I heard from dozens of folks who said there were parts of getting an abortion they felt unprepared for or surprised by—the pain, the bleeding, and all the other aspects associated with many medical procedures.
 The Gender Spectrum Collection

Conversations about the aftermath of an abortion can center on harmful and false narratives. We’re here to change that.

Abortion is life-affirming health care that should be accessible for all, on demand and without restrictions. Part of supporting access to abortion care is making sure patients who seek them are fully informed about what having an abortion entails, including the aftercare.

I recently put out a call on Twitter to learn more about the experiences people had after their abortion. I heard from dozens of folks who said there were parts of the experience they felt unprepared for or surprised by—the pain, the bleeding, and all the other aspects associated with many medical procedures.

Unfortunately, conversations about the aftermath of an abortion all too often center on harmful and false narratives about abortion regret and other so-called risks of the procedure. Beyond that, it seems abortion care has also fallen victim to the same culture of medical misogyny and politicization as birth control and intrauterine devices, wherein the discomfort experienced is downplayed not only because it is part of women’s health care, but also out of fear that acknowledging the reality of it will embolden those who seek to restrict, stigmatize, and scaremonger about the procedure.

So here’s our ultimate guide to abortion aftercare, an honest, abortion-loving rundown of what to expect after terminating a pregnancy.

For any abortion experience

It’s important to have a safe and comfortable place to either recover from a procedural abortion or to undergo a medical one. The process can cause intense cramping and bleeding, and some common items you might want to have on hand include:

  • A heating pad
  • Heavy-flow pads (lots of them)
  • Premade meals (or a plan to have meals delivered to your door)
  • Pain medication
  • Comfy, loose-fitting clothes
  • A list of TV shows to binge
  • A support system that can help with your caretaking and/or domestic needs.

You might also experience nausea after a medication abortion, so having stomach-friendly remedies such as ginger ale and plain crackers can also be super helpful.

No matter how you feel about your decision to terminate a pregnancy, hormone fluctuations after the procedure are normal and could cause you to experience mood swings. This makes sense, if you think about how your hormones affect your mood at different points in your menstrual cycle. If you feel a little low after having an abortion, know that your body will readjust.

Some folks who shared their abortion experience with me mentioned having side effects like hives or smell sensitivity. While nothing too serious for most people, they may cause you to worry if you’re unprepared. All of which underscores the reality that, like all medical decisions and procedures, abortion affects everyone a little differently. It’s worth discussing your concerns with your provider ahead of time, as well as any reactions you’ve had to medications or procedures in the past.

Also, there may be an abortion doula collective in your area—your local abortion fund or clinic should be able to point you in their direction. Abortion doulas, like pregnancy and birth doulas are trained to provide compassionate care and support for all kinds of abortion needs.

Medication abortion aftercare

medication abortion typically involves taking two pills, mifepristone and misoprostol. Usually, patients take mifepristone in their provider’s office, after which they are sent home with misoprostol to be taken between 24 and 48 hours later.

“One thing to note is that typically you don’t get the cramping until you take the misoprostol,” said Dr. Diane Horvath, a Baltimore-based OB-GYN. “People sometimes freak out at the visit and say, ’Oh my God, is the pain going to start now?’ The pain typically starts after you take the misoprostol. And usually people are doing that in their home, or in a safe space that they’re able to be in for the rest of the process.” Horvath tells patients to plan on staying put for the duration once the misoprostol kicks in.

“So don’t take the misoprostol and go somewhere; don’t take it and go to Target,” she said. “Be home or in the home of somebody, or in a space that you trust.”

The worst of the bleeding and cramping is usually over within 24 hours; Horvath said she asks patients about what they do for work and the demands of their day-to-day so she can help them figure out when it might be best to take time off. (Horvath added that occasionally, patients might need a second dose of misoprostol to complete their abortion; that’s something you can discuss with your provider, as well.)

Once the fetal tissue has passed, the bleeding and cramping should lessen, but you should expect to experience bleeding similar to that of a period for a week or two, said Dr. Ashley Brant, an OB-GYN.

“Bleeding the second week is usually lighter than a period,” Brant said. “If you’re still spotting at the two-week mark, that’s probably OK too, as long as the bleeding is getting lighter over time. Dark red and brown bleeding is normal, as are small, stringy clots.”

When it comes to returning to normal activities, Horvath said that’s another conversation to have with your provider. She added that not having sex or using tampons for six weeks is an outdated standard; now she tells patients to “try not putting anything in your vagina for a week.” There’s no evidence to support the claim that waiting longer is necessary, Horvath said, as it’s not a birth or major surgery. Once the tissue has passed, do what feels most comfortable for your body.

As for pain management after a medication abortion, studies show that nonsteroidal, anti-inflammatory drugs such as ibuprofen often provide the best relief because they’re effective at blocking prostaglandins, the fatty, hormone-like compounds that cause the uterus to contract during your period. Horvath noted that it’s normal and OK for a patient to feel like they might need something stronger, like a prescription painkiller.

“I always ask people, ’How are your periods?’ And if someone says, ’Oh, I never have cramps on my period,’ I’m like, ’OK, you’re going to have to buckle up for this, because this is going to be really crummy for a few hours. You’re going to feel really shitty,’” Horvath said.

The most important thing is for patients to feel prepared for the process so they aren’t alarmed when the cramping or bleeding sets in. Horvath also recommends that patients take any pain medication before their pain becomes unbearable—don’t wait for it to get to a ten. When the pain is at a three or a four is when the medicine can really do its job, Horvath said.

One final tip for pain relief: “I always tell people, if you use cannabis for pain control or for anxiety, please feel free to use your cannabis to manage your symptoms from your medication abortion,” Horvath said.

Horvath also said patients should remember that undergoing a medication abortion will cause their hormone levels to fluctuate, which can lead to nausea, breast tenderness, hot flashes, mood swings, and sleep disruption. As such, she advises patients to be gentle with themselves, and to remember that medical intervention of any kind can be a stressful experience.

“You’ve had something done to your body, and your body is home,” Horvath said. “I mean, I think even going to the dentist for a lot of us is like a jarring feeling.” (I couldn’t agree more.)

Procedural abortion aftercare (early)

Much of the same aftercare advice applies to a procedural abortion: Give yourself time to rest, listen to your body, and talk to your provider in advance about what to expect and how best to prepare.

Horvath pointed out that the side effects of an early-term procedural abortion can vary—some patients report no cramping at all, while others experience significant cramping. She said the level of cramping typically mirrors that of your period, so if you get awful cramps when you menstruate, expect that you’ll also have cramps after your abortion. As your uterus shrinks back down to size, the contractions can cause bleeding and some intense pain in the first few days following the procedure.

Don’t be afraid to discuss the nitty-gritty details with your provider, Horvath added: Ask how much post-abortion bleeding is normal, how many times you should expect to change your pad, and what kind of clotting might be common versus what could be a sign you need to get checked out.

“It’s really normal to pass some clots, particularly after a second trimester or a later abortion,” Horvath said. “But those clots shouldn’t be the size of your fist. It could be the size of a lemon; that’s OK to have a couple lemon-sized clots. It’s not OK to have three fist-sized clots, [and] it’s not OK to have a clot the size of your shoe—that’s too much. If you saturate two maxi pads per hour for more than an hour, then call us. But [providers should be] really specific: I don’t mean panty liners; I mean full-size maxi pads.”

Later-abortion aftercare

For a later abortion, the cramping and bleeding may be more intense. “As the pregnancy length increases, the recovery becomes more like the recovery from a vaginal delivery in terms of bleeding and cramping,” Brant said.

Horvath recommends taking a few days off from work if your schedule or employer allows—especially if your job is physical—but this isn’t absolutely necessary if you need to work to provide for yourself or your family.

The later in pregnancy your abortion occurs, the more your body is ready to give birth. As a result, some patients who have a later abortion may start lactating. While your natural instinct might be to express the breast milk, Horvath said this will have the opposite of the intended effect—it will encourage your body to produce more milk.

Horvath suggested a midwifery trick: Freeze some cabbage for a few days before placing the frozen leaves in a well-fitted, supportive bra overnight. Avoid stimulating your breasts or letting hot water run over them in the shower. After a few days, the cabbage should have stopped the milk production. Brant advised taking over-the-counter Sudafed to help slow lactation.

With later abortions, know that there are ways to memorialize the pregnancy if desired, and your provider should be ready to discuss those with you. Later-term abortions can involve wanted pregnancies, meaning the emotional implications of this procedure are heavy. Some folks who reached out on Twitter said they wished they knew about the options available to them in advance, like taking a memento home from the hospital, such as footprints, handprints, or a certificate. Some of these options might also be available for patients having earlier abortions if they feel that it’s right for them.

Horvath said many of her later-term abortion patients feel anxious about how to discuss their experience with the people in their lives. One day they could be pregnant to the point of showing, and later they’re not—but there’s no baby at home.

“I’ve told people that if they’re comfortable, [they can say] something along the lines of, ’We lost the pregnancy, I don’t really want to talk about it,’” she said. “And that speech seems to work well because it kind of covers everything. I also tell people [that] if somebody gives you any shit, you just tell them you’re done talking.”

A safe procedure

Abortion is health care. And surely, anti-abortion activists will exploit the reality that abortion can cause severe cramping and mood changes by using it to bolster their rhetoric. But study after study has disproven theories about “post-abortion syndrome,” as well as other tropes about abortion regret. One of the most accurate indications of how you will feel after an abortion is your own mental health prior to having one.

Abortion as a medical procedure is also incredibly safe. Ask pretty much anyone who’s had a routine medical procedure and they say these experiences are generally not super pleasant! Getting a cavity filled sucks, undergoing a colonoscopy sucks, having your appendix removed sucks. Lots of common and safe procedures that people have every single day involve pain and bleeding and unpleasantness, but that doesn’t mean they should be politicized or have restrictions imposed on them.

Abortion is no different.

Source: https://rewirenewsgroup.com/article/2022/02/02/a-guide-to-caring-for-yourself-or-others-after-an-abortion/