Termination of Pregnancy for Medical Reasons

If you've received heartbreaking news following your amniocentesis or other diagnostic tests, you may elect to terminate your pregnancy. Some parents make this wrenching decision after learning that their child will be born with a severe disability or a condition that will cause the child to suffer through potentially painful treatments for a disease that is incurable. Here’s everything you need to know about termination of pregnancy for a medical reason. 

About one-fourth of women will have an abortion before they turn 45, according to the Guttmacher Institute. These abortions are often voluntary—for example, a woman may end the pregnancy if a child will interfere with her education plans, or if she doesn’t have the financial means to raise another person. Occasionally, however, couples must terminate a wanted pregnancy for medical reasons, like fetal abnormalities or maternal health issues.

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Fetal Abnormalities: Doctors conduct a few tests in the second trimester of pregnancy, including blood work and amniocentesis (testing of the amniotic fluid.) Occasionally, these tests can uncover a condition that could negatively impact the baby’s quality of life, or that could result in fetal death before birth or shortly after birth. Parents-to-be must decide, in these instances, whether they want to terminate the pregnancy.

Some conditions that necessitate pregnancy termination include:

• Chromosomal abnormalities that can affect the child’s well-being, like trisomy 13, trisomy 18, Down syndrome, Turner syndrome, Tay-Sachs disease, and Potter's Syndrome
• Birth defects like certain forms of spina bifida, meningocele, kidney abnormalities, heart defects, and anencephaly (neural tube deformation that affects the brain). Babies with severe birth defects generally don’t live long after birth.
• Hydrocephalus (cerebral spinal fluid builds in the brain)
• Premature rupture of the membranes (your water breaks too early)
• Impending miscarriage

Maternal Health Issues: A mother might face a certain health condition that could prove fatal to herself and/or her baby. These include placental abruption, cancer, hyperemesis gravidarium (severe morning sickness), infection, or advanced preeclampsia. Pregnancy termination might be recommended in such cases.

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Most of the time, doctors terminate a pregnancy through standard abortion techniques. The exact technique used will depend on several factors, including your gestational age and the baby’s condition. Discuss these techniques with your provider.

Medication abortions (abortion pills) are often used in the first 10 weeks of gestation. A woman will take two separate pills (mifeprex and misoprostol) to promote the body to thin the uterine lining and expel the contents. Most women experience heavy bleeding, clots, and cramming after a medication abortion—and other side effects like nausea, diarrhea, fatigue, and mild fever are also likely. Medication abortions are about 95% effective.

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Doctors may also a vacuum suction technique (called vacuum aspiration) until the 16^th week of gestation. A dilation and extraction (D&E) technique, which removes the fetus with suction and tools, can also typically used between 14-24 weeks. Both minimally-invasive procedures are more than 99% effective, but they must be conducted in a healthcare center or clinic. Side effects include bleeding and cramping.

Late-term abortions, which happen if the pregnancy is life-threatening to the mother or complications prevent the baby’s survival, are generally scheduled inductions. Doctors will induce labor by injecting medication into the fetus, amniotic sac, vagina, or vein; the woman will go through natural labor and delivery.

Before making the decision to terminate your pregnancy, confirm the diagnosis and thoroughly discuss the possible extent of your child's disability. Your health care provider can help put you in touch with specialists who can provide specific information, including high-risk obstetricians, genetic counselors, therapists, pediatric surgeons, and developmental pediatricians.

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Perinatal social workers or therapists may also help prepare you for the onslaught of emotions that may accompany a pregnancy termination. After an abortion you can expect to feel weepy, angry, and exhausted, so having such support in place is essential for surviving this ordeal. You might also rearrange burial services with your doctor or the healthcare service.