Becoming a Parent
Continuing Your Pregnancy
If you plan to continue your pregnancy, it is important that you begin prenatal care with a qualified health care provider to ensure that you will continue to have a healthy pregnancy. If you are concerned that the medical care associated with a pregnancy may be too expensive for you to afford, you should know that you may be eligible for Medicaid coverage through your pregnancy and beyond. In Hawai‘i, financial help is available for low-income women through the Medicaid’s Quest program. The MothersCare
referral line offers free information and referrals to women on a broad range of pregnancy related issues.
Choosing a Health Care Provider
When planning your birth, you have options in choosing what type of health care provider you prefer to assist you. Options include obstetricians/gynecologists, midwives and family practice doctors. Each of these providers is affiliated with a hospital or clinic. Home births are also available through some providers, where the processes of labor and birth occur at your own home.
Choosing your care provider is an important decision in determining what type of birth experience you will have. You may want to interview a few people before deciding on a provider to ensure he or she meets your birthing needs. Check out the philosophy of the hospitals delivery department by visiting their website. Some places offer tours of their labor and delivery departments, which provide a good opportunity to ask staff about their approach to the child birth experience. Questions to ask include: Can you have a natural child birth experience and what types of pain control options are available? Asking friends, family members and neighbors for their recommendations and experiences is also a good way to learn more about doctors in your area.
More information on Becoming a Parent
Hawai‘i Pro-Choice Adoption Resources
Another way of handling an unplanned pregnancy is to choose adoption. There are two types of adoption: open adoption and closed adoption. In an open adoption, you and the adoptive family can maintain contact as the child grows, through picture, letters, email, phone calls and visits. In a closed or traditional adoption, the records will be sealed and you will not have contact with your child or the adoptive family. You can, however, enroll with a “Reunion and Information Registry” so that your child can find you when he or she turns 18.
If you think you might want to choose adoption, you should begin planning and working with a reputable adoption agency while you are pregnant. Many women do not realize that it is important to begin planning with an adoption resource before the birth. Women who have left their infants in the hospital are considered to have abandoned their babies. Unfortunately, when this happens, the newborn is often placed into foster care and it can take years to be adopted into a good family.
It is possible to plan an adoption after the baby is born by informing the hospital social worker that you are considering adoption. You can also find an adoption agency to handle all the arrangements of placing the newborn with a family and making you feel comfortable and respected. The agency may also assist you throughout your pregnancy, including arranging for prenatal care and even helping with housing and transportation. In the following section is a list of common misconceptions about adoption and the “Birth Parent Bill of Rights,” which was prepared as a public service by Spence-Chapin, a nonprofit, licensed child placement agency.
For more information about the adoption process in Hawai‘i, go to www.childandfamilyservice.org or www.h-i-c.org.
If you are considering adoption, you may be concerned about the medical expenses involved with continuing your pregnancy. You should know that the adoption agency you choose to work with can help by arranging financial assistance to cover this essential medical care. You may also be eligible for coverage under Medicaid’s Quest program.
Choosing an Adoption Agency
If you choose to explore adoption, there are several questions to ask the adoption agency. The answers will help you determine whether the agency will respect your rights to make the decision that is best for you and your baby.
What percentage of birth parents changes their mind and keeps the baby?
The answer to this question should give you an idea about whether or not the agency pressures women to give up their babies. If very few mothers change their minds and keep their babies, it is possible that they are not given the option to rethink their decision.
If you are interested in exploring open adoption, ask the agency about their open adoption policy. Open adoption, in which the birth parent(s) continue to have contact with the child after the adoption takes place, is a good option for some women. Children can also benefit from having access to their family of origin.
What percentage of adoptive families opts for an open adoption?
Are adoptive families informed about open adoption options? Does the agency facilitate this kind of relationship? The number of adoptive families that choose this option may indicate whether the agency makes this option available to them.
Can I select my baby’s adoptive family?
Some agencies allow birth parents to choose an adoptive family with which they feel comfortable. Choosing and meeting the family can give a birth parent the peace of mind that their child is going to a good family. Birth parents tend to choose families that match the baby in terms of temperament and personality. Birth parents do a better job than social workers in choosing the family that fits their baby best. If this is an option you feel strongly about, be sure to ask if the agency encourages it.
Do you have an ethnically diverse group of adoptive families?
If an agency has an ethnically diverse group of adoptive families waiting for a child, it is more likely that children will be placed in a well matched, loving home. Most birth parents prefer to choose a family similar to their own ethnicity.
Can I talk with a birth mother who has chosen adoption?
Talking with a birth mother who has gone through the experience of adoption may give you an opportunity to ask questions and explore how the adoption process may feel from the point of view of someone who has been there.
More information on Choosing Adoption
Ending a Pregnancy: Abortion Care
Types of Abortion Services Available
In this section, you will find information and answers for many of the questions you may have about abortion care. However, it is important to note that most abortion providers do not offer every abortion method to patients. If you have additional questions regarding a procedure, the abortion provider is the best resource.
What Types of Abortion Procedures Are There?
Vacuum Aspiration (Suction Curettage): This is one of the most common first-trimester abortion methods (used within the first three months of pregnancy). A suction machine is used to empty the uterus with a mild suction. The physician may then use a spoon-shaped instrument, called a curette, to ensure that the abortion is complete. This method is used when a pregnancy is between 6 and 15 weeks. The procedure itself takes between 5 and 10 minutes. A local anesthesia is administered to alleviate the pain of the procedure, but some providers offer patients stronger anesthesia, such as conscious sedation or general anesthesia Side effects associated with vacuum aspiration include abdominal cramping and vaginal bleeding.
Manual Vacuum Aspiration (MVA): MVA is a first trimester abortion method that empties the uterus using non-electric suction instruments. MVA is similar in function to the vacuum aspiration method, but without electricity and the electrical suction noise. Some patients prefer MVA because it is quieter. However, the procedure takes slightly longer and is not as widely available to patients as the electrical version. The method is used when a pregnancy is up to 12 weeks. A local anesthesia is all that is required to alleviate the pain of the procedure, but some providers offer patients stronger anesthesia, such as conscious sedation or general anesthesia. Side effects associated with manual vacuum aspiration include abdominal cramping and vaginal bleeding.
Medication Abortion: Medication abortion is a non-surgical method used to induce abortion up to 49 days of a pregnancy (seven weeks). During a medication abortion, a physician does not enter the uterus. Instead, a medication—either Mifeprex (also known as RU486, the early option pill, or mifepristone) or Methotrexate—is administered, either orally or by an injection, to induce the abortion. At a second appointment, one to two days later, the woman must take a second medication (called misoprostol), which is inserted into the vagina or taken orally, which causes the uterus to contract and empty, effectively ending the pregnancy. Follow-up visits are extremely important with medication abortion to ensure that the abortion has been completed. The benefit of medication abortion is that it can be used earlier than common first-trimester surgical methods and is an alternative for patients uncomfortable with surgery and anesthesia. Since medication abortions are less effective as the number of weeks of pregnancy increases, they are usually not performed when more than seven weeks have passed since your last menstrual period. After seven weeks, a surgical abortion is often the best option. Side effects associated with medication abortion include nausea, diarrhea, abdominal cramping or pain, hot flashes, vomiting, fatigue, or vaginal bleeding. Medical abortion usually takes several hours to complete; mifepristone generally works faster than methotraxate. It can take up to three or four weeks after taking the first medication for the abortion to be completed. One to two weeks after taking the drug, women must see their doctor for a follow-up exam to ensure that the abortion was completed and there are no complications.
Dilation and Evacuation (D&E): Dilation and Evacuation is the most common second trimester abortion procedure. D&E involves vaginally inserting laminaria (sterilized seaweed) into the cervix, causing the cervix to gradually dilate or widen. This insertion is typically done one day before the procedure. Once the cervix is sufficiently dilated, a surgical procedure is performed that involves suctioning the uterus by vacuum aspiration. Conscious sedation is used to alleviate the pain of the procedure, but some providers offer patients stronger anesthesia, such as general anesthesia. After the cervix is dilated, which can take anywhere from a few minutes to two days, the surgical procedure itself takes about 10 to 20 minutes to complete.
Pain Relief Methods
Like any surgical procedure, the surgical abortion procedure is painful. The pain feels similar to or sometimes stronger than menstrual cramps. As the uterus is emptied, and begins to contract to its regular, non-pregnancy size the pain from the contractions can range from barely noticeable to very painful. There are several pain relief methods used for abortion procedures. The usual methods are local anesthesia and conscious sedation, though sometimes general anesthesia is used. Not all abortion providers have all pain relief methods available for use by a patient, and sometimes the strongest pain relief method is not necessary and may increase the risk of the procedure.
Below are descriptions of the different anesthesia methods available to women during an abortion procedure:
Local Anesthesia: An injection that numbs the cervix, usually providing sufficient pain relief for most women. With local anesthesia, the patient is alert and awake throughout the procedure. Local anesthesia lasts for less than an hour. There are no side effects associated with local anesthesia.
Conscious Sedation: The intravenous (into the vein) administration of an analgesic (pain relief medication), such as Demerol, with a sedative, such as Valium, resulting in deep relaxation without loss of consciousness. Conscious sedation creates an altered state of awareness, relieving patients from anxiety and discomfort, but allowing patients to breathe on their own, respond physically and answer questions. Conscious sedation may be administered by a physician or a nurse trained in the procedure. Conscious sedation is increasingly used as an alternative to local anesthesia (not strong enough for some women) and general anesthesia (unnecessarily strong for many abortion procedures). Conscious sedation lasts from one to four hours, and requires that a patient have someone accompany or drive her home if she leaves during the time that the anesthesia is still effective. Side effects associated with conscious sedation include nausea, vomiting, headache, dizziness, dry mouth, sweating, hiccups, coughing and drowsiness. Patients who have asthma, severe respiratory allergies, or who have used drugs or alcohol within the 24 hours before the procedure should not use conscious sedation as a pain relief method.
General Anesthesia: An intravenous (into a vein) injection of a drug, or an inhalation drug (an inhaled gas) or a combination of both. This technique causes the patient to be unconscious, deeply relaxed (sleep-like), to feel no pain, be totally unaware of the surgery and have no memory of the surgery later. Often, a breathing tube is placed down the patient’s throat to ensure that proper breathing continues through the surgery. Monitors are used to check breathing, heart rate and other vital signs. General anesthesia may be administered by an anesthesiologist, a doctor or nurse trained in the procedure. Side effects associated with general anesthesia include nausea, sore throat, headache, muscle aches and a general “hangover” feeling. Once the anesthesia has worn off (usually 10 to 20 minutes after the procedure) the patient will feel as if they have “woken up.” However, the body reflexes can continue to be influenced by general anesthesia for at least 24 hours, and a patient will need someone to accompany or drive her home after the surgery. Sometimes patients are advised by their provider not to drive or operate any heavy machinery for a certain time period after having general anesthesia.
Abortion Safety and Follow-Up Care
Abortion is one of the safest medical procedures available. Each year, more than one million American women have an abortion. Less than one percent of all abortion patients experience a major complication associated with the procedure. The risk of the procedure, however, increases if the abortion is performed later on in the pregnancy. It is important for you to:
Inform the abortion provider of any past or present health problems you may have.
Tell your provider of any current medications, supplements, or street drugs that you use, as well as allergies to medications or pain relief methods.
Follow all post-operative instructions and return for a follow-up examination.
Ask questions if you are unsure of anything about the procedure.
As with all surgical or medical procedures, it is important to recognize and quickly react to signs of potential complications. Your abortion provider will inform you of what to expect and what would be unusual after an abortion procedure.
If you are pregnant and did not plan to be, you have options. Many women have made the difficult choice between abortion, adoption and motherhood. But remember: you are not alone. The choice is yours to make. If you feel guilty, isolated, upset and unsure of what to do next, consider seeking support from your partner, your family, friends, clergy or a professional counselor.
Options Counseling is Your Right
You have a right to receive comprehensive, non-biased counseling and support. This includes information about abortion, adoption and parenting, and an exploration of your feelings about pursuing each choice. Beware of any counselors who try to steer you in one direction or scare you away from certain choices. These counselors may try to convince you to make a choice that fits with their religious or political agenda. Anti-choice groups have opened “crisis pregnancy centers” that are really intended to prevent women from choosing abortion, rather than helping them make the decision that is best for them. If you feel a counselor is pressuring you to make a choice that isn’t right for you, find another clinic.
How can I decide which choice is best for me?
Consider each of your choices carefully. Ask yourself:
Which choice(s) could I live with?
Which choice(s) would be impossible for me? How would each choice affect my everyday life?
What would each choice mean to the people closest to me?
It may help to take time and ask yourself:
What is going on in my life?
What are my plans for the future?
What will I have to sacrifice or give up?
What are my spiritual and moral beliefs?
What do I believe is best for me in the long run?
What can I afford?
Reprinted with permission from Planned Parenthood® Federation of America, Inc. © 2004 PPFA. All rights reserved.
Seek Care Right Away
If you are pregnant, seek care from a health care provider right away, regardless of whether or not you choose to continue your pregnancy. There are many health concerns, such as ectopic pregnancy (where a pregnancy is implanted in the fallopian tubes) and high blood pressure that must be checked for and addressed early on.
Learn more about:
Becoming a Parent
Ending a Pregnancy