Does Previous Abortion Have an Impact?

[walking burp cloth]

OK.....So I am going for my doula certification, so I am still naive about some things. When a woman has had a previous abortion does this interfer with her pregnancy and birth if she later becomes pregnant again? Just thinking of scar tissue or any thing else. Is there anything out of the ordinary that I need to consider or be infomiative on if I have a client who has had a previous abortion? Physically and/or emotionally?

[CookieMonsterMommy]

As long as it were not particularly traumatic, then there should be no physical ramifications. Rarely is there any scar tissue, unless the abortion "went wrong" (ie the uterus was punctured, cervix was torn, etc). These complications are rare, even in late term abortions. Most abortions are done as out patient procedures during the 1st trimester.

However--If she had an abortion and regrets it (was pressured, feels she made bad choice, pregnancy was a result of sexual abuse, etc), and/or feels mournful of her loss, then she can certainly have emotional issues that could lead to physical issues, such as failure to progress, pain, need for control, etc.

This would be true for any pregnancy related sadness or fear, and isn't specific to women who have had previous abortions.

During your interview, if you ask about abortions, you can follow up with "Was it uncomplicated?". I usually end the interview/intake with "Are there any special issues that you think might affect your pregnancy/birth experience?". I wouldn't ask that directly after the abortion question, because I wouldn't want her to think that I feel she should regret it, or that I anticipate problems because of the abortion.

[dewi]

No affect on her physically if it is a routine procedure.
It is considered a routine outpatient procedure.
The studies show that almost all women are grateful to have been able to have an abortion if they wanted one.

I donate money to an organization that helps Christian Evangelist women and women from intolerant communities for them to come to NYC for an abortion if they want one (a women does not need money to get an abortion) and if they want it gives them a place to stay in another woman's apartment overnight after the abortion.
Grateful is the prevailing emotion both immediately and long term.

[CarolynnMarilynn]

I do find that previous D and C can affect things later on, and is emerging as a risk factor for future pregnancies. Saying that, I am pro-choice and think that unwanted pregnancies can cause much more harm. Emotionally, the choice can be a good one, or a bad one. Each situation is so individual.

[cicada]

Originally Posted by CarolynnMarilynn

I do find that previous D and C can affect things later on, and is emerging as a risk factor for future pregnancies.

what are the risks?
a vast majority of women who've had d&c's have totally uncomplicated pregnancies/ births, right?

do you mean they have trouble giving birth, getting pregnant, or what?

i was unaware that this was a risk factor. grateful for any information.

[jenmidwife2b]

D and C possible risks:
http://www.betterhealth.vic.gov.au/b...curettage?open
Possible complications
Some of the possible complications of D&C include:

• Reactions to the medications used, such as allergic reactions to the general anaesthesia
• Cervical damage due to dilation or the passage of instruments
• Haemorrhage (bleeding)
• Infection of the uterus or other pelvic organs
• Scar tissue within the uterus, if the scraping was too vigorous
• Puncture

http://healthonnet.org/Dossier/Mothe...res/dandc.html
Complications include a small risk of excessive bleeding or uterine perforation and infection. Rarely, damage to the bowel or bladder. Repeat D & Cs or overscraping may lead to scar tissue, which may cause infertility or menstrual problems

It can also cause "incompetant cervix" ( I hate that term! )
http://www.allhealth.com.au/html/s02...tory=2&cr=true

• previous surgery on the cervix, such as a cervical biopsy or a dilatation and curettage, or D & C (including termination of pregnancy)

http://infertility.suite101.com/arti...l_incompetence
Who Is At Risk Of Incompetent Cervix?

The following groups of women may have a higher risk of incompetent cervix:

• Women with an abnormally shaped womb and cervix
• Those who have had treatment for cervical cancer or other cervical abnormalities
• Those with previous pelvic inflammatory disease, where the cervix is scarred
• Anyone who has had a D+C (dilation and curettage) for a miscarriage, infection or termination
• Anyone who has had several terminations of pregnancy, or damage to the cervix through termination
• Anyone who has had cervical damage during a previous childbirth
• Anyone who has suffered a previous second trimester miscarriage
• Those with previous vaginosis infection.

http://www.mayoclinic.com/health/d-and-c/AN00440
Not everyone who has a miscarriage needs suction dilation and curettage. Complications resulting from a D and C are rare but may include damage to the connective tissue of the cervix or uterine wall, which may affect future pregnancies.

[Alison Cole]

While all the issues listed in the previous post are possible results of an abortion procedure, the chances are very small, and (as has been said) an uncomplicated AB usually has no impact on future pregnancy. heck out this link: http://www.guttmacher.org/pubs/fb_induced_abortion.html and scroll down for stats on AB safety.

[maxmama]

Also, please remember that a D&C is very rarely used in this country for the 80-90% of abortions performed prior to 12 weeks. Suction curettage is different from a D&C, and of course a medical AB will be different still.

There has not been any correlation with an increased risk of future infertility or pregnancy complication and an uncomplicated first trimester abortion.

[AmieV]

The physical has been addressed...in general there's very few issues with pregnancy post abortion.

For a discussion of the emotional side, I hightly recommend the book "Ended Beginnings" by Panuthos/Romeo. It covers all kinds of pregnancy loss and healing from it. I can't even begin to delve into the possible emotional issues surrounding a pregnancy post abortion...I think it seems most women are absolutely fine, some have minor issues...some have more deep emotional work to do. That book was really helpful for me. I've read some other pregnancy after loss books when I got pregnant after my miscarriage, and I know they often covered abortion as well. You might check any of those out too.

[MommyMidwife]

I don't find that it affects her physically but mentally almost everytime.
jeni

[CookieMonsterMommy]

Originally Posted by MommyMidwife

I don't find that it affects her physically but mentally almost everytime.
jeni

Interesting. I've found it to be very rare that there is a mental/emotional issue. And when there has been, it was after an emotionally complicated abortion (such as she was pressured into having it).

[dewi]

This thread is way beyond the scope of a labor doula, for the original poster it is not appropriate for a doula to ask if a women had an abortion or bring any agenda to her birth about some supposed impact of abortions.

[applejuice]

Originally Posted by walking burp cloth

OK.....So I am going for my doula certification, so I am still naive about some things. When a woman has had a previous abortion does this interfer with her pregnancy and birth if she later becomes pregnant again? Just thinking of scar tissue or any thing else. Is there anything out of the ordinary that I need to consider or be infomiative on if I have a client who has had a previous abortion? Physically and/or emotionally?

Depends on how well the abortion was done and on the skill of the abortionist. Most women are simply happy to have the abortion over with and ask few questions at the time. I would surmise that few women ask for the post op records from their abortion.

Most complications would have to do with scar tissue at the cervix (affecting cervical competence), in the uterus or any infections that would cause tube damage or damage to the uterine lining.

I think your client needs to discuss this with her doctor, not her doula.

Who Is At Risk Of Incompetent Cervix?

Add to that list being a DES daughter or granddaughter. Doctors rarely list the iatrogenic causes of anything.

[dewi]

Again, this is not the doulas role to ask about abortions.

Plus this thread is starting to veer into misinformation about abortions and doctors who provide them.

None of the studies support the notion that "abortions are leaving scars on the uterus".

[Jane]

In my experience, no impact on the physical or emotional experience, to my eye as an outside observer of the labor.

According to the guttmacher data, about 40% of american women will have had an abortion by menopause. That seems reasonably accurate in the populations I've worked with. A woman with a previous abortion is a not a ratity - she is the everyday client.
A woman having an abortion or abortions before giving birth is a common experience. If it caused problems, there would be enough experiences to gather data. I haven't seen it reported and I haven't seen it in practice.

Totally off this topic, but I have seen one thing cause problems - conalizations for cervical pre-cancerous changes. That pops up relatively frequently.

[Individuation]

Originally Posted by dewi

This thread is way beyond the scope of a labor doula, for the original poster it is not appropriate for a doula to ask if a women had an abortion or bring any agenda to her birth about some supposed impact of abortions.

Yeah, I actually disagree with your previous post but I'm right with you on this one.

[maxmama]

Originally Posted by Apricot

In my experience, no impact on the physical or emotional experience, to my eye as an outside observer of the labor.

According to the guttmacher data, about 40% of american women will have had an abortion by menopause. That seems reasonably accurate in the populations I've worked with. A woman with a previous abortion is a not a ratity - she is the everyday client.
A woman having an abortion or abortions before giving birth is a common experience. If it caused problems, there would be enough experiences to gather data. I haven't seen it reported and I haven't seen it in practice.

Totally off this topic, but I have seen one thing cause problems - conalizations for cervical pre-cancerous changes. That pops up relatively frequently.

Cryo and LEEP are also things I hate to see on medical records.

I agree that one in two clients has had an abortion. If you don't know how to be a doula for someone with a history of abortion, that's just because you don't know who's had an abortion. We're completely average.

[mwherbs]

times when it can have a big impact- if it is discussed openly and the partner or who ever is in the room does not know about it-- it may be something a woman may choose to share with you , and certainly something for you to have researched but not something to be spoken about or mentioned without a private discussion or agreement before hand .

------

[applejuice]

Williams Obstretics discusses this in the chapter on elective abortion.

The article is inconclusive as far as subsequent pregnancies is concerned.

[erthe_mama]

The only way an abortion would actually affect a pregnancy is with how the placenta is positioned. I've read research (I'll try to find it so you can read it for yourself) that suggests that SEVERAL abortions (or c-secs for that matter) could lead to low-lying placentas or placenta previa. This is not found often however, since the majority of women who have had abortions do not have several of them, and they're not generally D&C's.

I've had mamas disclose to me that they've had abortion(s), but I've never found the need to discuss this at any length with them (especially not about any medical implications it may or may not have). I'll bet though that there are some mamas who would ask (since there's all sorts of different people on this planet), but I haven't encountered them personally.

However, imho, there's no such thing as knowing too much about pregnancy and birth (as a doula or caregiver), so it's cool of you to ask on this forum about it.