occur in about 1% of women having a surgical abortion during the first trimester. These may include: Infection Retained pregnancy components or an undiagnosed STD may cause an infection requiring outpatient PID treatment, or hospitalization for intravenous antibiotics. If pregnancy components are retained after an aspiration procedure, the woman may need another aspiration procedure in addition to repeat curettage. Persistent or excessive bleeding Abnormal bleeding may result from uterine muscles not contracting or blood vessels not constricting to stop the bleeding. Also, blood clots may develop inside the uterus after the procedure. The women will need repeat suction and medication to stop bleeding. The uterus and/or intestine may have been perforated (a wall punched through by the instrument inserted within the uterus). On occasion with hemorrhaging, a woman may require a blood transfusion to replace large blood losses and/or additional abdominal surgery to repair the damage. The cervix may be lacerated (cut or torn) requiring suture repair in order to stop significant bleeding. Failed Abortion Sometimes, when this procedure is performed during the earliest stages of human development, the suction device may miss the baby. In such cases, the pregnancy continues; a sonogram is performed to locate the baby for repeat suction and D&C (if there is no ectopic pregnancy). Dilation and Evacuation (D&E) Technique When Used? Dilation and Evacuation is the most common surgical technique used in the 2nd trimester. Generally, it is performed when the pregnancy is between 12 - 24 weeks gestational age. NOTE: Because the developing baby is bigger at this stage and bone calcification has occurred, forceps are used to empty the uterus. The cervix must be opened wider (than that required in a D&C or Suction Aspiration) to allow entry of forceps. Forceps refers to the surgical instrument resembling pliers with sharp teeth used to grab and pull out body parts/tissue. Intravenous sedation or general anesthesia may be required. Procedure Description Method 1 (May require a minimum of 2 visits) While at the clinic, laminaria (a seaweed-based substance) is inserted into the cervix causing dilation. The woman goes home and returns the next day. After returning to the clinic, she lies on her back with feet in stirrups. The laminaria is removed and the size of the cervical opening is evaluated. The cervix is cleaned; a clamp is attached to part of it. If the cervical opening is wide enough for forceps to enter, the process of grabbing, crushing and tearing away the baby's body parts begins. After the procedure, the baby's parts are reassembled to insure that all pieces have been removed. A final curettage may be performed. Method 2 (The entire procedure is done during a single clinic visit.) Laminaria is inserted inside the cervix to cause it to dilate. If after a given period of time the cervix is not open wide enough, it is stretched to allow forceps inside the uterus. The procedure continues according to protocol until all the baby's body parts are removed from the uterus. A final curettage may be performed. Any Complications or Side Effects? During this procedure, the doctor cannot see inside the uterus. He or she may use an instrument to evaluate the depth of the uterus. Also, the risk of major complications is higher in 2nd trimester abortions than in 1st trimester abortions. These complications may result from the uterine walls being thinner, more blood vessels are present and the baby is bigger. Complications may include: Infection Retained pregnancy components or an undiagnosed STD may cause an infection requiring outpatient PID treatment, or hospitalization for intravenous antibiotics. If pregnancy components are retained, the woman will need another curettage procedure. Persistent or excessive bleeding Abnormal bleeding may result from uterine muscles not contracting or blood vessels not constricting to stop the bleeding. Also, blood clots may develop inside the uterus after the procedure. The woman will need medication to stop bleeding. The uterus and/or intestine may have been perforated (a hole punched through the wall by instruments inserted within the uterus). The walls of the uterus are much thinner in 2nd trimester. On occasion, the hemorrhaging is severe enough to require a blood transfusion and abdominal surgery. The cervix may be lacerated (cut or torn) requiring suture repair in order to stop significant bleeding. Cervical Incompetence A woman may not be able to carry a future pregnancy to term as a result of injuries to the cervix during a 2nd trimester abortion. Injection or Poisoning Technique When Used? Saline (or other toxic level chemical) injection is performed when a pregnancy is 16 weeks and beyond (when enough amniotic fluid is present to surround the baby.) Saline Injection Note: This procedure may require hospitalization. A long needle is inserted through the mother's abdomen (belly) into the amniotic sac. Amniotic fluid is removed from the sac and is replaced by a very strong salt solution meant to kill the baby. By the 4th month of pregnancy, the baby has been drinking and breathing in amniotic fluid to help the organs develop properly. However, when the salt solution is substituted for the normal amniotic fluid, it causes severe burning of the baby's skin, eyes, mouth and lungs. Labor may begin within 24 hours of the saline injection resulting in the delivery of a badly burned, shriveled, dead baby. Any Complications or Side Effects? Delivery of a badly burned infant The infant may survive this procedure and be delivered alive. But, may not live for a very long time thereafter. Future Infertility Problems The woman may have future infertility problems if the uterus has been badly scarred during this procedure. Partial Birth Abortion (D&X) Technique When Used? This technique is approved for use in women with pregnancies 20 weeks gestational age and beyond. Procedure Description General anesthesia may be required to complete this procedure. Day 1 and 2 Laminaria (a seaweed-based substance) is inserted into the cervix and left in place for up to a 2-day period. Day 3 An ultrasound is used to locate the baby's legs. The doctor takes large forceps to grab each leg and pull them through the cervix and down into the vagina. The remainder of the body, except the head, is pulled through the cervical opening. The head remains inside the uterus. The doctor makes an incision (cut) at the base of the skull and inserts a catheter (tube) to suck out the brain, causing the skull to collapse. The dead body is then removed completely from the uterus. Any Complications or Side Effects? When this procedure is used on full term sized infants, it is in effect, intentionally rearranging the baby's in utero position from head down to feet and legs down for a breech delivery. Infection Retained pregnancy components or an undiagnosed STD may cause an infection, as well as or other post-procedure complications that require treatment including intravenous antibiotics. If pregnancy components are retained, the woman will need another procedure to remove fragments. Persistent or excessive bleeding Abnormal bleeding may result from uterine muscles not contracting or blood vessels not constricting to stop the bleeding. Also, blood clots may develop inside the uterus after the procedure. The woman may need another procedure and/or medication to stop bleeding. The uterus and/or intestine may have been lacerated or perforated (a hole punched through the wall by instruments inserted within the uterus). The walls of the uterus are at its thinnest in 3rd trimester. On occasion, the hemorrhaging is severe enough to require a blood transfusion. The cervix may be lacerated (cut or torn) requiring suture repair in order to stop significant bleeding. Cervical Incompetence A woman may not be able to carry a future pregnancy to full term as a result of injuries to the cervix (excessive stretching and tearing) following this procedure. PRE-ABORTION HEALTH AND SAFETY CHECKIST

Call 1 800 395 - HELP

Be absolutely certain that you are pregnant before you make an appointment for an abortion. Things other than pregnancy may delay your menstrual period.

Understand that an abortion may involve taking potent medications or having surgery. The techniques used may impact your health and well-being. You have the right to receive accurate information before you proceed with the abortion.

Have the doctor explain the technique that he or she recommends to you.

Know and understand the physical health risks associated with the abortion technique that is recommended to you. The immediate and long-term effects should be explained to your level of understanding.

Ask about the possible risks:

Infection
Infertility
Hemorrhage or excessive bleeding
Perforation of the uterus or bowel (intestine)
Pelvic Inflammatory Disease (PID)
Incomplete abortion
Breast cancer linkage (especially if your family history involves breast cancer)

You have the right to know what is being removed from your body.

During the 1st trimester, the developing human baby grows very rapidly and experiences significant changes in appearance and size. At conception - The baby receives 23 chromosomes from each parent encoding the sex, hair and eye color as well as the body and personality type.

21 Days - The foundation of the brain, spinal cord and nervous systems is already established. The heart begins to beat.

28 Days - The backbone and muscles are forming along with the arms, legs and eyes.

6 weeks - The brain begins to control movements of the muscles and organs.

8 weeks - At this stage of human development the baby is called a fetus (Latin for unborn child); everything is now present that will be found in the adult stage of development.

10 weeks - The developing baby can squint, swallow and suck its thumb.

12 weeks - The developing baby now sleeps and actively moves the head, toes, fingers and hands.

Know that the abortion carries possible emotional, mental and psychological trauma and/or stress. Initially, many women report feelings of relief following an abortion. However, some women begin experiencing unpleasant symptoms weeks, months or even years after an abortion. These symptoms can include:

Feelings of grief, sadness, regret, depression or anger
Dreams about aborted child
Emotional distress when seeing others babies or pregnant women
Emotional distress around the anniversary of the abortion
Emotional distress around the time of the "would-be" due date
Inability to bond emotionally with partner (75% break-up post-abortion)
Difficulty in bonding and mothering future children
Sexual inhibitions
Thoughts of suicide

Ask the Name of the Doctor performing the abortion
The fact that abortion is legal does not guarantee a high standard of medical care. Abortion clinics may not volunteer the name of the doctor unless you insist on knowing it. Remember, the procedure you select may require surgery. You need to know the name of the surgeon in case of complications or if malpractice issues arise.

Check the record of the doctor performing your surgery for previous malpractice lawsuits settled against him or her. In Maryland, call Health Claims Arbitration Office, Department of the Attorney General of the State of Maryland: (410) 767-8201. Otherwise, check with the Office of the Attorney General in your area.

Know that abortion is ELECTIVE surgery. It is surgery that you choose rather than one that is medically necessary. You can change your mind at any time, right up to the time the abortion has begun. Just say, "STOP!" Don't be pressured into having surgery that you do not want.

You should be able to receive BOTH pre- and post-abortion counseling as part of your overall care. Ask ahead of time whether these services are available. If not, choose another abortion provider.

Understand you legal rights AFTER an abortion. An abortion clinic might insist that you sign a statement saying you will not hold the clinic or doctor liable for damages, which might occur because of the abortion. However, this document has virtually NO legal authority. If you are injured during the abortion, you retain your right to seek financial compensation in a court of law, regardless of what you signed.

INFORMED CONSENT ISSUES

Whenever a patient considers having a surgical procedure, he or she is entitled, by law, to receive accurate and adequate information regarding the procedure and the associated medical risks. These issues include, but are not limited to:

1. why a given procedure is necessary or selected over others;
2. a description of the procedure to the patient's level of understanding;
3. the associated risks and possible medical complications;
4. anticipated recovery time;
5. follow-up care ; and
6. emergency care and phone numbers to call in case of an emergency.

 

What is Post-Abortion syndrome? There are many negative emotional reactions that have been associated with abortion. Some women experience "impacted grieving," which reflects an inability to complete the grieving process. Other women experience specific self-destructive tendencies, including eating disorders, sexual dysfunction, and substance abuse. A widely used term for emotional problems is "post-abortion syndrome" or PAS. Actually, post-abortion syndrome has been proposed as a specific diagnosis for those women who experience a specific, related set of emotional problems. Specifically, PAS is proposed as a subset of Post-Traumatic Stress Disorder (PTSD) when PTSD is the result of an abortion. Many women who have emotional problems after an abortion fit within the diagnosis for PTSD. What is Post-Traumatic Stress Disorder? PTSD can occur when a person undergoes a traumatic experience that is beyond their normal ability to "cope" and results in intense fear, feelings of helplessness, being trapped, or loss of control. Those who witness or participate in a violent death, or who experience physical injury or sexual assault (such as victims of war, a plane crash or rape) are at greatest risk for experiencing PTSD. With PTSD, the victim wants to forget about the event and put it behind her, but at the same time, she is driven to express her feelings of fear and pain. As a result, she is caught in a trap, constantly alternating between feeling numb and reliving the traumatic event. Her efforts to "cope" with her feelings can take on a life of their own, often resulting in abnormal behaviors. Many women who have had abortions describe the dreamlike quality of the experience, as if they were standing outside the scene watching themselves go through the abortion. "I felt as though I was walking through a dream," writes Lori, who was pressured by family members to abort when she developed complications during her pregnancy. "Later I had this incredible isolated feeling, like a wall went up." Just what are the risk factors for PAS?

Call:             1 800 395 HELP

Who is at risk? Specific factors have been identified which predispose a woman toward developing emotional problems after an abortion. The more factors that one has, the higher the chances of her developing "Post Abortion Syndrome (PAS)." There is help available for those who are suffering emotionally from a prior abortion. It's called post abortion counseling, and most pregnancy centers offer help at no charge. To find the Center nearest you, call 1-800-395-HELP. To find out if you if you need healing, take the questionnaire called, "How Do I Know If I Need Healing." If you have checked off more than one symptom, you could be suffering from PAS. There is help available today. You don't need to suffer in silence or be alone in your thoughts. You can be free. Healing and reconciliation are available. Please call today. HIGH RISK FACTORS FOR DEVELOPING POST ABORTION SYNDROME (PAS) IN WOMEN: Women who feel they were coerced into having an abortion, by either a person or a situation. Women who are motherly, tender hearted and sensitive. Women who have had incest in her past. Women who felt ambivalent about the abortion decision. Women who were raised in a religious home where morals and values were clear. Women who have had more than one abortion. Women who had abortions due to fetal anomalies. These women often feel that they were pressured into making a fast decision by the medical community, and often have some anger issues. Women who were awake during the procedure and may have had visual contact with the fetus. Women who had a 2nd or 3rd trimester abortion. They are confronted with the knowledge of how well-developed their baby was. Women who have recently become pregnant with a "wanted" child. This may trigger a grief response for the aborted child. Women who had existing children at the time of the abortion. Women who learn about fetal development for the 1st time. Realization that it is more than a "blob of tissue" can cause shock and grief. Women with prior emotional problems. Women who have just had a spiritual experience where a whole new sense of morality has been implemented. IN MEN: Men who are excluded from the abortion decision. Men who are prolife. Married men whose spouses abort against their will. Men who are ambiguous about the abortion decision. STAGES OF POST ABORTION SYNDROME (PAS) Generally there are stages one goes through following an abortion. Not everyone will experience every one or even in this order, but these are common stages that have been documented by researchers on PAS. Relief--agony of having to make a decision is finally over. The "problem" is resolved, for better or worse. Denial or repression-- burying the hurtful emotions surrounding this experience. Anger--Toward anyone who helped cast the "deciding vote"; the ones who pressured her for the "right" reasons. (Boyfriends, husbands, parents, siblings, friends). Depression and bitterness-- sets in. "I will not forget or forgive. No one will ever hurt me again." Builds a wall around herself for protection. Distancing self from God-- "God could never forgive me, so why try?" STEPS TOWARD HEALING and RESTORATION Post abortion counseling involves several steps which are very briefly outlined below. There are numerous web sites detailing a more thorough examination of this subject. Three such resources are www.ramahinternational.org, www.rachelsvineyard.org, or www.afterabortion.org. Acceptance of Responsibility-- She acknowledges and accepts her responsibility in ending the life of her child. No more blame-shifting. Acceptance of God's unconditional forgiveness-- on an emotional, rather than a cerebral level of awareness. Forgiving one's self. Extending forgiveness toward others-- who helped make the abortion decision. Reconciliation with the aborted child.   If you are suffering after abortion, you may feel very alone. You may have experienced abortion many years ago and never told anyone. You may be struggling with a more recent abortion. As you investigate the resources listed here, keep in mind that not every program is a good fit for every person. Keep trying until you find a person or group where you feel safe, comfortable and welcome. Bear in mind that anytime you reflect back on a painful time in your life, you will most likely feel worse before you feel better, because you will be thinking and feeling more on a daily basis about what happened. That's normal, and it's one reason why support is so helpful on your journey. However, some people may try a particular resource, and continue to be in a lot of pain, experience flashbacks and intrusive thoughts, or have behaviors that they dislike and want to stop but which are continuing. If that happens, you may be tempted to say, "It must be me, and I can never expect to truly experience peace and joy again. Because of what happened, I will always have to struggle with destructive thoughts and unhealthy behaviors." Please keep trying! Many, many people have experienced complete healing of their post-abortion symptoms through one of these programs. You might want to read What does recovery feel like? if you are wondering whether more healing and recovery might be possible for you. back to index Types of programs When seeking support and healing for post-abortion trauma, one basic choice is between group support or one-on-one counseling.  If you're not sure whether a group setting or an individual setting is a better fit for you at this time, go to Thinking about a Group? for a collection of comments about that, and to Thinking about One-on-One Help? for comments about that.  Another choice is between in-person support (attending a weekend retreat, working with a therapist, a clergyperson or a peer counselor, or going to a weekly group) or online support (online chats, internet message boards, e-mail groups).  Several organizations offer a combination of email or internet-based group support and in-person support.  See Thinking about on-line support? And Thinking about in-person support? for reflections on these options.  Another choice is between programs with a spiritual component and those without.  Spiritual beliefs are personal and are often tied-in with how we look at abortion in general and our own experience with abortion in particular.  It is not uncommon to feel that we are unacceptable to God if we have had an abortion, or to feel that abortion is "the unforgivable sin".  That pain is indeed hard to bear, and it is one reason that many, but not all, post-abortion groups have a spiritual basis.  I indicate information about that with each listing. back to index   Basic expectations that you should have of a therapist or group as you seek post-abortion healing 1. Confidentiality.  Your confidentiality and privacy should be strictly respected at all times, unless you are threatening harm to yourself or others.  Also, no one should share the details of your story-even if no one would recognize that it is about you-with others without your explicit permission. 2. No pressure to "tell your story."  Because of wanting to reach out to those who still suffer, many people who have experienced post-abortion trauma do share their story with friends or in public.  This is a very personal decision, with many, many factors that you will need to consider.  If you indicate an interest in raising awareness through sharing your story, a good support group will encourage you to carefully discern what is truly best for you, and to take plenty of time in making this decision. 3. Prompt response.  If you e-mail an organization, you should expect a response within 48 hours.  If you call a hotline or therapist and get voicemail, you should get detailed information about when you can speak to someone in person.  If you leave a message, you should get a call back within 48 hours. 4. The program should not include any political component at all.  Because pro-life organizations such as the Catholic Church were inclined to believe that post-abortion syndrome exists, pro-life groups were and are very important in supporting post-abortion research and healing.  By contrast, some pro-choice activists can feel threatened by the idea that abortion can hurt a woman emotionally or spiritually, and react in damaging and defensive ways to your pain.  Bottom line: You may find help from a source you did not expect, but you should probably steer clear of any therapist, clergyperson or healing program that in any way will use or minimize your pain or vulnerability or tells you that you have to be pro-life or pro-choice to receive help or to heal.  5. The program and the individuals involved with it should be nonjudgmental, respectful, and knowledgeable. 6.   Avoid "quick fixes" and "spiritual bandaids"  See http://www.nacronline.com/dox/library/daler/quick.shtml   back to index Be Wise When Seeking Wisdom Some words to the wise from Theresa Burke, PhD, founder of Rachel's Vineyard and co-author with David Reardon of Forbidden Grief: The Unspoken Pain of Abortion: Post-abortion healing is a specialty unto itself.  The average psychiatrist, psychologist, social worker or counselor of any other academic stripe who does not understand post-abortion issues can often inflict more harm than good on the unsuspecting woman.  Many may believe they have enough insight to help, but unless they have had additional training, they often don't.  Certainly, if your thoughts and feelings become so overwhelming that you feel you can no longer cope, seek professional assistance immediately.  But generally, I encourage you to take the time to find one of the growing number of professional therapists and experienced lay counselors who have received special training in post-abortion healing.  (p. 247) Here is a longer excerpt from Forbidden Grief that is another word to the wise as you think about seeking help with any post-abortion issues you may be experiencing: The interaction between therapists and women who have experienced abortion is obstructed by unspoken secrets, fears and political biases.  It should be no surprise that because of their own psychological needs, many counselors simply don't want to delve into the subject of abortion.  If they do, some prefer to quickly reassure clients that they did the best thing and thereby close off any further expressions of grief.  This occurs because many counselors have neglected to identify their own fears and anxieties that might be aroused by such conversations.  Many therapists have been involved in an abortion themselves.  Others have encouraged clients to abort or have given their therapeutic 'blessing' to the abortion option for clients considering abortion.  This is often done out of ignorance of the research that shows that women with prior psychological problems fare poorly after abortion...While some therapists may simply be ignorant of these undisputed findings, others simply ignore or disbelieve them for their own psychological or political reasons.  Once a counselor has encouraged or approved of an abortion for Patient A, he may become 'invested' in defending abortion.  If he subsequently allows Patient B to delve into her post-abortion grief and associated pathologies, then the counselor may be forced to question his advice to Patient A.  He may be instinctively wary of witnessing an intense post-abortion reaction because it may provoke his own sense of guilt in having given Patient A bad advice.  Julianne described her experienced with her therapist this way:  After my abortion, I could not stop crying.  I went to see the therapist who had encouraged me to have the abortion.  I cried the whole time there.  She sat across from me with a blank look on her face.  She said nothing.  During this session she was removed and distant-emotionally cold and withdrawn.  As I was leaving her office, she came up to me and said, 'I don't usually touch my patients, but you look like you need a hug.' She then proceeded to embrace my shoulders and offer a squeeze.  I felt like I was being embraced by an evil presence.  I shuddered at her touch.  How dare she even come near me!  A hug!  I was sickened at the thought of such a trite expression-after having encouraged me to kill my own child!  Never a word of support for my motherhood!  Not an alternative plan, or a resource to help me.  She knew I didn't want another abortion.  She told me to have a ------ abortion because I would not be able to handle another baby.  Then she offered me a hug! God, I miss my baby.  That's who I wanted to hug...my baby who is gone, whom I will never hold or cuddle.  If the therapist has personally had an abortion, a client's confession of grief is quite likely to run into either a wall of denial or another quagmire of unsettled issues.  According to another of my clients, Hanna:  I thought I had put my own experiences behind me.  I was totally unprepared for the onset of emotions evoked by hearing one of my clients talk about her abortion.  There are times when I feel as though I have opened a Pandora's box and my life will never be normal again.  Memories I did not know existed have been surfacing at the most inopportune times.  My sleeping hours are plagued by graphic nightmares.  I vacillate between feeling in control and fully out of control.  As a professional counselor, I struggle to find a bridge that will allow me to merge my professional expertise with my personal trauma.  'Physician, heal thyself!' I do know that the time to reconcile this is now and that it is no accident.  I have arrived at this particular fork in the road.  Fortunately, Hanna recognized her own symptoms that screamed for attention and decided to seek help.  She was willing to deal with the trauma that she had for many years successfully pushed away but had never truly worked through." (The above excerpt is from pages 60-61 of "Forbidden Grief: The Unspoken Pain of Abortion", by Theresa Burke, PhD with David Reardon, PhD.)   back to index   Thinking about a group support program? Is group support the right choice for where you are on your journey? "Although the world is full of suffering, it is also full of overcoming it."-Helen Keller "Mutual help groups are a powerful and constructive means for people to help themselves and each other. The basic dignity of each human being is expressed in his or her capacity to be involved in a reciprocal helping exchange. Out of this compassion comes cooperation. From this cooperation comes community." - Phyllis Silverman, PhD, Dept of Psychiatry, Harvard Medical School, from Introduction to the Self-Help Sourcebook, 1995, p. 24 Research indicates that self-help groups can have a powerfully positive impact on us.  In post-abortion healing, this would be found at a weekend retreat, a weekly bible study or recovery group, in a structured online group or in a more free-wheeling e-group.  Yet, entering into a group can be scary.  Imagine going to a first meeting of Alcoholics Anonymous and saying for the first time outside the privacy of your own mind, "I am an alcoholic."  Or even just going to the first practice of a sports team at your new high school, or any other new group setting. It's common to have many anxieties and fears about attending a weekend retreat or group support meetings.  "Will my confidentiality truly be respected?"  "Even if people didn't say anything harsh, will I witness fleeting facial expressions of condemnation and judgment, and experience even more shame?"  "What if I start crying and can't stop?"  "Will I be the only one there with multiple abortions?"  The people who coordinate your particular support group probably experienced the very same fears at one point, and will be able to talk about them with you.  Besides abortion, you may have had other experiences in your life that cause you to experience other people as damaging and untrustworthy.   Meeting others in groups is a chance to experience people who are safe and trustworthy.  If you have had bad experiences with people, it can feel risky.  The rewards can be as great as the risk.  Here is a link to a website with many quotes about the advantages of mutual self-help groups:  http://mentalhelp.net/selfhelp/selfhelp.php?id=865 Theresa Burke of Rachel's Vineyard (www.rachelsvineyard.org) shares her thoughts on the value of a group support experience in Forbidden Grief: The Unspoken Pain of Abortion: The profound healing that Michelle experienced was new to her, but not to me.  I have been privileged to witness literally thousands of such transforming moments, when the labor of grief ends in the birth of a new, restored woman.  It as as though an emotional key turns, simultaneously releasing all the muck and grime and weight of past abortions while opening a door to a fresh new future...Tears of sorrow are mixed with tears of joy as women and men experience their first taste of freedom after years of cruel bondage. But such healing can only happen when the isolation and secrecy are dismantled, and one's story is revealed to others who do not seek to judge or condemn.  Only then is it finally possible, with the support of a small community of others who compassionately affirm the loss and respect the grief, to grieve one's losses to their fullness.  The importance of social support to the grief process reflects an important aspect of our human nature.  Though we are individuals, we are inescapably social beings.  The lack of social support will degrade or destroy our well-being.  Conversely, the experience of social support, in even a single relationship, can strengthen our well-being. For most of us, it is only when we have the support of others who will not judge or condemn us that we feel safe from social rejection.  This support makes it easier for us to confront and explore the deepest part of our souls.  With it, one learns how to accept forgiveness from God and one's aborted child.  With it, one learns how to extend forgiveness to oneself and others.  And with it, one discovers how the most difficult, soul-breaking experiences imaginable can be used as the foundation for building a richer, deeper, and more meaningful existence. From p. 246 of Forbidden Grief back to index Thinking about one-on-one help? Is one-on-one help the right choice for you at this time? One-on-one support and therapy as you begin to heal from post-abortion trauma could come in several forms.  You could seek help: from a mental health professional (a psychiatrist, psychotherapist, social worker, or other mental health clinician). from a clergyperson from a peer-counselor who will most likely use a recovery approach such as "Forgiven and Set Free",  "My Guilt, Grief and Shame are Ending Soon", the PACE program or "Her Choice to Heal", and meet with you one-on-one for a period of weeks at a time convenient to both of you.  (Generally, these sessions will be free or have a very low cost.) individual email counseling through a number of different online sites that offer it.  Advantages of one-on-one counseling include:  Personalized attention  Flexible scheduling  Ability to tailor sessions to your particular issues  Privacy Here is an excerpt from a comment made by someone who participated in one-on-one sessions with a peer counselor from Victims of Choice: My 10 counseling sessions have ended with my lay counselor from Victims Of Choice (VOC), and I wanted to write and thank you for this life changing experience. I learned of the VOC Ministry when you led a workshop at our church. I attended it because I was curious about a ministry dealing with men and women who have had abortions. Although I considered myself a committed Christian and had known the Lord for 15 years, I evaded the issue with Him that I too had had an abortion 25 years ago. I knew abortion was wrong and for years I had conditioned myself not to think about it. I told no one about my abortion - struggling to stay in denial even to myself. The abortion experience itself is very traumatic for a woman to endure. I learned that years of sleepless nights and other phobias were directly related to my abortion. My low self-esteem was mostly due to the tremendous guilt...hidden deep in my heart so no one could see what an awful thing I had done. But our wonderful God loved me too much to allow me to be in bondage to this buried sin. I clung to Isaiah 50:7 that says the Lord God will help us. I would set my face like a flint and ask Him to help me get over being so ashamed. After the workshop, I contacted VOC and made an appointment with a lay counselor. I really appreciated the discreet way in which I was treated. This very special person helped me to feel God's cleansing, healing and forgiving love! Here are some weblinks that offer advice on finding a compatible therapist: http://www.nacronline.com/dox/gethelp/therapy.htm back to index   In-person or online support? In-person support for post-abortion healing would either be on a weekend retreat, one-on-one counseling with a therapist, clergyperson or lay facilitator, or a weekly support group. On-line support would be through a message board, e-group, online recovery group, scheduled or spontaneous online chats, or email.  If you're reading this, you're already experiencing one of the many benefits of the internet:   Quick, fast, information on a targeted subject of interest to you, entirely at your own convenience, and with complete anonymity.  Ever since the internet came along, people have wondered how "the online experience" stacks up against face-to-face experiences.  Therapists wonder whether online therapy can be effective, Catholics wonder what it means to pray before the  Blessed Sacrament that is displayed on a webpage, young lovers wonder if it is "real" love if you only know the person online.   I would guess that for most people, as they journey toward healing, face-to-face contact will end up being very important at some point.  Online support, however, has great strengths.  For most people, it is not an either/or choice (either in-person or online support) but a both/and choice (both in-person and online support).    back to index   What Does Recovery Feel Like?  Almost anyone who has had a lot of recovery and healing from traumatic experiences and loss will tell you that you never stop healing this side of Heaven.   Yet, for many people a turning point comes when they can say, "I am not in that black hole any longer."    It's like falling in love...when it happens, you'll know.  If you have tried a particular therapist or support group, and you still regularly experience one or more of these symptoms in relation to abortion: Flashbacks or nightmares  Compulsive thoughts and feelings that started after the abortion Suicidal thoughts or feelings Depression or anxiety Lack of attachment to your children Self-hatred Shame Social isolation Relationship difficulties Compulsive or addictive behaviors that started after abortion Then I would urge you to try a different program or therapist.  As they say in 12-step programs, "You're not a failure until you fail to try."  Here's a link to a good article on reaching out for help: http://www.nacronline.com/dox/library/dalew/dw_help.shtml And here is a link to a page that beautifully describes some images of recovery:  http://www.nacronline.com/dox/library/meditate/m1_iofr.htm   As your healing journey continues, I'd like to share this final expression of what you might look forward to: 12 Signs of a Spiritual Awakening ( from an unknown 12-step source) 1.  An increased tendency to let things happen rather than make them happen. 2.  Frequent attacks of smiling. 3.  Feelings of being connected with others and nature. 4.  Frequent overwhelming episodes of appreciation. 5.  A tendency to think and act spontaneously rather than from fears based on past experience. 6.  An unmistakable ability to enjoy each moment. 7.  A loss of ability to worry. 8.  A loss of interest in conflict. 9.  A loss of interest in interpreting the actions of others. 10.  A loss of interest in judging others. 11.  A loss of interest in judging self. 12.  Gaining the ability to love without expecting anything in return. You are in my prayers. ~ Leslie       back to index Organizations, Descriptions and Links Disclaimer:  Neither I nor the Elliot Institute certify or endorse the programs or groups listed here.  I encourage you to read my views on the Basic, Minimum Standards a therapist or post-abortion group should meet.  Use your best judgment and discretion as you investigate these links.  If you are experiencing shame or guilt because of abortion, and have a negative experience with a particular group, you may believe that is what you deserve.  It isn't.  What you deserve is respect, a nonjudgmental attitude, and effective assistance as you heal.  If one person or organization isn't right for you, another one will be.   The Abortion Recovery Directory at http://www.abortionrecoverydirectory.com/ is a good place to start your search. The Abortion Recovery Directory is an online searchable database of post-abortion counseling services. This Directory originated in late 2004. The last I checked, it was still incomplete and many states returned no results, but others returned many. You can enter your zip code, city or state to find Christian-based abortion recovery services near you. As time goes on, the Directory aims to be a comprehensive listing of all such services. You should also look through the list below. This includes ministries with a national scope. By looking on their webpages, you'll also be able to find resources near you. Rachel's Vineyard Ministries at http://www.rachelsvineyard.org .       National toll-free hotline at 1-877-HOPE-4-ME (1-877-467-3463)      Theresa Burke, PhD, Director Rachel's Vineyard offers post-abortion weekend retreats and weekly support groups in 46 states and 7 countries. The retreat is Christian, and is offered in interdenominational, Catholic and ecumenical formats. It has been translated into five languages. Rachel's Vineyard has a monthly e-newsletter, "Vine and Branches", which is archived on their website and available on request. It has various aftercare resources including an email newsletter called "Oaktrees", an active e-group for former retreat participants called "Companions on the Journey" and individual email support through the website. Rachel's Vineyard has had an annual national Leadership Conference since 2000 and also offers one-day clinical trainings throughout the country. It hosts a very active e-group for mental health professionals and laypeople who serve on retreat teams, or are planning to offer the retreat.   Local Pregnancy Center Based Support Groups Many Pregnancy Resource Centers (PRCs) and Crisis Pregnancy Centers (CPCs) host post-abortion support groups. These groups typically meet weekly for a period of anywhere from 8 to 16 weeks, and use a variety of recovery guides, including "Forgiven and Set Free", "Her Choice to Heal", PACE (Post- Abortion Counseling and Education), the Rachel's Vineyard weekly support model, or the "My Guilt, Grief and Shame are Ending Soon" program. How would you find out if a PRC or CPC near you offers a post-abortion support group? The best way to do that is to call the Option Line at 1-800-395-HELP or consult their online directory at http://www.optionline.org/. You can do a zip code search of their extensive database. The National Office of Post-Abortion Reconciliation and Healing (NOPARH) at http://www.marquette.edu/rachel   and Project Rachel at http://www.hopeafterabortion.com  NOPARH has a national toll-free hotline at 1-800-5WE-CARE. Project Rachel is a post-abortion outreach of the Catholic Church, while NOPARH is intended as a non-denominational referral source for post-abortion help.  Project Rachel was founded in 1984 by Vicki Thorn, who is the director of NOPARH.   NOPARH has hosted several international conferences on post-abortion reconciliation and Vicki Thorn offers one-day trainings.  Catholic dioceses that have their own Project Rachel can also be a source for local referrals.   By calling the national office at 1-800-5WE-CARE, you will generally be referred to the local Project Rachel office nearest to you.  That office can then refer you to helpful and trained clergy, therapists, retreats and support groups. Healing Hearts Ministries International at http://www.healinghearts.org/. This international ministry was founded in the state of Washington and has grown to include in-person support groups in a number of other states. In addition to in-person support groups, Healing Hearts offers an online program. Ramah International at http://www.ramahinternational.org  Sydna Masse, Director; phone (941) 473-2188.  This Christian group supports post-abortion ministry through training programs, resources, research and promoting awareness of post-abortion issues.  Director Sydna Masse is the author of the recovery book, "Her Choice to Heal".  Sydna has also created a leader's guide so that "Her Choice to Heal" can be used as the basis for in-person weekly recovery groups.   Ramah International has a newsletter, various additional resources, and can be used as a point of referral to weekly recovery groups around the country.  You can also find e-mail support through the Ramah website.  Rachel's Network. Contact Martha Shuping at mshuping01@sprynet.com. Rachel Network is a group of professionals, clergy and peer counselors which provides direct services to women who have had abortions as well as training for counselors, clergy, and lay ministers. Rachel Network volunteers conduct the Rachel's Vineyard weekend retreat and can train teams for new retreat sites. They also offer the "Rachel Network Evening of Prayer for Post-abortion Healing," a program that can be done with almost no expense with only one volunteer. It takes place in an anonymous atmosphere in a darkened church (Catholic and other denominations), and has been a great source of healing, as a first step or as a stand alone program. Hope Alive at http://www.hopealiveusa.org/, Hope Alive is a group counseling treatment program designed to heal those afflicted with childhood traumas and pregnancy losses. The treatment program consists of 30 group sessions, each two-to-three-hours. There are Hope Alive group leaders in a growing number of states. Victims of Choice at http://www.victimsofchoice.com/  An informative and welcoming website.  Elizabeth Verchio, Director, has created  "My Guilt, Grief and Shame are Ending Soon", a 10-session program that is especially designed for one-on-one work between someone experiencing emotional and spiritual wounds and a trained peer counselor.  Victims of Choice offers many resources for establishing abortion recovery centers, including a 217-page Abortion Recovery Facilitator Guidebook.    Regional and local ministries. The weblog http://afterabortion.blogspot.com includes a long list of local and regional post-abortion ministries at this link: http://afterabortion.blogspot.com/2005/01/regional-and-local-resources-for.html   Online support: Message boards, e-groups and chat rooms that offer support after abortion. Safe Haven Ministries has an active message board and several weekly chats. Forgiving Abortion is an support board through the MSN message board system. Cheryl's Page has offered a low-traffic message support board since the late 1990s. There are over forty post-abortion e-groups in the abortion recovery section of Yahoo E- groups. But remember, anyone with an email address can create a Yahoo e-group on any subject under the sun. This may be a waste of time, or worse...   www.afterabortion.org