Therapeutic vs. elective abortions: Why medical need doesn't change the procedure

A therapeutic abortion is performed out of medical necessity. Your clinician may recommend a therapeutic abortion if continuing the pregnancy poses a significant risk to your health.

Your clinician may also recommend a therapeutic abortion if the pregnancy isn't viable, or if the fetus is unlikely to survive without long-term complications.

This rationale is the only thing that differentiates an "elective" or "voluntary" abortion from a "therapeutic" abortion.

The protocol for terminating a pregnancy or treating a miscarriage is often the same, regardless of the reason for receiving care.

Terms like "elective abortion," "therapeutic abortion," and "spontaneous abortion" are more-so used by legislators to define "acceptable" and "unacceptable" medical services.

Insurance providers also use these terms to describe the services they do and do not cover.

It's worth noting that what constitutes "medically necessity" is highly subjective.

Pregnant people are routinely denied lifesaving abortion care on moral or legal grounds. This often results in preventable mental, emotional, and physical complications and, in some cases, death.

To learn more about your legal rights, message the Repro Legal Helpline via a secure online form or call 844-868-2812.

When is therapeutic abortion an option?

Your clinician may present the option for termination if continuing the pregnancy presents a .

This could be related to a preexisting medical condition, such as:

• cancer
• heart disease
• kidney disease

Or it could be related to a condition that develops during pregnancy, such as:

• premature rupture of membranes (PROM), which can increase the risk of infection
• placental abruption, which can increase the risk of hemorrhagic shock
• preeclampsia, which can increase the risk of organ damage

They may also present the option if prenatal screening suggests a fetal anomaly. Some anomalies can of fetal death during pregnancy or shortly after birth.

These may include:

• anencephaly, where the brain, skull, and scalp do not fully develop before birth
• hydrocephalus, where fluid builds up in the skull and the brain swells
• Meckel-Gruber syndrome, where abnormalities develop in multiple organs
• Potters syndrome, where there are low levels of amniotic fluid
• thanatophoric dysplasia, where the limbs are shortened and the lungs are underdeveloped

Are there any alternatives to therapeutic abortion?

Your options depend on the particular circumstances of your pregnancy and your location. Your ability to access care may be limited by the laws in your state.

If the pregnancy is considered high risk for you but not the fetus, you might consider continuing the pregnancy. Your clinician might recommend inducing labor as soon as the fetus has developed enough to live outside the uterus.

You might also consider carrying a pregnancy with a suspected fetal anomaly to term. Some, but not all, fetal anomalies are considered fatal. Talk with your clinician about what this might mean for your pregnancy.

Stillbirth, death shortly after birth, or a reduced life span may be possible. Differences in development may result in conditions that require long-term or lifelong care.

Are complications possible without treatment?

Moving forward with a pregnancy that risks your life or health could result in serious complications.

It's important to be informed about the risks and all potential outcomes so you can make the best decision for your circumstances.

If you decide against termination, talk with your clinician about your options for managing symptoms, mitigating risks, and delivery. You might also consider creating or updating your advance directives for medical care.

In some cases, continuing a pregnancy could result in death for you or the fetus. Identifying potential resources for support may be helpful.

Thinking about your end-of-life wishes may be difficult, but it can alleviate some of the stress for your loved ones if this information becomes necessary.

How are therapeutic abortions performed?

More than half of all abortions performed at a medical facility in the United States are medication abortions. Some are completed with two medications - mifepristone and misoprostol - and some only use misoprostol.

The has approved the use of mifepristone and misoprostol to terminate pregnancies up to 10 weeks.

Suction (vacuum) aspiration can also empty the uterus during the first trimester. This is a minor surgical procedure that typically .

It may be necessary to dilate your cervix beforehand. Your surgeon may also use an instrument called a curette to scrape the uterine lining and confirm that it's empty. This is called a dilation and curettage (D and C).

Surgical abortion during the second and third trimesters is known as dilation and evacuation (D and E). It involves dilation and aspiration. Additional instruments, like forceps, are used to help remove the pregnancy.

First-trimester prenatal screening is performed during weeks 10-13 of pregnancy. Second-trimester screening is performed during weeks 15-22 of pregnancy. Because of this, many fetal anomalies aren't suspected or diagnosed until the second trimester. Although medical abortion may be used until , healthcare professionals typically recommend surgical abortion.

What can you expect after a therapeutic abortion?

Abortion services facilitated by a healthcare professional are safe and effective. Side effects are natural and to be expected, although they somewhat differ depending on the method used.

Medical or medication termination may be started in a clinic and completed at home. Many people experience some combination of the following symptoms after taking misoprostol:

• nausea
• weakness
• fever
• chills
• vomiting
• headache
• diarrhea
• dizziness

Monitoring your symptoms is a crucial part of medical termination. Your symptoms may increase in intensity from days 3-5, then gradually dissipate over the next couple of weeks.

Sedation can be used to increase your comfort during surgical termination. You may experience bleeding or cramping afterward, but it's usually than bleeding caused by medical termination.

You'll likely return home the same day as your procedure. Many people feel physically capable of returning to their usual activities the following day.

You might experience a variety of emotions afterward. These feelings may change over time. Remember that there's no "right" or "wrong" way to feel, and give yourself grace as you move forward.

Some people develop symptoms of post-traumatic stress that may .

Researchers conducted a 30-year longitudinal study, published in 2008, with over 500 women studied to the age of 30 to examine the relationship between pregnancy and mental health outcomes.

They suggest that termination for medical reasons may have a greater mental health impact than other reasons for termination or miscarriage, perhaps in part because the latter typically occurs early in pregnancy.

A emphasizes the importance of a person's physical, mental, and emotional health before pregnancy and termination in anticipating, understanding, and contextualizing the potential mental health impact.

Researchers found that people usually experienced a in mood after termination than the period before.

Negative mental health impacts were less common - research from 1992 states approximately of people experience them. Negative impacts usually manifest as severe or persistent depression or anxiety.

Researchers found that negative outcomes were more frequent among people with preexisting mental health conditions. Termination for medical reasons with a sudden onset of new symptoms. Rather, preexisting symptoms intensified.

Researchers also highlighted other demographic factors, like age at time of pregnancy and number of previous pregnancies, alongside a wide array of social, cultural, and economic factors that can influence a person's outcome.

The bottom line

The decision to continue or terminate a pregnancy is complex. Your unique circumstances often shape the decision process.

Many people find it helpful to talk about it with a partner, close friend, or family member. Reaching out to a mental health professional may also be beneficial.

If you don't have a therapist or counselor, your primary care doctor or gynecologist may be able to make a referral. Your healthcare professional can also provide information about your options and answer any questions you may have.

Your care team may make recommendations, but the choice is ultimately yours. You deserve support, dignity, and respect no matter what comes next.

Tess Catlett is a sex and relationships editor at Healthline, covering all things sticky, scary, and sweet. Find her unpacking her inherited trauma and crying over Harry Styles on Twitter.