No one likes to feel pain. But have you noticed that how we experience pain and how we feel about it can be different? It’s affected by things like how confident or nervous we are; what kind of support we have; and whether we are calm or afraid. (Think about getting a tattoo versus getting a shot!) Pain is usually a warning system in the body, but pain with an abortion can actually let you know that your body is working perfectly. As your uterus empties it cramps, which helps to stop the bleeding and get the uterus back to its normal shape. The uterus is a strong muscle that always likes to be contracted—so it’s actually a “good cramp!”
Pain is a kind of communication in your body. A signal is sent up the spine through the nervous system and is then evaluated by different parts of your brain. Your brain unconsciously decides what is painful or not, depending on your understanding of what the situation is, your past experiences, beliefs, emotions, etc. The more you understand what to expect, the more confident and relaxed you are, the fewer “alarms” go off and the less pain you feel.
Our emotions affect how we feel physical sensation. Our beliefs, emotions, and worries all contribute to how we feel pain. Research has shown that depression, anxiety, and guilt can all make it harder for us to cope with pain. A positive emotional state, like being confident and relaxed, can make it easier and less painful.
Fear can especially increase the amount of pain we feel. When we are afraid, our muscles tense, the heart begins to race, and we may begin to tell ourselves things like, “I can’t relax, this is really going to hurt, I can’t handle this.” Then, the next thing you know, we can’t relax and every sensation actually does become more painful. Fear triggers the brain to produce chemicals that make it harder for us to relax. In other words, when it comes to pain, the more you fear it, the more you feel it. Fear and negative thoughts can turn “uncomfortable” into “painful,” while confidence and positive thoughts can turn “painful” into “tolerable.”
It can be awkward lying on an examining table with your legs up in leg or foot rests, but most of us have learned to accept that it is necessary. Exams can make some women feel vulnerable if they have never had a pelvic examination before, or because of past experiences such as rape or sexual molestation. For some of us everything medical is traumatic. If the medical aspects of abortion are frightening to you, be sure to let the staff know so they can give you extra time, help, and patience. Your provider wants this to be a safe and comfortable experience for you.
About Pain Management and Medications
Clients may perceive a wide range of pain, from none at all, mild, to moderate pain, to even intense pain, but most women say that it’s “nothing they can’t handle.” Talk to us about what to expect and what pain management might work best for you. But medications aren’t the only answer to pain. Women who reported feeling relaxed and confident before their abortion also reported less pain regardless of what drugs they received.
To make your abortion procedure less painful, we offer the following medications to take before the procedure at no extra cost. Please let your counselor know if you would like to take any of these medications.
Toradol: This non-steroidal anti-inflammatory drug (NSAID)is the preferred drug for short-term management of moderate to severe pain. It takes 30 minutes to have a good effect and lasts for 4-6 hours. Toradol cannot be given along with any other NSAIDS, so please let your counselor know if you have taken ibuprofen, naproxen, or aspirin the day of your procedure. Toradol is given by injection. Some have reported a burning sensation at the injection site for about 15 seconds. You may drive after taking this medication.
Ibuprofen: This non-steroidal medication (NSAID) is a pain reliever especially good for cramps. Popular brands of ibuprofen include Advil and Motrin. Ibuprofen takes about 30 minutes to become effective, and lasts 4-6 hours. You should not take it if you choose to take Toradol or have ever had an allergic reaction to ibuprofen, aspirin, or naproxen. Please let your counsel know if you have taken ibuprofen, aspirin, or naproxen the day of your procedure. You may drive after taking this medication.
Lorazepam: This is an anti-anxiety medication, often known by the brand name, Ativan. It can make you feel relaxed and drowsy. When swallowed it takes 20-30 minutes to be effective. It can be dissolved under the tongue for a faster effect. It should be taken with a pain reliever. You will need someone to drive you after taking lorazepam.
Vicodin: This is a combination of generic acetaminophen and hydrocodone. Hydrocodone is in a group of drugs called opioid pain relievers. An opioid is sometimes called a narcotic. It is effective in 20-30 minutes and lasts for 4-6 hours. It can cause drowsiness and nausea, especially on an empty stomach. If you have not eaten in the past few hours we can give you crackers before you take the medication and an anti-nausea medication at no cost to you. It is important that you do not eat a heavy or greasy meal before the procedure after taking this medication even if you take the anti-nausea medication. You will need someone to drive you after taking Vicodin.
Other medications given at your surgical abortion appointment:
ANTIBIOTIC: To reduce the chance of infection we will give you a single dose of an antibiotic before the procedure.
Zofran: (ondansetron, on DAN se tron) blocks the actions of chemicals in the body that can trigger nausea and vomiting. When you come in you can ask for this if you feel nauseated. You should not take Zofran if you are allergic to ondansetron or similar medications. Before taking Zofran tell us if you have liver disease or a personal or family history of Long QT syndrome. You may ask for Zofran at the front desk when you come for your appointment.
What else can help?
- MAKE THE BEST DECISION FOR YOUR LIFE. It helps to feel confident about your decision. If you are unsure, take more time and get help from clinic staff or at the Pregnancy Options Workbook, Before Abortion downloadable audio abortion counseling, or call Backline (1-800-493-0092). Believe in yourself and your ability to make a good decision about your pregnancy.
- GET SUPPORT. Talk to people who will support and encourage you. Ignore people who will try to shame you or make you feel bad about yourself. Try to choose someone who understands what you are going through to come with you to the appointment.
- YOU DON’T DESERVE TO BE IN PAIN. The situation that brings you here is often complicated and can make you feel bad. Remember that you are a good person doing the best you can in a tough situation. Be kind to yourself.
- CREATE A POSITIVE ATTITUDE. The words that you use can actually influence how your brain perceives pain. Replace thoughts like “I’m so scared,” and “I’ll never get over this,” with positive messages like, “I’m strong, I’m brave,” “I know this a good decision,” and “I can handle this.”
- RELAX. If you know any relaxation techniques, such as meditation, visualization, or controlled breathing, practice them before your appointment. Reiki or “healing touch” can also be helpful. Be ready to use these tools to help yourself cope during your abortion procedure. Slow breathing is easy to learn today. Inhale to the count of 4 and exhale to the count of 4; do this several times until you feel your muscles relax.
- DISTRACT YOURSELF. Sometimes a distraction, such as talking or even imagining you are somewhere else can help. Generally, the support staff at the clinic are good at helping you focus on something else.
- SMELL SOMETHING NICE. Studies have shown that pleasant smells (lavender can be a mild mood enhancer) can help to reduce the perception of pain, especially for women. Talk to the staff about putting drop of a favorite fragrance on a cotton ball and breathing in the scent during the procedure.
Explain Pain by David Butler and Lorimer Moseley, www.Noigroup.com.
Considering Abortion, and various handouts at www.abortioncarenetwork.org.
The Pregnancy Options Workbook at www.pregnancyoptions.info
Before Abortion at www.beforeabortion.com
Backline talkline about all pregnancy at www.yourbackline.org