Here's the scenario: you're young and sexually active. One day while having sex, the condom breaks. You go home in a panic, questions racing through your head at lightning speed. What if I'm pregnant? If I am pregnant, what am I gonna do? If I need an abortion, where can I go? Are my parents going to find out? How will I pay for it?
And there's more.
First, take a deep breath and slow down. These questions will soon be addressed, and once you have some information then you can take the time -- but not too much time, in some cases -- to make your decision.
Pop A Pill If the condom breaks and you fear pregnancy, there is something you can do about it. It's a form of emergency contraception called Preven -- more commonly know as the "morning-after pill." It prevents a fertilized egg from implanting into the uterus. But don't sleep on it -- if you take it too late, the egg will already be in place.
"You have to make sure you get it within 72 hours of having intercourse," says Dr. Sheryl Ross, OB/GYN and co-author of Expecting Fitness and Two At a Time: Having Twins, written with Jane Seymour.
The most accessible way to get Preven is through a clinic, such as Planned Parenthood. If you have had a pregnancy scare within the last 72 hours, the California chapter of Planned Parenthood will make the morning-after pill available to you, no appointment or exam necessary. However, that policy may vary from state to state, so make sure to check your local chapter for their respective guidelines for obtaining the pill.
"Emergency contraception is available to everybody," says Nancy Sasaki, President and CEO of Planned Parenthood, "but it's typically given in situations where the condom broke or women who have had unprotected sex are calling us -- it's available to them."
Sasaki hopes that Planned Parenthood will eventually be able to offer emergency contraception to women coming in for their annual exam who are at risk for these types of accidents, so they may have it accessible in their home for emergencies.
A Non-Surgical Answer If it has been over 72 hours -- but less than seven weeks from the start of your last menstrual cycle -- and you do not wish to have a child, you may opt for a non-surgical abortion also available through some Planned Parenthoods called mifepristone -- or RU-486, also known as the "abortion pill."
This form of non-surgical abortion is FDA approved and involves first taking a dose of mifepristone -- which stops the production of progesterone, necessary to maintain a pregnancy -- then a follow-up dose of misoprostol -- which will cause the cervix to soften and dilate, producing contractions.
Both medications work to expel the embryo similar to a natural miscarriage -- you can expect to experience lower abdominal pain, nausea, bleeding, vomiting and diarrhea. You will also need to visit a women's clinic or your doctor for complete details, because treatment may vary and will be individualized.
Seek Advice But if you just don't know what to do, don't keep quiet about it. Talk to someone. There are other choices besides abortion, such as adoption. There are many programs -- usually offered through clinics -- that can give you information and counsel.
"Teens should have options told to them," says Ross. "I think that should be standard, because young women, especially emotionally, have a harder time because they may know an abortion might not be the right thing to do. But what we see is that women have a hard time with that choice."
It's also important to understand that your feelings are normal, adds Ross, and whatever your decision may turn out to be, it doesn't make you a bad person.
Going Through With It If you can't go through with the pregnancy and it's too late to utilize either the morning-after pill or the abortion pill, you can opt for surgical abortion. If you're afraid to get one because you think you'll need your parents' permission or they may be able to somehow find out, there may not be cause for worry.
"In some states, once you're pregnant, you may become an emancipated minor. Your parents might not have to know anything," Ross explains.
But if you happen to be under 18 and a resident of a state which requires one or both of your parents to give permission or be told of your decision prior to the procedure, you can ask a judge to excuse you from these requirements. This procedure is called a"judicial bypass" -- make sure to call your nearest Planned Parenthood center to find out more about the law in your state.
Teens usually choose to go to clinics such as Planned Parenthood, because services are cheaper. However, if you were hoping to go through your insurance company to entirely avoid the cost of an abortion, you will most likely be let down. Many insurance companies, such as Unicare, do not cover elective abortion and even with the ones that do, a claim must be submitted and it will be mailed to your parents.
But there are a few exceptions. According to a representative at Kaiser Permanente, if you are over 13 years of age you can get an abortion without your parents finding out -- depending on your coverage. To be safe, make sure to call your insurance company to confirm the scope of your benefits.
Once you've made the appointment, you may be wondering what the process will be. Dr. Ross's practice "use[s] laminaria, which is a seaweed compound inserted into the vagina at least four to six hours before the procedure," says Ross. "It helps to dilate the cervix, to prevent any cervical compromise from the dilatation and curettage, also known as D&C." Dilatation and curettage involves scraping the uterine lining.
Next, "a plastic suction is inserted into the uterus and we remove the product of conception though the D&C," Ross continues.
Surgical abortions are considered outpatient procedures, which means you can leave that day -- with someone else driving, of course. Generally, if you have the abortion within the first eight or nine weeks, "you really recuperate quite well," adds Ross.
"You can work the next day," she says. "In the second trimester, it's a little different, so you might need a week to recuperate. Nowadays, it's sad that they're done after 12 weeks."
Post-Trauma Issues For many young women, an abortion can result in confused feelings and emotions, and they should not be ignored.
"They don't have anyone to talk to," says Ross. "They don't trust anyone, and it's an enormous amount of guilt. They can go into a bad depression, and it can be very difficult to cope."
Ross adds that the question young women should ask themselves is, "How am I going to get through this emotionally?"
"I recommend counseling," she answers, "because it helps. The guilt factor is huge, and I think it's important that it is addressed. I definitely think counseling is more important than the procedure itself."
If you decide to have an abortion, and later suffer from feelings of guilt and anxiety, it's important that you seek help -- with your parents' assistance if possible. But if you feel you're unable to turn to your parents, make sure to find out about local programs and health centers that can provide support for you during your trying time.
Safety First Keep in mind that access to emergency contraception or an abortion is not an excuse to engage in irresponsible sex. You should always protect yourself -- from both unwanted pregnancies and sexually transmitted diseases -- by using condoms or practicing abstinence.
Here's another thing to keep in mind: if you take birth control lightly, and have more than one abortion, you may have problems with fertility in your future.
"We've found an increase in uterine scarring in patients that have had two or more abortions," says Ross, "and that can affect fertility, because the environment isn't as good for the embryo."
Bottom line? Take the proper precautions at all times and use emergency contraception for its intention -- emergencies. But, if you slip up, make sure that you consider all of your options. And remember, everyone can make mistakes.
Just make sure you learn from them.