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In 1986, Dr.Wortman founded a private office in Rochester which was dedicated, in part, to providing safe, sanitary, legal and confidential abortion services in an atmosphere that was non-judgmental and supportive. This private office eventually became the Center for Menstrual Disorders and Reproductive Choice (CMDRC). Today, "The Center" provides the most up-to-date, superior abortion services anywhere in New York State.
This is not a clinic! We are a private gynecological office and many of our clients go on to become active patients of ours, returning for annual examinations, menstrual disorders, and care for a variety of gynecological concerns. Dr. Wortman, a Board Certified Gynecologist, offers a full range of gynecologic care and services.
Dr. Wortman has over 28 years of experience in providing first and second trimester abortions and has pioneered many "firsts" for the women of Upstate New York. These include the routine use of ultrasound before, during and after each procedure, the routine use of antibiotics following abortion procedures, and the lowest complication rate available for abortion procedures in Upstate New York. He was the first physician to offer meaningful pain relief to patients undergoing abortion procedures and to offer mid-trimester abortions in a confidential office setting in Upstate New York.
At The Center, Dr.Wortman, with his highly trained nursing staff, provides services that are tailored to each woman's individual needs. In addition to "state of the art" medical care, we offer compassion and emotional support before, during, and after your visit. The decisions that surround an unwanted pregnancy are emotionally wrenching. Answering the question, "What should I do?" is difficult. You must ultimately decide what the best choice is for you. We are here to assist you in making a choice you "can live with". We provide you with a choice and facilitate that choice whatever it may be. We are not just here to perform abortions but to truly help you in the decision making process as well.
If you choose to terminate your pregnancy, it is our mission to provide that service in a safe, sanitary, legal, confidential and non-judgmental manner. We are here to safeguard your reproductive future so that you have a choice in the future. You should expect nothing less during this crisis in your life.
Whether you chose to receive your care at our office or at another facility we recommend a visit to www.afterabortion.com. The information and resources may prove very helpful to you and it is worthwhile touring their webpage.
Our Services
The Center for Menstrual Disorders and Reproductive Choice provides abortion services from the time of a positive pregnancy test to 20 weeks gestation. In cases where the pregnancy poses a threat to maternal health, or when a birth defect, incompatible with normal life, is present, abortion services are provided until the 24th week*. Sedation and pain management are available at your request.
Medical Abortions (RU486, Mifepristone) - conception to 63 days
The appearance of mifepristone (Mifeprex), or RU-486, in September of 2000, represents the first time the U.S. Food and Drug Administration has approved the use of a medication to induce an elective abortion. Mifepristone was first developed in the 1980s by researchers from the French pharmaceutical company, Roussel Uclaf (hence the "RU"). Clinical testing of mifepristone began in France in 1982. In 1988, the French government licensed mifepristone for use. Since then, it has been approved in Sweden, the United Kingdom, China, Israel, and 9 other European countries. In September 2000, it was approved here in the United States.
What is a medical abortion?
A medical abortion is a two-step procedure. In the first step, the medication, mifepristone (Mifeprex), is taken. Mifepristone causes the death of the embryo/fetus that is less than 63 days from your last period (49 days since conception). Following this, a second medication, misoprostol (Cytotec), is taken. Misoprostol causes uterine contractions and allows all pregnancy-related tissues from the uterus to be passed.
What about mifepristone? Is this drug safe?
Mifepristone (Mifeprex) has been extensively studied in Europe and has been approved by the United States FDA—to 49 days since the first day of your last menstrual period.
This does not mean that the drug is completely safe or completely understood. For instance, we still cannot determine the future effects of mifepristone on future fertility or on the future children of women who have taken it. This data takes over 20 years to collect and does not yet exist. That being said, large studies show no detrimental effects on future fertility or the health of children born to future pregnancies. Although no drug is completely safe, it would appear that mifepristone, when used in combination with misoprostol by a competent physician and within published guidelines, is as safe as surgical abortion and has acceptable side effects.
How does mifepristone work?
Mifepristone works by blocking the hormone progesterone from sustaining an early pregnancy. Chemically, mifepristone is known as an antiprogesterone.
What is misoprostol?
Misoprostol (Cytotec) is a prostaglandin. This drug acts to soften the cervix and also causes uterine contractions that expel the early pregnancy.
How effective is the combination of mifepristone and misoprostol?
95% of women who are less than 49 days pregnant (from the last menstrual period) and receive this two-drug combination will have a complete abortion. About 1% will have ongoing pregnancies and 4% will require an additional surgical procedure.
What about the other 5%?
The other 5% will require a suction abortion, also known as suction curettage. This is performed at our office. You may request intravenous conscious sedation.
Are there any women that should not take the mifepristone and misoprostol combination?
Certain women should not take this two-drug regimen. They include women with an allergy to either of these medications, women who use steroids, have bleeding disorders, or who are taking anticoagulants (blood thinners). Other contraindications include women with porphyria or pregnancies that are greater than 63 days. You should be aware that the FDA has only approved this drug for use in pregnancies less than 49 days. Our experience suggests that it can be safely used on properly screened women until 63 days. Women with ectopic (tubal) pregnancies cannot take mifepristone.
What are the advantages of mifepristone and misoprostol?
Mifepristone requires no anesthesia, no mechanical dilation, and no use of suction to accomplish an abortion. The abortion happens in the privacy of your own home.
What are the disadvantages of mifepristone?
The failure rate is about 5% during the first 7 weeks. This is about 5 times greater than with surgical abortion. With the mifepristone and misoprostol regimen, the most painful part occurs while you're at home - away from a doctor's care. During a surgical abortion, a short-acting sedative/hypnotic and a narcotic can be given intravenously to make the procedure completely painless.
With mifepristone, the actual abortion occurs 1-7 days after you take it. The majority occur within 24 hours. Surgical abortions take several minutes to complete.
Both surgical abortions and medical abortions require three visits—the first for the intake and consult, the second for the surgical procedure or the medication (depending on your choice) and the third to be sure that your uterus is healing normally. For medical abortions the third visit is a week later and for surgical abortions we prefer to check you two weeks later. In both instances you would have an ultrasound examination to check for any retained tissue.
With surgical abortions, the heaviest vaginal bleeding occurs in a physician's office, while you are under observation. With mifepristone and misoprostol, the heaviest vaginal bleeding occurs when you're at home.
In summary, how does medical abortion compare to surgical abortion for pregnancies less than 63 days?
Comparison of Medical versus Surgical Abortion
|
|
Surgical |
Medical |
Where it occurs |
Doctor's office |
home |
|
Failure rate |
Less than 1%* |
1%* |
|
Length of time |
5 minutes |
1-7 days |
|
When pain occurs |
During the procedure |
1-7 days after misoprostol |
|
Risk of perforation |
Less than 1/5000 |
None |
|
Risk of infection |
1% |
1% |
|
|
|
|
*In a small percentage of cases (4%) both medical and surgical abortions may require a re-suction procedure to remove retained products of conception.
Between conception and 63 days gestation, a woman may choose between a medical or a surgical abortion. Both medical and surgical abortions are safe methods and may be performed up to 63 days of gestation as calculated from the first day of your last menstrual period. Surgical abortions have been studied for many decades and have an excellent safety record with very low rates of complications in experienced hands. Medical abortions allow women to undergo the abortion process in the privacy of their own homes. Both medical and surgical abortions require 3 office visits. Surgical abortions have the 'advantage' of allowing the woman to be treated with intravenous sedatives during the 'worst' portion of the procedure. You should discuss these options with your physician or healthcare provider and arrive at the best possible choice for you!
Patients now have the option of having a pregnancy termination as soon as they have a positive pregnancy test. Urine pregnancy tests are so sensitive that they are often positive even before a missed menstrual period. Prior to ultrasound guidance and sensitive measurements of beta-HCG (the hormone that causes the positive pregnancy test) patients were often told that they could not undergo a surgical pregnancy termination until at least 6-8 weeks from their last menstrual period. This often meant 2-4 weeks of "waiting" as an unplanned pregnancy continues to grow along with a woman's anxiety. With current technology you may call the office and schedule an appointment for a surgical or medical abortion as soon as you have received a positive pregnancy test.
The efficacy of surgical abortion is over 99%--the same as medical abortion. Both procedures may require suction "completion" in about 4-5% of cases because of retained tissue or clots. With medical abortions, the abortion happens in the privacy of one's own home at any hour of the day or night. Early surgical abortion allows the termination to be performed under controlled circumstances. Medical abortions occur from 1-7 days after the first medication is taken. Oftentimes, repeat doses of misoprostol (the prostaglandin that causes the actual passage of tissue) are required, resulting in further unpredictable delays.
What are the disadvantages of early surgical abortion?
Frankly, not many. This is still a surgical procedure. Operator skill and experience are very important. Additionally, the procedure is highly dependent on sonographic (the use of ultrasound) skills, examination of tissue, and adherence to a strict protocol. In the presence of a known genital tract anomaly (double uterus, double cervix, double vagina), or severe cervical stenosis (a cervix which is scarred), early medical abortions may be safer than early surgical abortions.
How safe is surgical abortion?
The mortality rate of first trimester abortions is approximately 1 out of a quarter-million women. This, incidentally, compares favorably with a single oral dose of penicillin, which has a fatality rate (from anaphylaxis) of 1/100,000. Infections occur in less than 1% of surgical abortions. Uterine perforation occurs in approximately 1/5000 cases.
Can patients receive sedation for early surgical abortion?
Yes!
What happens on the day of the procedure?
Patients are asked to bring the following information: the date of their last menstrual period (LMP), insurance information, results of a urine or serum pregnancy test, and Rh type (if known). If a woman is planning on receiving intravenous sedation, she should be accompanied by an adult who must remain in our waiting room during the entire procedure. Please note that children are not allowed in our waiting room. The actual procedure takes 2-4 minutes, excluding the time necessary for ultrasound examinations (about 1-2 minutes). Micrhogam will be administered to all Rh negative women. If you are receiving intravenous sedation you should expect to spend 30-60 minutes at our office for observation.
What is the procedure like?
All patients experience the stimulus of surgical manipulation differently. Most patients will experience some cramps during dilation—the intensity varies from one woman to the next. Patients who receive conscious sedation are essentially pain free.
Is sedation necessary?
Abortion, unlike other surgical procedures, is not emotionally neutral. Many complex issues confront a woman undergoing abortion in a very short period of time. It is our objective to provide comfort without being judgmental. We often encourage patients to take advantage of intravenous sedation if they feel they can benefit from it.
Suppose the patient wishes to begin the procedure without sedation and then changes her mind?
No problem. This happens all the time.
What happens after the procedure?
Patients are given routine postoperative instructions, prophylactic antibiotics, contraceptive advice and/or a prescription, and, whenever appropriate, MicRhogam. Follow up appointments for a post-operative ultrasound are scheduled for 2-3 weeks after a surgical abortion.
Does insurance cover the procedure?
The vast majority of Rochester-area carriers, as well as private insurance companies, do cover the majority of the procedure costs. We check each contract individually for your specific coverage.
What are my limitation postoperatively?
Patients will be asked to refrain from driving the day of the procedure if they have received intravenous sedation. Otherwise, they should plan on spending several hours resting at home before resuming normal activity.
Are there any long-term risks that I should know about?
The risk to future fertility and subsequent premature delivery is virtually immeasurable. Surgical abortion is an exceptionally safe procedure.
Surgical abortion from 63 days to 12.9 weeks
During this period, the risks of medical abortion outweigh the risks of surgical abortion, and therefore surgical abortions are performed from this point in gestation. Intravenous sedation and narcotics are made available to all women. Surgical procedures are extremely safe during this period.
Surgical abortions involve a two-step process: mechanical dilation of the cervix and vacuum aspiration. Mechanical dilation involves the insertion of progressively larger dilators into the cervix (opening of the birth canal). The suction process involves the insertion of a vacuum tube into the uterine cavity.
Surgical abortion from 13-20 weeks
At this advanced stage, safety dictates that the procedure takes place over a 24-hour period. In unusual circumstances, an additional 12-24 hours may be required. A laminaria (sterilized seaweed, about the size of a matchstick) will be inserted into the cervix and we wait 24 hours to allow the cervix to dilate. Once the cervix is dilated, suction assists removal of the uterine contents with the use of ultrasound guidance.
Abortions performed after 16 weeks are definitely associated with greater risk than abortions performed earlier in gestation. The risks of mid-trimester abortions include hemorrhage, infection, and uterine perforation. While the risks are small when compared to a normal vaginal delivery, it is important to recognize that the risks or abortion increase with gestational age after the 16th week. For this and other reasons, it is always wisest to make an early decision about an unplanned pregnancy.
Is a mid-trimester (13-20 weeks) abortion dangerous?
No. Although nothing is completely without risk, surgical abortions--when compared with such common procedures as appendectomies, tonsillectomies, and even childbirth-- are far safer. In general, the complication rate of first trimester (including medical) abortions is safer than with mid-trimester abortions. For this, and other reasons, it is important to decide on the outcome of an unplanned pregnancy as soon as possible.
Can complications occur after an abortion?
The most common complication of an abortion is retained tissue or retained blood clots. The treatment for this complication is most often a re-suction procedure. The next most common complication is infection -- occurring in less than 1% of all women who have abortions. Hemorrhage is an uncommon complication of mid-trimester abortions and occurs in less than 1 in 1000 abortion procedures and hysterectomy occurs in less than 1 in 20,000 procedures.
Can complications be prevented?
Although complications can never be completely prevented, their incidence can be minimized. We do out best to minimize complications by providing you with a vast amount of experience and the best technology available. You can help by following all of the postop instructions that we supply. It's important to take any antibiotics that are prescribed or supplied. You should call us immediately if you have any concerns about infection, excessive bleeding, fever, or excessive pain. We would rather you call me only to out find that your concern is not a medical problem, than have you wonder if you should. As a rule, if you have a question or a doubt, call me.
Will there be any pain during of after the abortion?
Yes. In most cases there is real, although brief, pain for women who choose to have this procedure under local anesthesia. This pain varies from mild to severe and depends on the individual - some women having a higher pain threshold than others. The pain may last no more than 30-60 seconds and is often described as similar to a labor pain or a severe menstrual cramp. You may prevent some of the pain by taking aspirin (two tablets), ibuprofen (400-800mg), or Aleve (two tablets), approximately 30-60 minutes prior to the procedure.
Many women choose to have a combination of an intravenous sedative and narcotics during the actual procedure. These medications are very effective and nearly always provide a pain-free experience.
Will this abortion affect my ability to have children in the future?
Numerous studies have concluded that there is no impaired fertility after an elective pregnancy termination. Furthermore, women who have undergone abortions are no more prone to have miscarriages in subsequent pregnancies than are women who have never had abortions.
How will I feel afterward?
Some women are very relieved after the procedure while others are tired and emotionally drained. Many women are very sad and tearful while other struggle with guilt. There are a wide range of responses, and they vary considerably from women to women.
Grief is a very common experience. Terminating a pregnancy involves a great loss to many women -- often the grief is similar to what one experiences when losing a close friend or relative. For many women, the grief over a pregnancy termination is worse because of the relative secrecy and stigma surrounding the decision.
Guilt is also a common emotion following an abortion. Often, women experience a very real fear that they are "going to pay for this" in some way. They may feel that they won't be able to have children when they are ready to. This guilt is a normal reaction to a very difficult choice.
If I do experience guilt or sadness, how long will it last?
Each woman experiences the grief process differently, so it's difficult to set a time limit as to when these feelings should begin to subside. In general, if feelings of grief or guilt begin to interfere with normal daily functions, such as sleeping, ability to perform at work, or eating, you should call us to discuss whether or not you might wish to come into our office for counseling.
PAIN RELIEF AND SEDATION
There's a good deal of confusion about the subject of pain relief and sedation. If you were to look in Yellow Page advertising you'll note that many offices now offer "intravenous sedation" or "conscious sedation". You should know that not all "intravenous sedation" or "conscious sedation" is the same. Moreover, you may not be interested in intravenous sedation. What we provide is a choice of different kinds and levels of sedation---a choice you get to make.
Many women don't require any additional pain medication other than a local anesthetic agent. Some women just want a "pill" to relax them prior to and during their procedure. At the other extreme are women who want to feel nothing and remember nothing of their experience. The point is that we all have different needs and fears – what's unique about our practice is that we can accommodate your different requirements.
So, the first thing to understand is that we offer a variety of choices.
1. Oral medications—some women simply require oral medications. There's no charge for these medications. We usually provide you with an oral sedative – such as Xanax or Valium – in combination with an oral narcotic – such Hydrocodone or Oxycodone. If you chose this method of sedation you'll be issued prescriptions at your initial visit. We ask only that you have someone drive you to and from your appointment.
2. Combination of Oral and intramuscular medications—Oral medications, while useful for many women, cannot provide the depth of sedation or pain relief of medications given by injection. For some women—especially those that wish to avoid "I.V.s" we offer an oral sedative that you would take an hour or two prior to your procedure followed by an intramuscular injection of a narcotic about 30 minutes before your procedure. There is a nominal charge for this form of conscious sedation. As with oral medications you'll need to have someone drive you to and from your visit.
3. Intravenous conscious sedation---For women who wish to have a deeper level of sedation and pain relief we offer intravenous conscious sedation. The advantage of intravenous sedation is that the drugs are almost immediately effective and wear off in a relatively short period of time. If you have elect to have intravenous conscious sedation you can control the level of sedation—you just need to tell us how deeply sedated you wish to be. Some women just want "something to take the edge off" but prefer to be awake. Others want to be "out"—to have no memory and to feel nothing of the procedure. You get to determine what level of sedation you wish. We use a combination of two drugs---Versed (midazolam), a sedative and fentanyl, a narcotic. Remember, that not all conscious sedation is the same! Versed and fentanyl is only used by specialized facilities with personnel who are specially trained in its use. There are many requirements with respect to licensing and training for an office to provide these medications----ours is one of the very few offices in upstate New York that meets those requirements.
Advantages of intravenous conscious sedation:
- The medications, since they are given intravenously can be carefully controlled.
- You control the depth of sedation and pain relief
- The drugs work quickly—you can feel the effects within seconds of their administration
- The drugs also wear off quickly so that within 2 hours you'll feel "normal".
Disadvantages of intravenous conscious sedation
- Compared to other forms of sedation and pain relief we offer these are comparatively expensive. Although we try and control our costs (and yours) the credentialing, training, safety equipment and regulatory requirements make this form of conscious sedation more expensive than the others.
- You will need someone to accompany you to the office, remain here with you and drive you home. This is sometimes difficult—especially in situations where no one else is available to accompany you.
- It does involve an I.V! Many women are frightened at the thought of an intravenous line. We understand that fear. In general, these are very tiny needles—even smaller than the ones used to draw your blood.
4. Intravenous Toradol (Ketorolac) – Toradol is neither a narcotic nor a sedative. It falls into the same classification of medications as ibuprofen (Motrin) or naproxen (Naprosyn, Aleve). The difference is that it is significantly more potent in reducing the cramps associated with a surgical procedure. The cost of this medication is minimal and we do not require that someone accompany you or drive you home. It is an ideal medication for someone who needs to have a medication "to take the edge of the pain" but does not want to be sedated and prefer to be fully awake.
Summary—We understand that all of us are different with respect to our ability to tolerate pain, discomfort and anxiety. It's why we offer a variety of choices to accommodate your physical, emotional and financial needs. Please feel free to talk to one of our providers if you need guidance in selecting a choice that's best suited to meet your needs.
ULTRASOUND
What is ultrasound-guidance and why is it used during a pregnancy termination?
Ultrasound guidance is a technique whereby we place an ultrasound probe on your abdomen during any procedure involving placing instruments in the uterus. Without ultrasound the procedure is "blind" and the doctor operates exclusively by "feel". Ultrasound allows us to actually "see" inside the uterus and prevents the vast majority of injuries to the uterus through the use of instruments.
A pregnancy termination isn't like any other surgical procedure. There are many issues that women face during this difficult decision. Among those questions are "will I be safe from injury (complications)? and "will I be able to have children when I'm ready?"
In 2003 we began performing all of our surgical procedures under ultrasound guidance. That means that during a procedure there's someone who places an ultrasound probe on your abdomen so that the physician can actually "see" the procedure at all times. Without ultrasound guidance such procedures are "blind." There's nothing wrong with "blind" procedures—in fact it's the standard of care in our community as well as other communities. Dangerous complications aren't very common as a result of surgical abortions—especially in the first trimester--so why use it? The answer is simple—it simply makes the procedure safer. Nothing, even the simplest surgery is completely without risk, but ultrasound guidance reduces the risks ever more.
What are these risks? The major risks we try to eliminate are uterine perforation and leaving tissue behind. We are convinced that the use of continuous ultrasound monitoring reduces the risk of uterine perforation to less than 1 in 5000 procedures. Reducing that risk is extremely important to us because it reduces the most serious complication associated with this procedure—injury to your uterus and other organs--and reduces the possibility that your procedure will prevent you from having children when you're ready for them. Ultasound guidance combined with postoperative ultrasounds (an ultrasound done immediately after your procedure using a vaginal probe) decreases the likelihood that significant amounts of tissue will be left in the uterus and cause prolonged bleeding following your procedure.