Aid For Women, 24-hour Form

Aid For Women, 24-Hour Form
720 Central Avenue, Kansas City, KS 66101, 913-321-3350
BRING THIS FORM WITH YOU to your appointment.

The "Women's Right To Know" Act of July 1st, 1997 (K.S.A. 65-6701): Voluntary and informed consent for an elective abortion is required unless it can be shown that you need a therapeutic abortion to save your life because of a medical emergency. For "voluntary and informed consent" we must provide you in writing at least 24 hours prior to your abortion:
1. DOCTOR'S NAME -- Ron Yeomans, MD will do your abortion at Central Family Medical, LLC dba Aid For Women.
2. PROCEDURE DESCRIPTION -- The most common kind of abortion we do is by suction aspiration. Following administration of a local anesthetic (numbing medicine) around the cervix, a series of tapered dilator rods, each a little wider than the one before, are inserted and removed to stretch the cervix open wider and then insert a cannula tube into the uterus. Suction is then applied to the cannula tube while gently removing the pregnancy tissue from the uterus. We may use a tear-drop shaped curette to dislodge any tissue that may still remain. The uterus is then re-suctioned to remove any remaining tissue. Patients who desire to have little or no experience of the procedure may choose our Conscious Sedation (Versed/midazolam and Nubain/nalbuphine) administered in addition to the local anesthetic lidocaine. If you do not dilate easily (possible at 12 weeks LMP or more) we will dilate your cervix as much as we can with dilator rods, then we will place small water-absorbing laminaria dilators into your cervix that expand over 5-6 hours like a tampon does. Later we will do a regular suction aspiration abortion as describe previously. If you choose a mifepristone medical abortion (under 7 weeks LMP, <9mm CRL) you will orally swallow mifepristone in tablet form which stops the pregnancy by separating the placenta from the uterine wall. Twelve to 36 hours later you will insert misoprostol tablets vaginally to dilate your cervix and thereby induce uterine emptying of the fetal tissue while you are at home. You will return 7 days later to verify by sonography that the fetal tissue is all gone. If tissue remains we may have to do suction aspiration to empty any remaining tissue, and you consent to this remedy.
3. POSSIBLE COMPLICATIONS -- 1. Infections, which are usually avoided if the woman observes her follow-up instructions and takes her prophylactic antibiotics 2. A tear in the cervix, which may be repaired with stitches. That may cause an increased risk of premature delivery in the future; 3. Anesthesia or other medication allergic reactions; 4. Perforation of the uterine wall and possibly other organs (less than 0.1%), which may heal themselves or may require surgical repair; 5. An abortion that is not complete (approximately 1-2%) or in which blood clots accumulate in the uterus (1%) requiring removal; 6. Excessive bleeding (less than 0.1%) which may require a blood transfusion. Mifepristone medical abortions are reported to have a higher rate (1%) of excessive bleeding possibly requiring a transfusion than with surgical abortions, and a 0.001% chance of a rare but fatal Clostridia Sordelli infection.
Serious complications though are rare. First trimester procedures are safer than carrying to full-term. The mortality rate with legal abortions is 1 in 160,000 (0.6%)¹. Death and serious complications with full-term pregnancy, and for second trimester abortions the risk is somewhat higher than carrying to full-term1. The side effects from the misoprostol used in the medical abortion are severe cramping and bleeding. Side effects from the misoprostol upon an incomplete abortion viable pregnancy include severe bone deformities and therefore must be removed by suction aspiration. Risks to future reproductive health from an abortion are associated with an infection severe enough to cause fallopian tube scarring (an infection that severe is highly unlikely and is usually related to a sexually transmitted diseases acquired prior to the abortion), or a perforation of the uterus and the hysterectomy that might have to be done if perforated (highly unlikely). Anti-abortion protestors claim without significant proof that breast cancer, ectopic pregnancies, post-abortion-syndrome and future problems conceiving are somehow linked to abortion.
4. ALTERNATIVES -- You may continue this pregnancy to full-term instead of having an abortion. We can help initiate private adoptions. Women needing financial assistance to continue the pregnancy may be eligible for Medicaid/Aid For Dependent Children(AFDC)/public assistance. You may check with a social worker to determine eligibility if desired. Social Services: Wyandotte county KS 913-279-7000, Johnson county KS 913-826-7300, Missouri: 800-392-2161. However, since Congress has limited benefits to 2 years maximum lifetime benefits, your chances of long-term benefits are getting much worse. In the phonebook listings under Abortion Alternatives you can find private agencies who would be willing to help you with your needs if you carry to full-term. Their assistance is not limited to, but usually consists of maternal clothing, children's clothing up to size 5, cribs & car seats for babies, food, helping get you into an apartment either with an apartment deposit or inexpensive housing referrals, teaching you valuable job skills (nursing and computer smarts) and completing your G.E.D., emotional support groups during pregnancy and for single mothers, some day care, some emergency funds, inexpensive or free legal help, obstetric referrals, and parenting and budgeting classes .^4,5,6
5. GESTATIONAL AGE -- When did your Last normal Menstrual Period (LMP) start? __________. Counting from LMP to the time of your appointment with us, how many weeks is that? ___________. This is also called weeks gestation, whereas Date-of-Conception is usually two weeks less than LMP counting. We do NOT count from conception.
6. VIABILITY statement required (K.S.A. 67-6501 Sec. 27(a)(4)):"No person shall perform or induce an abortion when the fetus is viable unless such person is a physician and has a documented referral from another physician not financially associated with the physician performing or inducing the abortion and both physicians determine that: (1) The abortion is necessary to preserve the life of the pregnant woman; or (2) the fetus is affected by a severe or life-threatening deformity or abnormality." And if the child is born alive, that the physician is legally obligated to maintain the life and health of the born child. Viability is legally defined as 22 weeks gestation (LMP).
7. PROBABLE ANATOMICAL & PHYSIOLOGICAL CHARACTERISTICS:^2*

LMP^*	CRL^*	Gross apearance & internal development
5mm	3mm	Optic vesicles appear. Double heart recognized. Pregnancy test is positive.
6mm	4mm	Head is bent forward; limbs are bumps, tail prominent. Initial stage of most organs has begun.
10mm	30mm	Eyes, ears, nose, mouth recognizable; digits formed, tail almost gone. Sensory organ development well along. Random movement is seen on ultrasound.
14mm	80mm	Skin pink, delicate; resembles a human being, but head is disproportionately large. Brain configuration roughly complete. Internal sex organs now specific. Bone marrow producing blood. Bones are hardening. Genetic testing by amniocentesis is possible.
18mm	135mm	Hair and nails appear. Fetus is active. Arm-leg ratio now proportionate. Sex determination possible. External sex organs grossly formed. Heart muscle well developed.

*LMP -- length of the fetus, Crown-to-Rump Length, in millimeters as measured by ultrasound.
*CRL -- means from the first day of the last menstrual period in weeks.

8. RISKS OF FULL TERM PREGNANCY -- Risk of maternal death within 42 days after delivery is 9 per 100,000 live births. Some figures are up to 14 death per 100,000 live births when you include obstetric complications within the first year.³ Possible complications from full term delivery include: 1. Major abdominal surgery (Caesarian section) occurs in greater than 15 women per 100 births.⁴ 2. Allergic reactions to anesthetics or other medications. Reactions may produce a fever, rash, and discomfort or, in rare cases may be life-threatening. 3. Infections. Approximately 4% of women become infected after childbirth and must be treated with antibiotics. If not treated, infections may cause infertility or, in rare cases may be life-threatening. 4. Heavy bleeding from clotting problems, placental tearing or surgery that requires medical treatment. Fewer than 5% will require a transfusion. 5. Blood clots. Clots in the lungs are the leading cause of maternal death after a live birth. 6. Complications of high blood pressure (strokes and seizures). 7. Complications of medication to stop premature labor (fluid in lungs and heart failure).
Women who are more likely to have serious complications during and after pregnancy are those with reduced access to prompt medical care and those with poor general health and living conditions. Mild depression occurs in up to 70% of women immediately following childbirth. Up to 10% of women experience depression of a lingering nature after childbirth.
9. THE Rh FACTOR COMPLICATIONS (Isoimmunization) -- There are four major blood types, each with a sub-category of Rh-Positive or Rh-Negative. There is approximately a 15% chance that you be Rh-Negative, which would mean that your pregnancy would be 85% likely to be Rh-Positive. When even the tiniest amount of Rh-Positive fetal blood mixes with your own Rh-Negative blood, your immune system attacks the Rh-Positive pregnancy, resulting in compromised health or possibly fetal death. This can be prevented with an injection of Rh Immune Globulin (Rhogam). If you are Rh-Negative you are required at this clinic to receive this Rhogam injection if you have an abortion. There is a cost for the Rhogam injection.
10. DEPARTMENT OF HEALTH AND ENVIRONMENT INFO -- The Kansas Department of Health and Environment (KDHE) has published a booklet of color photos of what the pregnancy looks like at different stages, and a directory of abortion alternatives. The anti-abortion legislators who got this law passed feel that you will be better informed by seeing these graphic photos and the long list of alternatives. So that we do not have to pass the cost of mailing additional information to you we would like you to view these booklets at your local Kansas public library, at our clinic, at our website www.aidforwomen.com, or call KDHE at 1-888-744-4825 (785-291-3744) and request that they send you those booklets. You must have received those booklets at least 24 hours prior to your appointment. We are required to make sure that you have had access to this booklet. You will sign a form here stating that the following information (two booklets titled, "If You Are Pregnant", and, "If You Are Pregnant: A Directory of Available Services") was presented to you in writing at least 24 hours before the abortion by the staff of the doctor who is to the perform your abortion. If you wish we will mail out separately the two booklets to you.
11. FATHER IS LIABLE FOR CHILD SUPPORT -- the father of your pregnancy is responsible for child support if you decide to continue and could be tracked down with his Social Security Number through the IRS and New Hire laws that have been implemented in most states under Unemployment laws. Currently, child support is difficult to collect if they do not have a regular job, or work for unreported cash payments.
12. YOU CAN CHANGE YOUR MIND -- You can change your mind to have an abortion anytime prior to actually dilating your cervix without affecting your right to future health care from other physicians, nor will federal or state benefits be lost.
13. CERTIFICATION -- You must sign a form which will state that you have received all of this information. Your physician MUST have a copy of the certification form before we will do the abortion.
14. NO PAYMENT REQUIRED BEFORE 24th HOUR -- by law we cannot require you to pay for the abortion before the 24 hours of receiving this information, but this does not stop us from requiring payment after receiving this 24-hour notification and before the abortion.

By signing below, you acknowledge that you have read and understood the information above, and that you received this information at least 24-hours prior to your abortion.

__________________________________________________January 6, 2009, 4:32:12 pm
Patient name, date and time the 24-hour FORM was RECEIVED

¹ "Safety of Abortion", Susan Dudley, National Abortion Federation, c.1996
² Current Obstetric and Gynecologic Diagnosis & Treatment 1987, Ed. Martin L. Pernoll, MD, Appleton & Lange, Norwalk, CT, c. 1987,page 145.
³ 1990 Year Book of Obstetrics and Gynecology, Year Book Medical Publishers, Inc., Chicago, Illinois, c. 1990, p. 41 referring to previously published report, "Maternal Mortality in the United States: Report From the Maternal Mortality Collaborative", Rochat RW, Koonin LM, Atrash HK, Jewett JF, Maternal Mortality Collaborative (Centers for Disease Control, Atlanta; Harvard Univ) Obstet Gynecol 72:91 - 97, July 1988.
⁴ Current Obstetric and Gynecologic Diagnosis & Treatment, p. 498.
⁵ Advice and Aid Pregnancy Center, 913-385-3484 ⁶ Birthright, 800-550-4900 ⁷ Lighthouse,816-361-2233

24hr.php, Apr'08.
© Central Family Medical, LLC d.b.a. Aid For Women, 2008.