BEFORE YOU DECIDE
table of contents PAG E S 4 & 5 General Questions and Answers Understanding Your Pregnancy PAG E S 6 & 7 Fetal Development PAG E S 8 - 11 Emergency Contraception • Morning-After Pill • ella® PAG E S 12 - 15 First Trimester Abortion Methods and Risks • Medical Abortion • Suction Abortion PAG E 16 & 17 Second Trimester Abortion Methods • Dilation and Evacuation • Medical Abortion Later Term Abortion Methods PAG E S 18 - 2 3 Immediate and Long-Term Risks PAG E S 2 4 & 2 5 Explore Your Options PAG E 26 Definitions PAG E 27 - 31 References
know t h e fac ts Facing an unplanned pregnancy is hard. Fear, confusion, and anger are just some of the feelings that you may be experiencing. You have the right to be fully informed about this important decision. You decide: You deserve to know the facts. This brochure will help you understand more about your pregnancy, the new life developing inside you, and abortion.
You have options.
general questions S H O U L D I TA K E T H E M O R N I N G - A F T E R P I L L? The morning-after pill is not a quick fix—–it’s a little more complicated… Do you know the answers to these questions? • Am I already pregnant from a previous sexual experience? • Has this drug been adequately tested for long-term side effects? • Can this pill end a life? Understanding the way the morning-after pill works and its side effects is a step that helps you make a healthy decision for your body. See page 8 for more information.
S H O U L D I B E CO N C E R N E D A B O U T H AV I N G A N A B O R T I O N? Abortion is not a simple medical procedure. For some women, it is a lifechanging event with significant physical, emotional, and spiritual consequences. Some women who struggle with past abortions say that they wish they had been told all of the facts about abortion beforehand.
unders tanding your pregnanc y During pregnancy, your body goes through many changes. Some common symptoms of early pregnancy include a missed period, nausea, breast tenderness, frequent urination, tiredness, and mood swings.1 Most pregnancy tests are very reliable. However, to diagnose and confirm that you are pregnant, a visit to a physician or other appropriate healthcare provider will be necessary. An ultrasound exam can confirm the status of your pregnancy. This information is important whether you are considering abortion or continuing with your pregnancy. Many pregnancy centers provide ultrasounds at no charge. To find a center near you, go to: B4YouDecide.o r g
ns & answers W H AT C A N I D O A B O U T P E O P L E P R E S S U R I N G M E? You have rights; no one can force or pressure you to have an abortion. This is your decision to make and you will be the one most affected by the consequences. If your partner, husband or parents are pressuring you to make a quick decision, explain your needs and try to involve them in counseling to explore your positive options. You have the right to continue with this pregnancy.
C A N I H AV E A B A BY A N D S T I L L L I V E M Y L I F E? You may see this unplanned pregnancy as a major roadblock in your life. It may encourage you to know that many women in the same situation have found the resources and courage they need to make positive choices and live without regrets.
fetal development day
YO L K S AC
When fertilization occurs, the baby’s features, including sex, hair and eye color, are determined.2
B A BY (D I A M O N D O N T H E R I N G)
weeks LMP – last menstrual period
The baby’s heart begins pumping just 22 days after fertilization3. The embyro’s heart motion can be seen during an ultrasound done at 6 weeks LMP. 2D ultrasound image of embryo at 6 weeks from the LMP (4 weeks after fertilization)
The tiny embr yo grows rapidly, and by 9½ weeks from the LMP, has distinc t fingers and can hiccup. 4
2D ultrasound picture of baby at 9 weeks from the LMP (7 weeks after fertilization)
Illustration of baby at 9 weeks from the LMP (7 weeks after fertilization)5
F E TA L D E V E LO P M E N T
Unborn babies begin forming unique fingerprints by the time they reach 12 weeks from the LMP.6 Photo of baby’s feet in the uterus 11 weeks from the LMP (9 weeks after fertilization)
2D ultrasound image of baby at 13 weeks from the LMP (11 weeks after fertilization)
Gender differences in behavior have been observed by this point in development. Females move their jaws more often than males.7
The inner ear is fully developed and the baby can respond to a growing range of sounds.8 Photo of baby in the uterus at 22 weeks from the LMP (20 weeks after fertilization)
F E TA L D E V E LO P M E N T
emergency Pregnancy, and life itself, begins at the time of fertilization and not when the embryo implants in the uterus (as some in the medical community have stated).9 During fertilization, the egg and sperm unite to form a genetically unique living individual whose gender, hair and eye color, and to some extent, personality and intelligence is established.10
Only eight out of one hundred women will become pregnant after a single act of intercourse in mid-cycle (when ovulation occurs).11 How likely is it that you could get pregnant right now? Learn the facts before exposing your body to artificial hormones.
EMERGENCY CONTR ACEPTION
contraception This new individual continues to develop during the next week while it travels to the uterus and implants. Although clearly alive, some disagree about when this human life becomes a person. Do we need to be a certain size to be considered a person? All forms of emergency contraception have the potential to prevent the new life from implanting. This is not a contraceptive effect, but abortive, resulting in the embryo’s death.12
female reproductive system F E R T I L I Z AT I O N
FA L L O P I A N T U B E UTERUS
I M P L A N TAT I O N
OVA R Y
VAG I N A
EMERGENCY CONTR ACEPTION
COMMON FORMS OF
1. Plan B One-Step®13 Plan B One-Step (also known as the “morning-after pill”) is intended to prevent pregnancy after known or suspected contraceptive failure, unprotected intercourse, or forced sex. It is one pill that contains large amounts of levonorgestrel, a progestin hormone found in some birth control pills. It is recommended to be taken within 72 hours of sex. It may work by preventing the egg and sperm from meeting. It won’t disrupt an implanted pregnancy, but may prevent a newly formed life from implanting in the uterus and continuing to develop, which is a form of early abortion. Side effects may include changes in periods, nausea, lower abdominal pain, tiredness, headache, and dizziness.14 If your period is more than a week late, you may be pregnant. Plan B One-Step should not be taken during pregnancy. Nor should it be used as a routine form of birth control because it isn’t as effective.15 Women who experience severe abdominal pain after taking the drug may have an ectopic (tubal) pregnancy, and should get immediate medical help. 16 Studies on Plan B’s effectiveness come down to an educated guess and confirm that earlier estimates were overstated and conclude that “it is more effective than nothing.”17 A systematic review of 14 studies about emergency contraception (EC) (a total of over 13,000 women) concluded that increased access increases its use, but was not shown to reduce unintended pregnancy rates.18 There are no long-term studies on the safety of current forms of EC if used frequently over long periods of time. 19
EMERGENCY CONTR ACEPTION
emergency contraception 2. ella ®20 Ella (ulipristal) is an emergency contraceptive for use within 5 days of unprotected sex or contraceptive failure. It is to be used only once during a menstrual cycle. If used as directed, ella is reported to reduce the chance of pregnancy, but is not effective in every case.21 Ella may reduce the chance of pregnancy by preventing or postponing ovulation. It also may work by preventing an embryo from implanting in the uterus, which is a form of early abortion.22 Ella is a chemical cousin to the abortion pill Mifeprex. Both share the progesterone-blocking effect of disrupting the embryo’s attachment to the womb, causing its death.23 Ella’s impact on existing human pregnancies was not tested, however, ella did cause abortions in pregnant animals, including monkeys, and carries the same potential in humans.24 The most common side effects of ella include headache, nausea, stomach (abdominal) pain, menstrual cramps, tiredness, and dizziness.25 Women who experience abdominal pain after using ella should be evaluated right away for an ectopic pregnancy. Ella may not be as effective if taken with certain drugs, or may change the effectiveness of certain drugs.26 Much is unknown about the drug, including its effect on women who are under 18, on pregnant women, and on women who are breast-feeding.27 The effect on pregnancies that continue after using ella® is also unknown.28.
EMERGENCY CONTR ACEPTION
LE ARN ABOUT
abor tion procedures 1s t trimes ter medical abor tion methods
M I F E P R E X ® / M I F E P R I S TO N E (“ T H E A B O R T I O N P I L L” ) 2 9 This drug is approved by the Food and Drug Administration (FDA) for use in women up to 70 days (10 weeks) after their last menstrual period (LMP).30 However, it is used “off-label” beyond 10 weeks.31 The FDA approved procedure requires a single office visit, other visits are up to the abortion provider’s discretion. On the first office visit, the woman is given mifepristone to swallow, which causes the death of the baby. Twenty-four to forty-eight hours later misoprostol tablets are taken which cause cramping that expels the baby. It is possible that she may see identifiable parts expelled if she is beyond 8 weeks LMP. By 10 weeks LMP, the developing baby is over one inch in length with clearly recognizable arms, legs, hands, and feet.32 Follow-up occurs one to two weeks after taking the first pill to determine if the procedure is complete and to check for complications. The abortion provider decides if the follow-up is a phone call, a blood test, an in-office exam, and/or an ultrasound. Risks: • FDA black box warning: “Warning: Serious and sometimes fatal infections and bleeding.”33 • Bleeding: Vaginal bleeding lasts for an average of 9–16 days; 1 in 100 women bleed enough to require surgery (D&C) to stop the bleeding.34 • Infection: According to the FDA, several U.S. women who used the abortion pill died due to an overwhelming total body infection (sepsis).35 This complication should be considered in any woman who feels sick (with weakness, abdominal pain, nausea, vomiting or diarrhea, with or without fever) after using Mifeprex.36 • Undiagnosed ectopic (tubal) pregnancy: This abortion pill will not work in the case of an ectopic pregnancy where the embryo lodges outside the uterus (usually in the fallopian tube). If not diagnosed early, there is a risk of the tube bursting, internal hemorrhage, and maternal death in some cases.37 • Failed abortion: The abortion pill doesn’t always cause an abortion.38 • Failure rate increases with advancing gestational age. • A surgical abortion is usually done to complete a failed medical abortion.39 • Risk of fetal malformations: Research links the use of misoprostol during the first trimester with certain types of birth defects when the pregnancy continues after the regimen is used.40 • Information is lacking about the longterm mental health effects of medical abortion, particularly, how women feel about giving themselves an abortion, and seeing baby parts expelled. Women who change their minds after taking just the first pill(s) (mifepristone) of a medical abortion and want to try to continue their pregnancies may call “The Abortion Pill Reversal” at 877-558-0333 and/or visit their website at: abortionpillreversal.com or seek the help of an obstetrician.
1s t trimes ter medical abor tion methods (continued)
1s t trimes ter surgical abor tion methods
M E T H OT R E X AT E 41 This drug is FDA-approved for treating certain cancers and rheumatoid arthritis, but is used off-label to treat ectopic pregnancies and to induce abortion. It works by stopping the growth of rapidly dividing cells. It is used up through 49 days of pregnancy and given orally or by injection. Three to seven days after methotrexate is administered, misoprostol is taken, which causes cramping and bleeding that expels the baby. Side effects of methotrexate include diarrhea, mouth ulcers, nausea, abdominal distress, fatigue, chills, fever, and dizziness. Bleeding typically last 2–3 weeks. Both methotrexate and misoprostol are associated with reports of birth defects in pregnancies that continue. M I S O P R O S TO L O N LY This form of medical abortion only uses the second drug given in “the abortion pill” method. It is typically inserted vaginally, requires repeated doses and has a significantly higher failure rate than “the abortion pill” method. It is associated with nausea, vomiting, diarrhea, and with potential birth defects in pregnancies that continue.42
F I R S T T R I M E S T E R S U C T I O N / A S P I R AT I O N A B O R T I O N A B O U T 4 -13 W E E K S A F T E R T H E L A S T M E N S T R UA L P E R I O D (L M P) 4 3 This surgical abortion is done throughout the first trimester. The patient typically receives pain medication and antibiotics. For very early pregnancies (4-7 weeks LMP), after local anesthetic is given, a long, thin tube is inserted into the uterus and the baby is suctioned out. Later in the first trimester, the cervix needs to be opened wider because the fetus is larger. The cervix may be softened the day before using medication placed in the vagina and/or slowly stretched open using thin bundles made of seaweed inserted into the cervix. The day of the procedure, the cervix may need further stretching using metal dilating rods. This can be painful, so in addition to local anesthesia, sedation or general anesthesia may be used, if available. General anesthesia increases both the cost and the risk of the procedure. Next, the doctor inserts a stiff plastic tube into the uterus and applies suction by either an electric or manual vacuum device. The suction pulls the baby’s body apart and out of the uterus. The doctor may also use a sharp loop-shaped tool, called a curette, to scrape any remaining fetal parts out of the uterus.
The risk of complications from abortion increases with advancing pregnancy. Late term abortions carry the greatest risk.
2 nd trimes ter abor tion methods D I L AT I O N & E VAC UAT I O N (D & E) : A B O U T 13 W E E K S A F T E R L M P A N D U P 4 4 The majority of second trimester abortions are performed using this method. The cervix must be opened wider than in a first trimester abortion because the baby is larger. Laminaria and/or vaginal medications are placed in the cervix for several days before the procedure to soften and dilate the cervix.45 Up to about 16 weeks gestation, the procedure is similar to the first trimester one (with the following addition). After the cervix is stretched open and the uterine contents are suctioned out, any remaining fetal parts are removed with a forceps (grasping tool). A curette (a loop-shaped tool) may also be used to scrape out any remaining tissue. After 16 weeks, much of the procedure is done using forceps to grasp, tear, and pull the baby’s body apart and out through the cervical opening, as suction alone will not work due to the baby’s size. The doctor keeps track of what fetal parts have been removed so that none are left inside. Lastly, a curette, and/or the suction machine are used to remove any remaining tissue or blood clots, which if left behind could cause infection and bleeding. MEDIC AL METHODS FOR S E CO N D A N D T H I R D T R I M E S T E R I N D U C E D A B O R T I O N 4 6 This procedure induces abortion using drugs to cause labor and eventual delivery of the baby and placenta. Like labor at term, this procedure typically involves 10-24 hours in a hospital’s labor and delivery unit. Digoxin or potassium chloride is injected into the amniotic fluid, umbilical cord, or fetal heart prior to labor to avoid the delivery of a live fetus.47 The cervix is softened using laminaria and/or medications. Next, pitocin, misoprostol, and sometimes mifepristone are used to induce labor. In most cases, these drugs result in the delivery of the dead fetus and placenta. The patient may receive oral or intravenous pain medications. Occasionally, scraping of the uterus is needed to remove the placenta. Potential complications include hemorrhage and the need for a blood transfusion, retained placenta, and possible uterine rupture. ABORTION PROCEDURES
later term abor tion methods D&E AF TER VIABILIT Y (F R O M A B O U T 2 4 W E E K S A N D U P) 4 8 This procedure typically takes 2-3 days and is associated with increased risk to the life and health of the mother. Because a live birth is possible, injections are given to cause fetal death. This is done in order to comply with the federal Partial-Birth Abortion Ban Act of 2003 which requires that the baby be dead before complete removal from the mother’s body. Medications (digoxin and potassium chloride) are either injected into the amniotic fluid, the umbilical cord, or directly into the baby’s heart, causing his/her death. The remainder of the procedure is the same as the second trimester D&E. Fetal parts are reassembled after removal from the uterus to make sure nothing is left behind to cause infection or bleeding. An alternate procedure, called “Intact D&E” is also used. The goal is to remove the baby in one piece, thus reducing the risk of leaving parts behind or causing damage to the woman’s body. This procedure requires the cervix to be opened wider; however, it is still often necessary to crush the fetus’ skull for removal as it is difficult to dilate the cervix wide enough to bring the head out intact.
Abortion carries the risk of significant complications such as bleeding, infection and damage to organs. Serious immediate physical complications occur infrequently in early abortions, but increase with later abortions.49 CURRENT INFORMATION REPORTS THE FOLLOWING RISKS: H E AV Y B L E E D I N G Some bleeding after abortion is normal. However, there is a risk of severe bleeding known as hemorrhaging. This may result from cervical tears, uterine punctures, retained tissue, or when the uterus fails to contract after it is emptied. When this happens, a D&C may be required to stop the bleeding, and sometimes a blood transfusion may be necessary.50 I N CO M P L E T E O R FA I L E D A B O R T I O N 51 Sometimes, a surgical abortion fails to suction out the embryo and the pregnancy continues. This is more common in very early pregnancies (4-6 weeks LMP). In other cases, the abortion removes some, but not all of the pregnancy tissue. This can lead to infection and bleeding. I N F E C T I O N 52 Infection can develop from the insertion of medical instruments into the uterus or from fetal parts that are mistakenly left inside (known as an incomplete abortion). This may cause bleeding and/or a pelvic infection requiring antibiotics, and may result in the need for a surgical procedure to fully empty the uterus. Infection may cause scarring of the pelvic organs. DA M AG E TO T H E O R G A N S 5 3 The cervix and/or uterus may be cut, torn, or punctured by abortion instruments. This may cause excessive bleeding requiring surgical repair and result in scarring of the uterine lining. If the uterus is punctured, the bowel and bladder may be injured. The risk of these types of complications increases with the length of the pregnancy. ABORTION & RISKS
of surgical and late term abor tion Getting complete information on the risks associated with abortion is limited due to incomplete reporting and the lack of record-keeping linking abortions to complications.54
E M B O L I 55 Clots may form in the bloodstream. If they break off and travel, they are known as “emboli.” These emboli can lodge in the lungs, causing illness and even death. Another form of emboli, known as “amniotic fluid embolism,” is a rare cause of death in later term abortions. In a process not well understood, amniotic fluid gets into the mother’s bloodstream and causes a severe allergic-type reaction. A N E S T H E S I A 56 Local anesthetics, sedatives, and pain medications may cause allergic reactions of varying degrees of severity. Convulsions, heart complications, and—in extreme cases—death, are known risks of general anesthesia. R H S E N S I T I Z AT I O N 57 Every pregnant woman should receive blood type testing to learn if her blood type is “Rh positive” or “Rh negative.” All pregnant women who are Rh negative should receive Rhogam® to prevent the formation of antibodies that may harm current or future pregnancies. D E AT H In extreme cases, complications from abortion (excessive bleeding, infection, organ damage, blood clots, and adverse reactions to anesthesia) may lead to death.58 The risk of death immediately following an induced abortion performed at or below eight weeks is extremely low (less than 1 in 100,000) but increases with length of pregnancy. The abortion-related mortality rate increases to 6.7 deaths per 100,000 abortions performed at or over 18 weeks.59 ABORTION & RISKS
long-term risks of abor tion
ABORTION & RISKS
Finding out the real risks associated with abortion is difficult due to incomplete reporting of complications. There is evidence that induced abortion can be associated with significant loss of both emotional and physical health long term.60 Get the facts before going through a procedure or taking medicine that could have long-term effects on your health.
CONSIDER THE FOLLOWING AS YOUR MAKE YOUR DECISION: ABORTION & PRETERM BIRTH Women who undergo one or more induced abortions carry a significantly increased risk of delivering prematurely in the future.61 Premature delivery is associated with higher rates of children with cerebral palsy, as well as all other newborn complications (respiratory, bowel, brain, and eye problems).62 ABORTION & BREAST CANCER RISK Medical experts continue to debate the association between abortion and breast cancer. Research has shown the following: • Carrying a pregnancy to full term gives a measure of protection against breast cancer, especially a woman’s first pregnancy before the age of 30.63 Terminating a pregnancy results in loss of that protection.64 • The hormones of pregnancy cause breast tissue to grow rapidly in the first three months, but it is not until after 32 weeks LMP that breasts mature enough to produce milk and become more cancer resistant. That’s why a premature birth before 32 weeks LMP significantly increases a woman’s risk of breast cancer, as with late term abortions.65 • The majority of worldwide studies report a positive association (increased risk) between induced abortion and later development of breast cancer.66 • First trimester miscarriages, unlike induced abortions, do not increase a woman’s risk of developing breast cancer. 67 A B O R T I O N & P L AC E N TA P R E V I A 6 8 Placenta previa occurs when the placenta covers or partially covers the cervix. This can result in unpredictable massive bleeding that threatens the life of baby and mother, especially during labor. In addition to the risk of bleeding, it is associated with the risk of preterm birth and death early in infancy. The risk of placenta previa is higher in women who, among other factors: had a prior induced abortion (especially the D&C type), are over 34, had a prior C-section, and/or had a prior placenta previa.
P S YC H O LO G I C A L I M PAC T / E M OT I O N A L I M PAC T After abortion, some women say they initially felt relief and looked forward to their lives returning to normal. But other women report negative emotions after abortion that linger, unresolved. For some, problems related to their abortion emerge months or even years later. There is evidence that abortion is associated with a decrease in long-term emotional and physical health.69 In line with the best available research, women should be informed that abortion significantly increases risk for: • Clinical depression and anxiety70 • Drug and alcohol abuse71
• Symptoms consistent with posttraumatic stress disorder (PTSD).72 • Suicidal thoughts and behavior 73
The bottom line is that abortion is more likely to be associated with negative psychological outcomes when compared to miscarriage or carrying an unintended pregnancy to term.74 If you or someone you know is struggling with unwanted feelings after an abortion, pregnancy centers offer confidential, compassionate support designed to help women and men work through these feelings. You are not alone. R E L AT I O N S H I P I M PAC T Pregnancy often affects a woman’s most important relationships. Many couples choose abortion to preserve their relationship. Yet research reveals that couples who choose induced abortion are at increased risk for problems in their relationship.75 Women experiencing lack of support and pressure to abort from their partners were more likely to choose abortion.76 Women who face intimate partner violence are significantly more likely to experience abortion.77
ABORTION & RISKS
S P I R I T UA L CO N S E Q U E N C E S People have different understandings of God. Whatever your present beliefs may be, having an abortion may effect more than just your body and your mind —there is a spiritual side to abortion that deserves to be considered. What might God think about your situation? What thoughts do you have about your own spiritual development and your unborn baby’s future as a spiritual being?
ABORTION & RISKS
explore your options You have the legal right to choose the outcome of your pregnanc y.
Real empowerment comes when you find the s trength & resources necessar y to make your bes t choice.
E XPLORE YOUR OP TIONS
parenting Choosing to continue your pregnancy and to parent may feel overwhelming at first. The good news is that there are a lot of resources available to help single women or couples successfully raise their child. The caring people at your local pregnancy center are ready to connect you with needed resources such as: • prenatal care • childbirth prep
• parenting classes • infant & maternity supplies
• emotional and spiritual support
Many women and men find the help they need to make this choice a positive one.
adoption Developing an adoption plan empowers you to create a positive future for yourself and your child. Adoption probably isn’t your first thought as you make this pregnancy decision. However, you may be surprised to learn that you can select the parents who would raise your child and that you may have some level of ongoing relationship with your child, if you wish. Unlike abortion, adoption brings the lifelong satisfaction of knowing that you gave your child the chance for a life of his or her own. Teenage mothers who choose adoption are more likely to finish school, get a job, eventually marry, and no more likely to have depression than mothers who choose to be single parents.78 Each year thousands of women in America make this choice. This decision is often made by women who first thought abortion was their only way out.
E XPLORE YOUR OP TIONS
definitions79 A B O R T I FAC I E N T
A substance, drug, or device given with the intent of causing the destruction of the embryo or fetus.
I N DU C E D
Intentionally ending a pregnancy and causing the destruction of the embryo or fetus.
A BO R T I O N*
CERVIX CONCEPTION (O R F E R T I L I Z AT I O N)
The narrow, lower end of the uterus. Joining of a man’s sperm and a woman’s egg to create the first form of human life.
Dilation & curettage. A surgical procedure that involves stretching open the cervix & using an instrument called a curette to scrape and remove portions of the uterine lining and contents.
E M B R YO
Human life in the earliest weeks of development, during which time the organs are formed.
FULL TERM PREGNANC Y G E S TAT I O N I M P L A N TAT I O N L AMINARIA
L A S T M E N S T R UA L P E R I O D (L M P) OFF-L ABEL USE
P L AC E N TA
A developing unborn baby with an observable human structure; the stage following embryo. Latin for “offspring.” The point at which the pregnancy has completed at least 37 weeks from the mother’s last menstrual period.
In human pregnancy, it is the length of time from fertilization until birth. When the embryo attaches to the inner uterine lining. Dried seaweed or kelp formed into narrow bundles that absorb fluid and expand in size when placed inside the cervical canal, causing the cervix to dilate; used in abortion. The date when a woman starts her last menstrual period before conception. This is the point in time from which the pregnancy and the age of the unborn baby are typically measured. The legal use of a medication or a medical device for a purpose for which it has not been specifically approved by the U.S. Food and Drug Administration.80 A pancake-like structure that provides nourishment to the baby through the mother’s bloodstream. An interval of about three months used to measure three successive stages of pregnancy: first trimester, second trimester and third trimester. Female organ where the unborn baby develops during pregnancy.
*For the purproses of this publication, everywhere “abortion” appears, it stands for “induced abortion.”
references U.S. Department of Health and Human Services (2010, September 27). Stages of pregnancy | womenshealth.gov. Retrieved from http://www.womenshealth.gov/pregnancy/you-are-pregnant/ stages-of-pregnancy.html 2 Mayo Clinic (2014, June 10). Fetal development: The first trimester. Retrieved October 5, 2016 from http://www.mayoclinic.org/healthy-living/pregnancy-week-by-week/in-depth/prenatal-care/ art-20045302?footprints=mine 3 Gittenger-de-Groot, A. (2000). Textbook of fetal cardiology: Normal and abnormal cardiac development. (p. 15–27). London: Greenwich Medical Media Limited. 4 deVries, J. (1982). The emergence of fetal behaviour. I. Qualitative aspects. Early Hum Dev., 7(4), 301–22. 5 Licensed from The Endowment for Human Development. http://www.ehd.org/ 6 Moore, K. Dermatoglyphics: Science in transition. 1991; (pp. 95–112). New York: Wiley-Liss. 7 Hepper, P. Sex differences in fetal mouth movements. Lancet. 1997;350(9094), 1820–21. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9428256 8 Glover, V., Fisk, N. Fetal pain: Implications for research and practice. Br J Obstet Gynaecol. 1999;106(9):881–86. 9.1 American Congress of Obstetricians and Gynecologists, “ACOG Statement on “Personhood” Measures.” Last modified 2012. Retrieved from http://www.acog.org/About_ACOG/News_Room/News_ Releases/2012/Personhood_Measures 9.2 Planned Parenthood. (2016). How to Get Pregnant - How Pregnancy Happens. Retrieved September 30, 2016, from https://www.plannedparenthood.org/learn/pregnancy/how-pregnancy-happens 10 Mayo Clinic. (2014, July 10). Fetal development: The first trimester. Retrieved September 30, 2016 from http://www.mayoclinic.org/prenatal-care/ART-20045302 11 Katz, V., et al. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby-Elsevier; 2007. 12 Larimore, W. L. (2000). The abortifacient effect of the birth control pill and the principle of the ‘double effect. Ethics & Medicine, 16(1), 23–30. 13 Physician’s Desk Reference. (2016). Plan B One-Step® (levonorgestrel) - Drug Summary. Retrieved September 30, 2016, from http://www.pdr.net/drug-summary/plan-b-one-step?druglabelid=573&id=1542 14 Teva Women’s Health, Inc. (2015, December). Plan B Onestep® Side Effects. Retrieved September 30, 2016, from http://www.planbonestep.com/FAQ.aspx 15 Teva Women’s Health, Inc. (2015, December). When is it not appropriate to take Plan B Onestep®? Retrieved September 30, 2016, from http://www.planbonestep.com/FAQ.aspx 16 Teva Women’s Health, Inc. (2015, December). Plan B Onestep® Side Effects. Retrieved September 30, 2016, from http://www.planbonestep.com/FAQ.aspx 17 Raymond, E. G., Trussell, J., & Polis, C. B. (2007). Population effect of increased access to emergency contraceptive pills, A systematic review. Obstetrics & Gynecology, 109(1), 181–88. 18 Trussell, J., Raymond, E., Cleland, K. (2016, July). Emergency contraception: A last chance to prevent unintended pregnancy. Retrieved on September 30, 2016 from http://ec.princeton.edu/questions/ ec-review.pdf 19 Ibid. 20 Watson Pharma, Inc. (2014, January). ella® full prescribing information. Retrieved October 3, 2016 from http://pi.actavis.com/data_stream.asp?product_group=1699&p=pi&language=E 21 U.S. Food and Drug Administration. (2012, April). FDA approved patient labeling: How effective is ella®? Retrieved October 3, 2016 from http://www.accessdata.fda.gov/drugsatfda_docs/ label/2012/022474s002lbl.pdf 22 Larimore, W.L. (2000). Growing debate about the abortifacient effect of the birth control pill and the principle of the double effect. Ethics and Medicine. January 2000;16(1):23–30. Updated October 1, 2004. 23 Harrison, D.J., Mitroka, J.G. Defining reality: The potential role of pharmacists in assessing the impact of progesterone receptor modulators and misoprostol in reproductive health. The Annals of Pharmacotherapy. Dec 21, 2010; 45(1):115–9. 24 U.S. Food and Drug Administration. (2012, April). ella® full prescribing information: Use in specific populations. Retrieved October 3, 2016 from http://www.accessdata.fda.gov/drugsatfda_docs/ label/2012/022474s002lbl.pdf 25 U.S. Food and Drug Administration. (2012, April). ella® full prescribing information: Adverse reactions. Retrieved October 3, 2016 from http://www.accessdata.fda.gov/drugsatfda_docs/ label/2012/022474s002lbl.pdf 26 U.S. Food and Drug Administration. (2012, April). ella® full prescribing information: Drug interactions. Retrieved October 3, 2016 from http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/022474s002lbl.pdf 27 U.S. Food and Drug Administration. (2012, April). ella® full prescribing information: Use in specific populations. Retrieved October 3, 2016 from http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/022474s002lbl.pdf 1
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