Abortion: A Woman's Right to Know

Patient Education Booklet

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Abortion: A Woman's Right to Know El Aborto: El Derecho de una Mujer a Saber, was developed by the Georgia Department of Public Health in response to the 2005 “Woman’s Right to Know” Act.

This booklet also includes information on the methods of abortion, as well as the medical risks associated with each method. In addition, this booklet discusses the possible emotional side effects of abortion, some common medical risks associated with carrying a baby to term, and the father’s responsibility.

Pregnancy leads to many questions. Each person and each pregnancy is unique. Your doctor can offer information and answers for your individual situation. This booklet includes pictures and details about development of the fetus throughout pregnancy. Your doctor will tell you how many weeks pregnant you are and the age of the fetus at the scheduled time of the abortion procedure.

The doctor will also discuss the medical procedures that might be used and the risks that should be considered, including the risks associated with continuing the pregnancy through childbirth. This booklet also covers some of this information.

The doctor will make sure that you know about resources that may be available to you as you are making decisions. You may be eligible for medical coverage if you continue your pregnancy. If you decide to keep your baby, the father must provide child support.

Another source of information is the Resource Directory for Pregnant Women and Their Families. You can find it online at http://health.state.ga.us/wrtk/services.asp or order it free of charge by calling 404-657-2850. Included are agencies and offices that can help you find alternatives to abortion, including services you can use if you decide to make an adoption plan.

"Women have a right to learn about all of the options available to them in the event of an unwanted pregnancy. The Woman's Right to Know Act is a common sense approach to a sensitive issue and it reflects the mainstream values that Georgians share."
-Governor Sonny Perdue

The Georgia Legislature passed the Woman's Right to Know Act and Governor Sonny Perdue signed it into law on May 10, 2005. You can see the law at http://www.legis.state.ga.us/cgi-bin/gl_codes_detail.pl?code=31-9A-1.

The law provides that an abortion can only be performed in Georgia after "voluntary and informed consent of the female" at least 24 hours before the abortion except in a medical emergency. It spells out what information doctors will provide and requires DCH to publish materials with additional details.

When you sign your consent for an abortion, you are saying that the doctor has told you about:

• Your medical risks associated with the chosen abortion procedure
• The probable age of the fetus at the time the abortion is scheduled
• Your medical risks if you decide to carry the pregnancy to term

• You may be eligible for medical coverage of prenatal care, childbirth and newborn care
• Fathers are required to assist in child support
• You have the right to review printed materials in booklet form or online at http://health.state.ga.us/wrtk/

• Agencies and services that may assist you through pregnancy, childbirth and raising your child
• Adoption agencies and contact information
• A description and pictures of development of the fetus every two weeks during pregnancy
• A statement about fetal pain
• Descriptions of common abortion procedures and their medical risks
• Possible harmful emotional effects following abortion
• Medical risks of pregnancy and childbirth

In Georgia an individual is an "unemancipated minor" until marriage or age 18 (whichever comes first). The law requires notifying the parents of minors before an abortion and provides for other protections.

Your parent or guardian will be involved in your choice to have an abortion in most cases. They may inform the doctor that they have already been told about the abortion or that they do not wish to be consulted. In any case they must be notified unless you go to court.

In addition, even after your parent or guardian has been involved, you must sign your own consent, "freely and without coercion" to obtain the abortion.

In a few cases there may be unusual circumstances when the doctor or the minor believes it is not in the best interest of the minor to notify the parent or guardian. These cases must be settled in juvenile court. County juvenile courts are listed at http://georgiacourts.org/councils/cjcj/counties.htm.

Doctors are required by law to provide statistics related to abortions to the Georgia Department of Public Health (DCH). Names are not used in these reports. All information collected is anonymous.

Often the first sign of pregnancy is a missed menstrual period about four weeks after the last normal period. There are different kinds of tests to determine pregnancy. Some may not be accurate for up to three weeks after conception, or five weeks after the last normal period.

During the first ten weeks the organs are forming and the embryo (called a fetus at 10 weeks) is most at risk of harm from medications, drugs, nicotine in cigarettes, alcohol, viruses (like German measles), and vitamin deficiencies (such as folic acid).

The size of the embryo from 10 weeks onward is measured from the crown or top of the head to the rump or bottom.

• Conception means a woman's egg has been fertilized by a man's sperm.
• Within a day, the egg begins to divide and develop rapidly.
• A few days later a cluster of cells arrives in the uterus (womb).
• By the eighth day after conception, this cluster has increased to hundreds of cells and attaches to the wall of the womb where it continues its rapid growth.

• The embryo is about ¼ inch long and has developed a head and a trunk.
• Structures that will become arms and legs, called limb buds, firs appear.
• A blood vessel forms and begins to pump blood. This will develop into the heart and circulatory system.
• At this time, a ridge of tissue forms down the back of the embryo. That tissue will develop into the brain and spinal cord.

• The embryo is about ½ inch long.
• The heart now has four chambers.
• Fingers and toes begin to form.
• Reflex activities begin as the brain and nervous system develop.
• Cells begin to form the eyes, ears, jaws, lungs, stomach, intestines and liver.

• The embryo, is about 1 to 1¼ inches long (the head is about half the length) and weighs less than ½ ounce.
• The beginnings of all key body parts are present, but they are not completed.
• Structures that will form eyes, ears, arms and legs can be seen.
• Muscles and skeleton are developing and the nervous system becomes more responsive.

• The fetus is about 2½ inches long and weighs about ½ ounce.
• Fingers and toes are distinct and have nails.
• Hair begins to develop, but won't be seen until later in the pregnancy.
• The fetus begins small, random movements, too slight to be felt.
• The fetal heartbeat can be detected with a heart monitor.
• All major external body features have appeared.
• Muscles continue to develop.

• The fetus is about 3½ inches long and weighs about 1½ ounces.
• The fetus begins to swallow, the kidneys make urine, and blood begins to form in the bone marrow.
• Joints and muscles allow full body movement.
• There are eyelids and the nose is developing a bridge.
• External genitals are developing.

• The fetus is about 4½ inches long and weighs about 4 ounces.
• The head is erect and the arms and legs are developed.
• The skin appears transparent. A fine layer of hair has begun to grow on the head.
• Limb movements become more coordinated.

• The fetus is about 5½ inches long and weighs about 7 ounces.
• The skin is pink and transparent and the ears are clearly visible.
• All the body and facial features are now recognizable.
• The fetus can grasp and move its mouth.
• Nails begin to grow.
• The fetus has begun to kick. Some women feel this movement.

• The fetus is about 6¼ inches long and weighs about 11½ ounces.
• All organs and structures have been formed, and a period of growth begins.
• The skin is wrinkled and appears pink to reddish in color due to being thin and close to the blood vessels.
• A protective skin coating, called vernix, is beginning to develop.
• Respiratory movements occur, but the lungs have not developed enough to permit survival outside the uterus.
• By this time, mothers usually feel the fetus moving.
• At this time an ultrasound can often identify the sex of the fetus.

• The fetus is about 7½ inches long and weighs about one pound.
• The fetus has fingerprints and perhaps some head and body hair.
• The fetus may suck its thumb and is more active.
• The brain is growing very rapidly.
• The fetal heartbeat can be easily heard.
• The kidneys start to work.
• At 23 weeks, approximately 31% of babies born survive. Babies born at this age require intensive care and usually have lifelong disabilities and chronic health conditions.

• The fetus is about 8¼ inches long and weighs about 1¼ pounds.
• Bones of the ears harden making sound conduction possible. The fetus hears mother’s sounds such as breathing, heartbeat and voice.
• The first layers of fat are beginning to form.
• This is the beginning of substantial weight gain for the fetus.
• Lungs continue developing
• At 25 weeks, approximately 68% of babies born survive. Babies born at this age require intensive care and usually have life-long disabilities and chronic health conditions.

• The fetus is about 9 inches long and weighs about 2 pounds.
• The fetus can respond to sound from both inside and outside the womb.
• Reflex movements continue to develop and body movements are stronger.
• Lungs continue to develop.
• The fetus now wakes and sleeps.
• The skin is slightly wrinkled.
• At 27 weeks, approximately 87% of babies born survive. Babies born at this age require intensive care and have an increased risk of developmental delays and chronic health conditions.

• The fetus is about 10 inches long and weighs about 2 pounds, 3 ounces.
• Mouth and lips show more sensitivity.
• The eyes are partially open and can perceive light.
• More than 90% of babies born at this age will survive. Some survivors have developmental delays and chronic health conditions.

• The fetus is about 10½ inches long and weighs about 3 pounds.
• The lungs that are capable of breathing air, although medical help may be needed.
• The fetus can open and close its eyes, suck its thumb, cry and respond to sound.
• The skin is smooth.
• Rhythmic breathing and body temperature are now controlled by the brain.
• Most babies born at this age will survive.

• The fetus is about 11 inches long and weighs about 3 pounds, 12 ounces.
• The connections between the nerve cells in the brain increase.
• Fetal development now centers on growth.
• Almost all babies born at this age will survive.

• The fetus is about 12 inches long and weighs about 4½ pounds.
• Ears begin to hold shape.
• Eyes open during alert times and close during sleep.
• Almost all babies born at this age will survive.

• The fetus is about 12 to 13 inches long and weighs about 5½ to 6 pounds.
• Scalp hair is silky and lies against the head.
• Muscle tone has developed and the fetus can turn and lift its head.
• Almost all babies born at this age will survive.

• The fetus is about 13½ to 14 inches long and weighs about 6½ pounds.
• Lungs are usually mature.
• The fetus can grasp firmly.
• The fetus turns toward light sources.
• Almost all babies born at this age will survive.

• The fetus is about 14 to 15 inches long and may weigh about 7½ pounds.
• At the time of birth, a baby has more than 70 reflex behaviors, which are automatic behaviors necessary for survival.
• The baby is full-term and ready to be born.

Early Non-Surgical Abortion

• A drug is given that stops the hormones needed for the fetus to grow. This causes the placenta or attachment of the fetus to the womb to separate, ending the pregnancy.
• A second drug is given by mouth or placed in the vagina causing the womb to contract and expel the fetus and placenta.
• A return visit to the doctor is required for follow-up to make sure the abortion is completed.

Possible Complications

Incomplete abortion Allergic reaction to the medications Painful cramping Nausea and/or vomiting

Diarrhea Fever Infection Heavy bleeding

Vacuum Aspiration Abortion

• A local anesthetic is applied or injected into or near the cervix, the opening to the womb, to prevent discomfort or pain.
• Conscious sedation and/or general anesthesia are also commonly used.
• The opening of the cervix is gradually stretched with a series of dilators. The thickest dilator used is about the width of a fountain pen.
• A tube is inserted into the womb and is attached to a suction system to remove the fetus, placenta and membranes from the womb.

Possible Complications

Incomplete abortion Pelvic infection Heavy bleeding

Torn cervix Perforated uterus

Dilation and Curettage Abortion

• A local anesthetic is applied or injected into or near the cervix to prevent discomfort or pain.
• Conscious sedation and/or general anesthesia are also commonly used.
• The opening of the cervix is gradually stretched with a series of dilators. The thickest dilator used is about the width of a fountain pen.
• A spoon-like instrument (curette) is used to scrape the walls of the uterus to remove the fetus, placenta and membranes.
• A follow up appointment should be made with the doctor.

Possible Complications

Incomplete abortion requiring vacuum aspiration Pelvic infection Heavy bleeding

Torn cervix Weakened cervix Perforated uterus

Dilation and Evacuation (D&E)

• Sponge-like pieces of absorbent material are placed into the cervix. This material becomes moist and slowly opens the cervix. It remains in place for several hours or overnight. A second or third application of the sponge material may be necessary.
• Following dilation of the cervix, medications may be given to ease pain and prevent infection.
• After a local or general anesthesia has been administered, the fetus and placenta are removed from the uterus with medical instruments such as forceps and suction curettage. Occasionally for removal, it may be necessary to dismember the fetus.

Possible Complications

Heavy bleeding Cut or torn cervix Perforation of the wall of the uterus

Pelvic infection Incomplete abortion Anesthesia-related complications Weakened cervix

The risk of complications for the woman increases with each week of pregnancy. Below are descriptions of possible complications.

Pelvic Infection (Sepsis): Bacteria (germs) from the vagina may enter the cervix and womb and cause an infection. Antibiotics are used to treat an infection. In rare cases, a repeat suction, hospitalization or surgery may be needed.

Incomplete Abortion: Fetal parts or parts of the placenta may not be completely emptied from the womb, requiring further medical procedures. Incomplete abortion may result in infection and bleeding.

Bleeding: Some amount of bleeding is common following an abortion. Heavy bleeding is not common and may be treated by repeat suction, medication or, rarely, surgery. Ask the doctor to explain heavy bleeding and what to do if it occurs.

Cut or Torn Cervix: The opening of the womb (cervix) may be torn while it is being stretched open to allow medical instruments to pass through and into the uterus.

Perforation of Wall of the Womb: A medical instrument may go through the wall of the uterus. Depending on the severity, perforation can lead to infection, heavy bleeding or both. Surgery may be required to repair the uterine tissue, and in the most severe cases a hysterectomy may be required.

Anesthesia-Related Complications: As with other surgical procedures, anesthesia increases the risk of complications.

Early abortions that are not complicated by infection do not cause infertility or make it difficult to carry a later pregnancy to term. If complications occur after an abortion, it may be more difficult to become pregnant in the future or to carry a pregnancy to term.

When a medical emergency requires the performance of an abortion, the doctor will talk with the woman before the abortion. The doctor will explain the medical indications supporting the physician's judgment that an abortion is necessary to avert her death or that a 24-hour delay may create serious risk of substantial or irreversible impairment of a major bodily function.

By 20 weeks gestation, the unborn child has the physical structures necessary to experience pain. There is evidence that by 20 weeks gestation unborn children evade certain stimuli in a manner which in an infant or an adult would be interpreted to be a response to pain. Anesthesia is routinely administered to unborn children who are 20 weeks gestational age or older who undergo prenatal surgery.

Each woman having an abortion may experience different emotions before and after the procedure. Women often have both positive and negative feelings after having an abortion. Some women say that these feelings go away quickly, while others say they last for a very long time. These feelings may include emptiness and guilt as well as sadness. A woman may question whether she made the right decision. Some women may feel relief about their decision and that the procedure is over. Other women may feel anger at having to make the choice.

Counseling or support before and after an abortion is very important. Family help and support is very important, but the woman may need additional help if the feelings that appear after an abortion become more intense. Talking with a professional counselor before having an abortion can help a woman better understand her decision and the feelings she may experience after the procedure. If counseling is available to the woman, these feelings may be easier to handle.

Remember, it is a woman’s right to be fully informed by her doctor prior to any procedure. A woman should be encouraged to ask questions.

A woman choosing to carry a child to full term can usually expect to experience a safe and healthy process. For a woman’s best health, she should visit her doctor before becoming pregnant, early in her pregnancy, and at regular intervals throughout her pregnancy.

Many changes in a woman’s body take place so that she can carry the pregnancy. However, these changes can lead to complications in some women. Major complications include the following:

Possible Complications

• Some pregnant women have blood pressure problems during or after pregnancy, especially first pregnancies. An abnormal increase in blood pressure after the 20th week of pregnancy, called preeclampsia, can cause swelling, headaches, vision problems, stomach pains and if not treated life-threatening convulsions and coma. This condition is the leading cause of maternal death in the United States.
• Some pregnant women develop diabetes during pregnancy (gestational diabetes). Complications of gestational diabetes include high blood pressure, a large baby making delivery difficult, and gestational diabetes in future pregnancies.
• Some women may develop uterine infection during or after delivery, and on rare occasions this causes death.
• Some women experience heavy blood loss during delivery.
• Women may experience rare events such as blood clots, stroke, or anesthesia-related death during or immediately following delivery.
• Some women experience post-partum depression.
• Women with severe chronic diseases such as heart disease, kidney disease, liver disease, and asthma are at greater risk of developing complications during pregnancy, labor and delivery.

Fathers play an important role in their child's life. Children who have an ongoing, positive connection to their fathers do better in school, tend to stay out of trouble and get along better with their peers than children without such a relationship.

Fathers have a legal responsibility to provide for the support, medical insurance and other needs of his minor child. In addition, children have rights of inheritance from their father.

For help on how a man can be a responsible, loving parent, visit the National Fatherhood Initiative at http://fatherhood.org or call 301-948-0599.

For more information regarding the Georgia Paternity Acknowledgment Program, please call 404-521-2160, or toll-free at 866-296-8262. For more information on the Georgia Fatherhood Program, please call the DHR Office of Child Support Enforcement at 404-463-8800, or toll-free at 800-227-7993. Information is also available at http://ocse.dhr.georgia.gov.

The Georgia Department of Public Health acknowledges the following contributions for this publication:
Text excerpts from:

• If You Are Pregnant: Information on Fetal Development, Abortion, and Alternatives, Minnesota Department of Health
• If You Are Pregnant, Kansas Department of Health
• Abortion: Making a Decision, Louisiana Department of Health and Hospitals
• Fetal Development Understanding the Stages and Abortion Making an Informed Decision, Virginia Department of Health.

The photos found throughout this booklet with the exception of the 40 week photo were created by Lennart Nilsson/Albert Bonniers Förlag AB, A CHILD IS BORN, Delacorte Press. 40 week photo created by Minnesota Department of Health. The illustrations were created by Peg Gerrity, Houston, Texas (copyright http://www.peggerrity.com). All illustrations and photos are used with permission.