First Trimester Abortion

ABOUT THE ABORTION PROCEDURE
First trimester abortions are performed by vacuum aspiration up to 13 weeks of pregnancy.

ON THE DAY OF YOUR APPOINTMENT
DO NOT EAT, DRINK OR SMOKE AFTER MIDNIGHT THE NIGHT BEFORE YOUR APPOINTMENT TIME. NOTHING AT ALL BY MOUTH AFTER MIDNIGHT THE NIGHT BEFORE YOU SURGERY. THIS INCLUDES GUM, CANDY, WATER, ETC.

Do not wear any jewelry, including earrings, bracelets, rings, etc. All body piercing jewelry must be removed. Do not bring any valuables or a large amount of cash.

Please do not bring children to the clinic. Plan to spend 2 1/2 to 3 hours with us in a clinic setting. Prior to your clinic visit make sure that you have arranged for a ride to and from the clinic. Please bring your fee in the form of a money order, cashier's check, travelers' check, Visa, MasterCard, or Discover card. We do not accept personal checks. If you use a credit card, the person whose name is on the card must be present to sign for charges. If you are referred by a health plan, please bring your referral authorization and I.D. card (Kaiser, Cigna, etc.), and photo I.D. Medi-Cal patients must have the current month's Medi-Cal card and a photo I.D.

If you plan to use your private health insurance, please tell us at the time you make your appointment so that we may verify your insurance coverage before your scheduled surgery appointment.

The fee you pay at the time of surgery includes PREGNANCY TESTING, COUNSELING, PELVIC AND/OR ULTRASOUND, LABORATORY, SURGERY, RHOGAM (if required), MEDICATIONS GIVEN ON THE DAY OF SURGERY, POST-OPERATIVE MEDICATIONS, AND YOUR POST-OPERATIVE CARE AS AUTHORIZED BY US.

ABOUT YOUR VISIT
When you arrive at the clinic, you will be asked to complete information and consent forms. A counselor will explain the procedure to you and assist you in completing any additional paperwork including your medical history. The counselor will escort you to your locker where you will change into a gown that we provide. Your vital signs will be taken. A nurse practitioner will review your medical history and perform a physical examination. A lab technician will draw a sample of your blood to determine your RH factor and iron level. When your lab work is complete, you will be escorted to the surgical area. If you have chosen local anesthesia rather than general anesthesia, the nurse practitioner will numb the cervical area before you go to the surgical suite. If you have chosen general anesthesia you will go to the surgical suite.

IN SURGERY a licensed CRNA will administer anesthesia and a licensed medical doctor specializing in gynecology will perform the abortion by gently removing the contents of the uterus by vacuum aspiration. You will be in the surgery room about 5-7 minutes.

AFTER YOUR SURGERY
You will be taken to the general recovery room where trained medical personnel will care for you until you are ready to be discharged.

WHEN YOU ARE READY TO GO HOME
After you leave the recovery room, our nursing staff will offer you a light snack. The nurse will give you instructions on aftercare and explain your post-operative care. Before you are discharged to your driver, you will receive your medications to take home. You will also be given an instruction sheet that will include our 24-hour emergency number to call with any questions or problems you may have after you leave our facility.

OUR COMMITMENT
Family Planning Associates Medical Group (FPA), a nationally recognized leader in family planning, has been providing quality, professional, low-cost family planning services to the women of California since 1969.

Our centers throughout several states offer the most comprehensive women's health care available anywhere.

Licensed medical doctors specializing in gynecology, caring counselors, nurses, technicians, nurse practitioners, physician assistants and nurse anesthetists are all part of a team committed to provide concerned, confidential and personal care. WE BELIEVE IN BOTH PATIENT EDUCATION AND EXCELLENCE IN MEDICAL CARE.

In May of 1996 and each three-year period since, FPA became the first abortion provider in the State of California to be accredited by a national accrediting agency. After undergoing an extensive review by the California Medical Association and the Accreditation Association for Ambulatory Health Care, FPA was recognized as a provider of the highest quality health care and was awarded the maximum accreditation term of three years. The accreditation process is a method by which FPA is measured against nationally recognized standards.

Second Trimester Abortion

ABOUT THE ABORTION PROCEDURE
Second trimester abortions are performed between 13.5 to 21.5 weeks of pregnancy and require from two (2) to three (3) consecutive clinic visits.

ON THE DAY OF YOUR SURGERY APPOINTMENT

• If you are being seen at our Long Beach office, you should be prepared to stay from 3 to 6 hours on your surgery day.
• BE SURE to arrange to have someone drive you home.
• Please do not bring children to the clinic.
• DO NOT EAT, DRINK OR SMOKE AFTER MIDNIGHT THE NIGHT BEFORE YOUR SURGERY APPOINTMENT TIME. THIS INCLUDES GUM, CANDY WATER, ETC.
• Do not wear any jewelry, including earrings, bracelets, rings, etc. All body piercing jewelry must be removed. Do not bring any valuables or a large amount of cash.
• The fee you paid at the time of your first-day visit includes: COUNSELING, PREGNANCY TESTING, ULTRA SOUND, LABORATORY, RHOGAM (IF REQUIRED), INSERTION VISITS, SURGERY, MEDICATIONS GIVEN ON THE DAY OF SURGERY, POST-OPERATIVE MEDICATIONS, AND POST OPERATIVE CARE.

ABOUT YOUR FIRST-DAY VISIT

• Plan to spend from two to three hours at the clinic.
• Please do not bring children. You may drive yourself to and from the clinic facility on the days of your insertions. However, the day of your surgery you must arrange to have someone drive you home. It is very important that you have something to eat prior to coming in for your insertion. DO NOT EAT OR DRINK anything after midnight the day before your surgery.

When you arrive for your appointment, you will be asked to complete medical history and consent forms. An ultrasound will be performed to determine the length of gestation. If a recent ultrasound has already been performed at another FPA location, you will meet with a counselor to discuss your procedure, medical history, and both pre-operative and post-operative instructions. The counselor will assist you with any additional paperwork. Financial responsibility will be discussed at that time. After you have changed into a gown provided by the clinic, your vital signs will be taken. The laboratory technician will draw a sample of blood to determine your iron level and RH factor. You will be escorted to the treatment room where the practitioner will insert cervical dilators. After the insertion, the vaginal canal will be packed with sterile gauze which has been soaked in betadine (aneseptic solution) to keep cervical dilators in place and to prevent infection.

The fee you pay must be in the form of a money order, cashier's check, travelers' check, or Visa/MasterCard/Discover card. We do not accept personal checks. If you use a credit card, the person whose name is on the card must be present to sign for charges.

If you are referred by a health plan, please bring your referral authorization and I.D. care (Kaiser, Cigna, etc.) and a photo I.D. Medi-Cal patients must have the current month's Medi-Cal card and a photo I.D.

If you are using your private health insurance, please tell us at the time you make your appointment, so that we may try to verify your insurance coverage before your first scheduled appointment.

AFTER YOUR INSERTION
You will be escorted from the treatment room to the discharge area. The discharge nurse will give you post insertion instructions and medications.

WHEN YOU ARE READY TO GO HOME
The discharge nurse will give you an appointment time for your next day insertion or surgery. You will receive an instruction sheet that will include telephone numbers that you can call 24 hours a day if you have any questions or problems after you leave the clinic.

THE D&E PROCEDURE
When your paperwork, counseling, vital signs, ultrasound and laboratory work are completed, you will be assisted to the treatment area. After review of your medical history and a physical examination, a clinician will insert sterile cervical dilators (Laminaria) into the cervix. The dilators will remain overnight causing the cervix to soften and dilate. The discharge nurse will give you further instructions and an opportunity to ask questions. As the cervix dilates, you may or may not experience abdominal cramping.

If you are having a two-day (2) dilation and extraction procedure, you will return the following day for your surgery.

If you are having a three-day (3) dilation and extraction procedure, you will return the second day for reinsertion of Laminaria. On the second day, you will check in with the receptionist and be escorted to the treatment area. A clinician will remove the Laminaria inserted the first day and insert additional Laminaria into the cervix to further increase its dilation. The discharge nurse will give you additional instructions before you go home.

The third day you will return to the clinic/hospital for you surgery. A general anesthetic will be administered, and a licensed medical doctor specializing in gynecology will perform the surgery.

Medical Abortion

For generations, the medical profession has sought a safe and effective non-surgical method for terminating pregnancies. Historically, a multitude of herbs, drugs, and chemicals have been tried with limited success.

When research on RU486 began several years ago, interest in that elusive goal was rekindled. RU486 is now available for use in non-surgical pregnancy terminations in this country.

Mifepristone (Mifeprex), also known as RU-486, provides women with a medical alternative to surgical abortion. Mifepristone, in conjunction with Cytotec was approved for use as an abortifacient by the United States Food and Drug Administration (FDA) on September 28, 2000. Mifeprex is an antiprogesterone drug that blocks receptors of progesterone, a key hormone in the establishment and maintenance of human pregnancy. Mifeprex induces spontaneous abortion when administered in early pregnancy and followed by a dose of misoprostol (Cytotec), a prostaglandin.

Safety, Efficacy, & Acceptability
More than 600,000 women in Europe have had medical abortions using mifepristone between 1994 and 1995. U.S. health centers participated in clinical trials of mifepristone and misoprostol sponsored by the population council with 2,121 women involved in the study. The results published in the New England Journal of Medicine in 1998 demonstrated mifespristone to be effective in terminating 92 percent of pregnancies up to 49 days duration. Additionally, 95.7 percent of women in the same clinical trial reported that they would recommend mifepristone to others. Even among women for whom the method failed, 85.9 percent would recommend it to others. The most common side effects reported by women using mifepristone plus prostaglandin for early abortion are similar to those of a spontaneous miscarriage; uterine cramps, bleeding, nausea, and fatigue. Mifepristone is as safe as a surgical abortion. This completely noninvasive procedure and does not require anesthesia.

Cyctotec is a prostaglandin known by the generic name of misoprostol. It had previously received FDA approval for use in the prevention of ulcers in high-risk patients taking non-steroidal, anti-inflammatory drugs.

The non-surgical abortion method involves the ingestion of Mifeprex (RU486) orally after ultrasound verification of a pregnancy less than nine weeks gestation. Twenty-four to seventy-two hours later, Cytotec is inserted into the vagina by either the patient or medical personnel. In most cases, a miscarriage occurs within 24 hours. If bleeding does not occur after 24 hours, the Cytotec application is repeated. Usually bleeding is like a spontaneous miscarriage and spotting may occur for up to two weeks. An ultrasound may be used to verify the successful termination of the pregnancy.

If miscarriage does not occur by the 14th day, a surgical abortion must be performed. This situation occurs in less than 8 percent of patients. The primary advantage of non-surgical abortion lies in the ability to end the pregnancy in the privacy of the patient's own home. Furthermore, the theoretical potential for surgical complications is lessened. Side effects of Mifeprex can include nausea, vomiting, diarrhea, heavy vaginal bleeding, headache, dizziness, backache and fatigue. Occasionally, the cramping may become quite severe, particularly when the tissue is being expelled.

As in surgical abortion, risks of hemorrhage do exist. In rare cases, the incomplete passage of tissue requires a surgical evacuation.

Medical abortion is limited to patients less than nine weeks pregnant as verified by ultrasound. No sexual intercourse is allowed for two weeks after your miscarriage. The patient must agree to undergo a surgical abortion if the abortion is not completed medically.

If you feel that a medical abortion is for you, please let one of our counselors know. She will assist you by providing further information and initiating treatment.

If you have any questions or if you are experiencing complications, please contact our office, or after office hours, our 24-hour Care Center at:
1-800-821-1318 (California)
1-800-541-0356 (Illinois)

Tubal Sterilization

In 1969, two physicians, Edward C. Allred M.D. and Kenneth L. Wright M.D., founded the Family Planning Associates Medical Group (FPA) for the purpose of making family planning techniques available to all California women. Their principle service was the termination of problem pregnancies.

As FPA expanded, it became clear that additional family planning services were needed. FPA now has numerous clinic locations in Southern California that provide a variety of women's medical services such as birth control and sterilization as well as pregnancy termination.

FEMALE STERILIZATION
No method of birth control is without drawbacks. After struggling with various birth control methods, and after bearing the number of children you desire, you may want to consider permanent birth control or sterilization. Female sterilization is a surgical procedure that works by blocking the Fallopian tubes, thus preventing the eggs released by the ovaries from reaching the uterus and being fertilized by sperm.

HOW DOES IT WORK?
The Fallopian tubes can be blocked in several ways. Until recently, the most common methods were laparotomy and colpotomy. In a laparotomy, an incision is made in the abdominal wall through which the tubes are cut and tied. In a colpotomy, the tubes are approached through the vagina. Both of these procedures require a hospital stay.

Today's most popular method of female sterilization is the one used at FPA; tubal cauterization by laparoscopy. A long word for a short procedure. Laparascope is so simple and leaves such small scars that it is sometimes called "band-aid surgery."

LAPAROSCOPY
In a laparoscopy, a tiny incision is made just below the navel. The incision is only about one quarter of an inch long. Through this incision, the abdominal cavity is filled with carbon dioxide gas.

The gas lifts the abdominal wall and adjoining organs away from the fallopian tubes, allowing clear visibility. Another tiny incision is made just below the pubic hairline. A laparoscope, an instrument like a telescope with its own lighting, is then inserted through the first incision. The doctor looks through the laparoscope to get a clear view of the Fallopian tubes. A cauterizing instrument is inserted through the second incision. Looking through the laparoscope, the doctor uses the cauterizing instrument to grasp and seal a small section of the tube on each side of the uterus.

EFFECTIVENESS
Tubal sterilization by the cauterization procedure is considered 99% effective in preventing pregnancy. Rarely, the sealed ends of the tubes grow back together or an egg is fertilized outside of the uterus. However, the incidence of pregnancy after tubal cauterization is less than 3-4 in 1000.

PERMANENCE
Tubal cauterization is considered permanent although it is theoretically possible to reconnect the tubes. The procedure is expensive and complex requiring a major incision and hospital stay. The surgery is not always successful. This method of birth control should be chosen only if you are certain you do not want more children.

DECIDING
If you are interested in a tubal cauterization, you can make an appointment with one of FPA's skilled counselors who will answer your questions and help you make sure this procedure is right for you. You must be at least 18 years old. Because of the procedure's permanence, we recommend a one or two week waiting period during which you can withdraw your consent if you change your mind.

HOW LONG DOES IT TAKE?
Tubal cauterization, performed by one of FPA's fully trained and licensed gynecologists, takes only 20 to 30 minutes. With the preparation and post-operative observation, your total stay in the clinic is about five hours.

RECOVERY
You will probably be discharged from the clinic a few hours after your surgery. We advise you to rest for a day. You may feel tired and you may feel some soreness in the chest and shoulders. This soreness results from the position of your body during surgery and from the small amount of carbon dioxide gas that is still putting some pressure on your internal organs. Most of the gas is pumped out immediately after tubal cauterization, and the remaining gas gradually goes away during the 24-48 hours after surgery.

Your throat may be a little sore from the administration of the anesthesia and you may have a small amount of vaginal spotting.

Every woman is unique so the time needed to recover from surgery will vary. We recommend that you avoid heavy lifting and wait until after your two-week post-operative check-up to have intercourse.

COMPLICATIONS
No surgery is risk-free. While complications are rare, they do exist. Your counselor will explain the risks to you. Surgeons who are experienced with laparoscopy consider this procedure to be safer than a tonsillectomy, an appendectomy, or childbirth.

AFTER-EFFECTS
After the Fallopian tubes have been blocked, the ovaries continue to function normally. Sterilization has no effect on the production of hormones nor does it interfere with menstruation or menopause. It causes no physical changes.

The only known after-effect is a beneficial one. Without the fear of an unwanted pregnancy, you could feel a new sense of freedom and sexual responsiveness.

COST
In keeping with FPA's commitment to provide quality care at moderate cost, the fee for sterilization includes counseling, surgery, and follow-up care. During your first appointment, we will review the charges with you and help you decide what form of payment is best suited to your financial position. We accept private insurance, Medi-Cal, Champus, and several credit cards and major health agencies. Ask your counselor for further information.

WE'RE HERE TO HELP
FPA is a nationally recognized leader in family planning. We are the largest and most experienced family planning network in the country. We provide the finest medical care available. Our job is to let you know about the available family planning alternatives and help you make your own informed decision about the alternative that best suits your needs.

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