So, you’re pregnant and you don’t want to be. If you’ve decided that having an abortion is the best option for you, there will be many more questions and considerations ahead of you.
Although it may feel like it right now, you’re not alone—around 650,000 women in the United States get an abortion every year, according to the most recent data available from the Centers for Disease Control and Prevention (CDC). Though this procedure is common, it can also feel shrouded in secrecy, especially when you’re looking for advice on what to expect. According to experts, there are a lot of ways to prepare physically and emotionally for your abortion. Here’s what you can do.
1. Educate yourself about your abortion options and what each one entails.
Nearly one in four people getting abortions choose what’s colloquially known as “the abortion pill,” according to the CDC. This option (also called a medical, chemical, or pill abortion), is only available to people who are at most 10 weeks pregnant. If you’re further along than that, or if you have certain contraindications (like taking blood thinners), you’ll need a surgical abortion, which we’ll detail in a moment.
People often choose to have a medical abortion because it’s less invasive than its surgical counterpart. “It seems less clinical because you're taking medications that mimic a natural miscarriage,” ob/gyn Sara Imershein, M.D., M.P.H., vice chair of the D.C. section for the American College of Obstetricians & Gynecologists (ACOG), professor at the George Washington University School of Medicine, and board member of the NARAL Pro-Choice America Foundation, tells SELF.
Though there are different ways to have a medical abortion, the most common involves taking two pills, according to the Mayo Clinic. The first is mifepristone, which you’ll either take at the health center providing your abortion or at home. (Whether or not you can take this first pill at home depends on the laws in your state.) Mifepristone prevents an embryo from growing by blocking progesterone, a hormone that typically thickens your uterine lining to support a pregnancy. The second pill is misoprostol (you take this one at home 24 to 48 hours after the first pill), and it induces contractions to empty your uterus. You’ll experience cramping and bleeding as you pass the pregnancy and the uterine lining that would have supported it, typically for a few hours. You may also deal with symptoms like nausea, vomiting, fever, chills, diarrhea, and a headache, according to the Mayo Clinic. Your specific symptoms can vary based on how far along you are and just on how your body works.
A week to two weeks after the abortion, you’ll need to go into the doctor’s office for a follow-up to ensure all the tissue is out of your uterus. Some estimates show that medical abortions have a success rate (meaning the pregnancy is over and all the necessary tissue was expelled from the uterus) of around 93 to 98 percent, depending on how early you get the abortion, according to the Food and Drug Administration. (The completion rate went down as gestational age increased.) If during your visit your doctor discovers your abortion was incomplete, they may decide to prescribe another dose of misoprostol, or they might discuss with you the possibility of surgical intervention to complete the abortion.
There’s also the option to get a surgical abortion. This procedure takes around five to 20 minutes, and what research has been done shows it can be more effective than medical abortion, with 96 to 100 percent completion rates (although the disparity between medical and surgical abortions seems to be wider when you’re talking about less common forms of medical abortion than the mifepristone and misoprostol combination). This involves removing the fetus and placenta from your uterus through your vagina with a suction device or other medical tools. Depending on factors like the fetus’s gestational age, a surgical abortion is performed under local or general anesthesia.
Many people choose this option because they like the idea that it will be over in a few minutes, Dr. Imershein says. Even with pain medication, you may experience cramping during your surgical abortion, but it typically subsides quickly. You may also experience bleeding, cramping, or spotting for days after a surgical abortion.
Whichever route you’re going, your doctor should thoroughly explain all the important details of what to expect before, during, and after the procedure. That should cover how it works, the side effects you can expect based on specifics like how far along you are or what kind of pain medication you’re getting, potential risks and complications, as well as the clinic’s protocols (like if and when to stop eating or drinking the night before, depending on the kind of anesthesia you’ll have).
2. Remember that abortions are safe medical procedures when performed under the care of a medical professional. They carry fewer risks and complications than childbirth.
Abortion is one of the safest routine medical procedures you can have, especially in the first trimester (which is when over 91 percent of abortions take place).
Fewer than one woman will die for every 100,000 legal abortions performed by a professional, according to the CDC. For perspective, there were 17.3 maternal deaths for every 100,000 live births in 2013, according to the CDC’s most recent pregnancy mortality surveillance statistics. This is in large part because the longer you’re pregnant, the higher your risk for potentially life-threatening complications, according to a 2012 study in Obstetrics and Gynecology, which explains that many of the more dangerous conditions, like preeclampsia (high blood pressure during pregnancy), are most likely to present later in pregnancy.
3. Make sure you’re aware of any abortion legislation in your state that may complicate your experience.
For instance, some states have imposed mandatory waiting periods for medical abortions, meaning you may have to wait anywhere from 18 to 72 hours after a counseling session to actually have your abortion, according to the Guttmacher Institute. Here’s a general overview of what you can expect based on where you live, but it’s always smart to do some extra research beforehand so none of this takes you by surprise. This can be especially important if you have to take off work, travel, or find childcare in order to make an appointment.
Also, depending on your state, understand that your doctor may be required by law to lie to you or give you written materials with false information about abortion. Thirty-five states mandate some form of counseling before a person can receive an abortion, according to the Guttmacher Institute. The information included in that counseling varies by state, but sometimes this means that abortion providers are legally forced to share medically inaccurate information, like that abortion can increase the risk of breast cancer (science doesn't support this) or that having a safe, legal abortion is likely to impair fertility (again, science does not back this up).
Based on the state in which you live, your doctor may also have to perform an ultrasound and show you the resulting image, offer you the chance to see the image, or describe what the fetus looks like.
4. Try to let go of expectations about how you “should” feel about your abortion.
There is no right way to feel about it. “It’s a really different experience for every person,” Gillian Dean, M.D., senior director of medical services at the Planned Parenthood Federation of America (PPFA), tells SELF.
Dr. Dean says that in her experience, most of the women she's spoken reported feeling an immense sense of relief afterward. This was the case for Violet L.*, 45, who tells SELF she had an abortion at nine weeks 10 years ago and that it was much less scary and traumatizing than she anticipated.
Research hasn’t found an increased risk of psychological problems in people who terminate their pregnancies, Dr. Imershein says. In fact, seeking an abortion but being unable to access one has been linked with more negative mental health outcomes in the short-term than actually having the procedure, according to a 2017 study in JAMA Psychiatry. (In six months, women in both groups generally had similar mental health, meaning the mental health of the women denied abortions improved over time, and it remained steady for the women who got abortions.)
Conversely, some people do describe feeling heartbroken, ashamed, or the need to grieve after an abortion, Megan Aebi, a full-spectrum pregnancy doula and representative of New York-based volunteer organization The Doula Project, tells SELF. (Full-spectrum doulas are trained to counsel women not only through pregnancy and birth but also through experiences like miscarriages, fetal anomalies, stillbirths, and abortions.)
Whatever your emotions surrounding your abortion, all of them are completely valid. Give yourself permission to experience them without judgment, Aebi says.
Also, remember that even if you’ve had an abortion before, this time won’t necessarily be the same. “A woman can have a very different reaction to an abortion than at a time in her past [because] she’s in a different point of her life,” Dr. Dean says.
5. Remove as much financial stress as possible by figuring out how you’re paying for the abortion.
How much your abortion will cost varies widely depending on a number of factors, including the type you’re getting, how far along you are (they’re usually pricier after the first trimester, Dr. Dean says), the provider you go to, where you live, and your insurance coverage. With that in mind, one 2014 report based on all known abortion-providing facilities in the United States found that the median cost for either a surgical or medical abortion at 10 weeks was around $ 500.
If you have health insurance, your first step should be calling your insurer to find out if your abortion will be covered. (Many states restrict private insurance and Medicaid from helping with abortion; sometimes there are exceptions, like in cases of life endangerment.) You can also call your local abortion-providing health center to see if they charge less for services depending on your income.
There are also a number of organizations that may be able to help offset some of the financial burden. Check out the National Network of Abortion Funds (NNAF) and the National Abortion Federation Hotline Fund.
6. Tell only the people you actually want to and no one else.
Maybe you feel like shouting from the rooftops that this is the smart, safe, choice for you. Perhaps you’d rather not tell a soul. “When it comes to who you share this with, who you seek support from, and whose experience and advice you solicit and follow, [follow] your gut,” Dr. Dean says.
That might mean not telling your sister, who typically knows everything about your life but is staunchly anti-abortion. Or maybe you know your friend would be supportive, but they’re a total blabbermouth.
If you’re not sure whether or not to tell a friend or relative, Aebi says you can test the waters first by bringing up the topic of abortion. She recommends saying something like, “My friend is getting an abortion and they need a ride,” or, “There's so much talk about abortion in the news recently,” and gauging their reaction. As with any other major medical decision, this information is entirely your business, and only you should get to decide who to share that with.
7. Stock up on things like food, water, pads, and painkillers for after your abortion.
If you can, you should take off work the day of your abortion procedure, no matter the type (and maybe the day after, if you can swing it, although Dr. Imershein says most people are fine to go back by then). If you’re having a medical abortion, that means you’ll want to schedule your day off for when you take the second pill, not the first, because most people don’t experience any kind of discomfort or bleeding until then, Dr. Dean explains.
During a medical abortion, you may experience nausea and vomiting, but it's important to stay hydrated even when it feels like you can’t keep anything down, Dr. Dean says. Buy some ginger ale, soup, a sports drink, mint tea, whatever your go-to aids are for a queasy stomach. Aebi also recommends you have some comforting food at home, whatever that looks like for you, so you don’t have to venture out and grab anything if you’re not feeling up to it.
You’ll also definitely want to purchase lots of big pads to soak up and monitor the bleeding, Dr. Dean says. During a medical abortion and after a surgical one, you may experience heavy bleeding, then spotting that can last a few days or weeks. (Or you might have virtually zero bleeding afterward, Dr. Dean says.) If at any point you’re soaking through two or more pads an hour for two hours or more—or if you see clots larger than a lemon—you should call the doctor or the clinic that performed the abortion. Same goes for if you experience a fever or foul-smelling vaginal discharge, both of which could indicate an infection.
If you prefer using tampons, it’s important to know that the advice on whether (and when) they are OK to use in the period following your abortion is mixed. Some doctors say it’s safe immediately, while others advise waiting two weeks. “The idea is that the tampon will hold the blood back while normal vaginal bacteria grow and multiply, increasing a risk of infection,” Dr. Imershein explains. “We encourage people to use whichever method they’re most comfortable with, whether that’s pads, tampons, or a menstrual cup,” Dr. Dean says. Ask your doctor performing your abortion what they recommend.
To help with the cramping, which generally mimics period cramps but can vary in severity based on the person, stick to nonsteroidal anti-inflammatories like ibuprofen instead of drugs like aspirin, which can thin your blood and make you bleed more. You can also try a heating pad, hot water bottle, or Aebi’s cheap DIY option: Heat up some dried rice in the microwave, then put it into a sock to form a warm little pouch.
Even with all this information in mind, be sure to talk to your doctor about what kind of bleeding and cramping you can expect, along with any red flags that should get your attention.
8. Go into the waiting room with tools to distract yourself if you think you’ll need or want them.
Depending on your specific clinic, you may be in the waiting room for hours before your surgical procedure or appointment to begin a medical abortion, Dr. Imershein says. You may also need to wait around for any pain medication to kick in or hang out afterward while it wears off and you rest.
“Make sure that you have things to keep occupied,” Aebi says, whether that’s an engrossing true crime podcast or a calming coloring book. This is also where having a friend on hand may help, which brings us to our next point.
9. Consider bringing along a supportive companion.
Some health centers will require you to bring someone who can take you home after a surgical abortion, Dr. Dean says. This depends on the type of anesthesia you’ll be having. (If it’s general, you’ll definitely need an escort.) If that’s not the case for you, or if you’re doing an at-home medical abortion, having someone at your side is your decision.
If you do choose to have company, pick someone whose presence will lower any potential anxiety, Aebi says: “Make sure that they’re somebody that's calm and centering and supportive of the decision that you're making.”
If you can’t find the right companion, there are other options. Some clinics have abortion doulas who are there to support you before, possibly during, and after the experience. Whether it’s a friend or abortion doula, keep in mind that they may not be allowed in the procedure and/or recovery room, Dr. Imershein says. Find out your health center’s policy beforehand so you’re not caught off guard.
Depending on where you live, Dr. Imershein adds, an abortion funding organization may be able to connect you with somebody who can accompany you for however much of the procedure your clinic will permit. Ask your health center for guidance, or check out Radical Doula’s list of local volunteer organizations. Also, some NNAF member organizations provide abortion doula services.
10. Be clear with your companion about what you need from them.
Do you require a ride to and from the health center? Do you want someone to keep you distracted in the waiting room? Lie in bed and watch movies with you while you recover from the procedure or wait for the medication to work? Run to the pharmacy? Rub your back? Figure this out and let them know. “Helping them help you is something you can do to prepare yourself,” Dr. Dean says.
Violet, for example, remembers wishing she had asked a friend to come over while she recovered. “The thing that felt the worst was that afterward I just lay around in my bed by myself,” she says. “It would’ve been nice to have someone there.”
11. Ask your health center if you can bring earbuds to listen to something during a surgical abortion if you think that would be helpful for you.
If you’re going to be awake during a surgical abortion and want relaxation or distraction, listening to something might be helpful. Aebi recommends women seeking a sense of calm download a guided meditation app or curate a playlist of serene songs. Or maybe you’re looking for something more stereotypically empowering, Aebi says, adding, “You can stream Beyoncé before, during, and after your procedure if you want.”
12. As much as you can, mentally prepare yourself for the possibility of interacting with protestors.
The unfortunate reality is that you might come across anti-abortion advocates outside of the health center. They may confront you with disturbing images, ones “not based on the reality of abortion and not medically factual to make you feel uncomfortable and stigmatized,” Dr. Dean says.
Remember that you have the right to choose what happens to your body, and that includes getting an abortion if that’s the best choice for you. Furthermore, these protesters “do not mean that the health care you are going to receive in that health center isn’t of the highest quality, based on medical and scientific evidence, and based on compassion and care,” Dr. Dean says.
Also exercise caution online, where there exist not just trolls condemning people who terminate pregnancies, but anti-abortion sites spreading misleading information or possibly directing you to visit crisis pregnancy centers that hold an anti-abortion stance. If you’re looking for a supportive online community, Aebi recommends Shout Your Abortion, which bills itself as “a decentralized network of individuals talking about abortion on our own terms and creating space for others to do the same.”
13. Consider talking to a mental health counselor before and/or after your abortion.
Remember, while some people feel relieved or indifferent after their abortions, it’s also possible you’ll feel upset (or a mix of emotions, including sad ones). People more prone to having difficulty coping with an unplanned pregnancy and its termination include (but are not limited to) those with pre-existing mental illnesses like anxiety or depression, Dr. Imershein says.
“If you find yourself in that group, reach out to your health care provider,” Dr. Dean says. If you don’t have a regular therapist, Aebi recommends starting by asking the center where you got your procedure to connect you with resources. Many of them offer free counseling that you can take advantage before or after your abortion (though it may not be immediately after; it could take weeks, Aebi says).
There are various other resources at your disposal. Dr. Imershein points to an organization called All-Options, which has a free national talkline at 1-888-493-0092. The National Abortion Federation also has a hotline at 1-800-772-9100.
14. Think about your birth control plan going forward to prevent another unintended pregnancy.
“It’s great to go from pregnant to protected,” Dr. Dean says. Many abortion providers will encourage women to enact a post-abortion birth control plan. For example, Dr. Dean says, you can typically have an IUD placed on the same day of your surgical abortion or during your follow-up appointment after your medical abortion.
That’s why Dr. Imershein advises doing some research on birth control and talking to friends about their own contraception so you have an idea of what you want to do when it comes up at your appointment. Or, if you think you wound up pregnant because of a mishap with birth control, ask your doctor if that means you should consider a different method instead.
15. Remember, this is your body and your decision.
That means whatever your choice in dealing with an unintended pregnancy, you can change your mind, including right up until the last second of getting an abortion. But even if you know it’s definitely the right move for you, if you’re dealing with anxiety or other difficult emotions surrounding your abortion—or are surprised by your lack of these feelings—it can be easy to lose sight of the factors that went into your choice.
Returning to the reasons behind your choice and the opportunities this abortion is giving you rather than taking away can help keep things in focus. Violet, for instance, badly wanted a baby, but not with the person who got her pregnant. She didn’t end up having children, but still tells SELF she doesn’t regret her decision to have an abortion at all.
If you’re sure you want to have an abortion but have any fears or worries, it might make sense to talk to a counselor who can work through those feelings with you. “It’s really about recognizing that [you’re] making the most caring and loving decision for [yourself] and for your future,” Aebi says.
*Name has been changed.