Getting pregnant unexpectedly can be incredibly stressful, especially if you’re already struggling with substance use. In some cases, you might not know whether you should keep the pregnancy.
Your choices relating to pregnancy should be entirely up to you. Unfortunately, in many places across the country, these choices are much more limited than they once were. But getting support early can help you make an informed decision, protect your health, and get you on the path towards healing.
Ending the Pregnancy (Abortion Options)
People who wish to terminate their pregnancy do so for many reasons – health, personal circumstances, etc. – all of which are completely valid and should be entirely up to the individual giving birth.
Note that abortion laws vary widely from state to state, especially after Roe v. Wade was overturned. Abortion is now completely illegal in 13 states and extremely restricted in seven. AbortionFinder.org can help you find options in your state.
Medication abortion
The basics: 1
Medication abortion is commonly known as the “abortion pill.”
It consists of taking two medications (mifepristone and misoprostol) over the course of a few days. These come in pill form, but there is a version of misoprostol that can also be vaginally inserted.
It is available and effective from the time a pregnancy is detected up through 10-12 weeks of being pregnant (70 days or a little over two months).
It is 87-99% effective but becomes less effective the later in pregnancy it is administered.
What happens: 2
The first pill (mifepristone) empties your uterus. The second one (misoprostol) causes the pregnancy tissue to come out.
People will experience bleeding, cramps, and tiredness. It usually feels like intense period cramps.
Heavy bleeding and cramping will usually last a couple of days at most, but some lighter bleeding could last for a couple of weeks.
If you’re not bleeding 24 hours after taking the second medication or are bleeding severely, contact your doctor.
How to get it:
Medications for abortion need to be prescribed by a medical professional, but this can now be done via telehealth.
Abortion medications can also be accessed by mail. Plan C is a directory with information on how to get mailed pills in each state.
While many companies will send medication to any state (such as A Safe Choice), even those where abortion is illegal, there may be legal consequences if you are discovered.
Surgical abortion
The basics: 3
A surgical abortion is when the pregnancy tissue in the uterus is removed by a medical provider.
It is highly effective and very safe.
A surgical abortion is effective much longer into a pregnancy than medication abortion.
What happens: 4
A medical provider usually does tests to confirm the pregnancy as well as an ultrasound.
During the procedure, the individual is sedated and the cervix is numbed.
The provider will insert a tube into the uterus and suction out the pregnancy tissue.
The whole procedure only takes about 15-20 minutes, and the actual suctioning usually only takes one minute.
Abortions that happen later in a pregnancy (third trimester) may require induced labor or other surgical procedures to remove the fetus. These are rare and usually done for medical reasons.5
How to get it:
You can get an abortion from a doctor, an abortion clinic, or other health clinic like Planned Parenthood.
Different states have different laws on how late into a pregnancy someone can have an abortion.
In some severely restricted states, like Florida, an individual only has six weeks to have an abortion. Unfortunately, many people do not know they are pregnant until around or after this point. Others range between 12-18 weeks.
In other restricted but more flexible states, an individual has until the pregnancy is “viable” (AKA when the fetus can survive outside the uterus), which is different for every person, but usually falls between 24-26 weeks (in the second trimester)
The American College of Obstetricians and Gynecologists “strongly discourages” using “viability” as a condition in abortion laws because it can be interpreted based on political ideas rather than science.6
In a few states, abortion is legal with zero limit on how far someone is into their pregnancy.
Check AbortionFinder.org for your state’s specific laws around surgical abortion.
The decision to have an abortion can be difficult for some. If you’re struggling, consider speaking with a counselor or leaning on close friends and/or family for support.
It’s also helpful to have people you trust to help take care of you during and after your procedure.
Adoption
If an individual is unable to end their pregnancy or wishes to continue it, adoption can be an option. It is important to note that adoption cannot be legally undone.
Steps for placing a baby up for adoption
Learn about your options. Talk to an adoption agency, counselor, or attorney to understand the process. If you’re struggling with substance use, it’s important to be honest with whoever is helping coordinate the adoption process – it won’t automatically disqualify you and will help the adoptive parents with the baby’s health.
Choose an adoption process. There are state-licensed adoption agencies, private agencies, and national adoption agencies. Someone could also go through an independent adoption process. This could mean that the adoptive parents and birth parents work together directly with the help of an adoption attorney.
If you go with an adoption agency, male sure they are licensed, reputable, and willing to support you without judgement. Some agencies might be better-equipped to support people with substance use disorder – for example, some won’t screen pregnant women for drug use in order to reduce stigma and make them more comfortable.
Independent or private adoption is restricted or illegal in a few states. Other states have specific laws and regulations to ensure the child’s safety. A social worker is often required to do a home study before the baby is born.7
Create a plan. No matter what route you go, you have many choices on how you want the pregnancy and adoption to go. You can decide:
Whether you want an open, semi-open, or closed adoption.
An open adoption means you can have input in or choose an adoptive family and maintain contact with them throughout the process. Some birth parents and adoptive parents will even coordinate so the birth parent can remain a part of their child’s life in some way. This could be an option whether you’re going through an independent process or an agency.
A semi-open adoption means that there is less direct contact between the birth mother and adoptive family. They may still meet during the pregnancy but may not have as much information about one another. It can also mean that the birth parent receives limited to no information about their child after adoption.
A closed adoption means that no identifying information or communication is exchanged between the adoptive parents and birth parents. There is also no contact after the adoption process is over.
Whether or how much you want to be involved in choosing the family the baby goes to. If you don’t want to choose, an agency will do it for you.
Your birth plan (who’s with you, whether you want the adoptive family to be there during delivery, etc.).
Establish support during your pregnancy. The adoption process should always be free for birth parents. You may even be reimbursed for any pregnancy-related expenses through an agency and/or the adoptive family.
This can include medical care, housing, food, transportation, maternity clothes, and access to and payment for substance use disorder treatment.
You may also wish to seek therapy or counseling, as pregnancy and the adoption process can be incredibly difficult and emotionally taxing.
Loved ones can also be very helpful in supporting you throughout the process.
Sign legal consent. The birth mother must voluntarily terminate her parental rights after giving birth (assuming the process started before the baby was born). Some states require that she wait a certain period of time to do so. This is a big legal step and usually needs to be in writing and witnessed. The birth parent also needs to be mentally competent for it to be valid.
Receive post-adoption support. Some agencies provide mental health support and other resources after the adoption process is over. There are also groups that provide specific support for birth parents, like the On Your Feet Foundation. Additionally, agencies can help you connect with both pre- and post-natal care and recovery programs that support pregnant people with substance use disorder.
The Adoption Network Law Center might be a helpful resource for birth parents needing guidance through the adoption process.
Resources and Support
The decision to terminate a pregnancy or give up a baby for adoption is a deeply personal one. Although it might be the right decision for you, it can still be emotionally taxing. Get support:
Talk to a counselor or social worker. They can walk you through your options without judgement. Currently, no state requires a psychologist to report a patient who is seeking or who has received an abortion, even where it is illegal. The American Psychological Association’s ethics code requires psychologists to protect patient privacy and safety.8Psychology Today can help you find mental health professionals who specialize in pregnancy and postpartum care, adoption, and women’s health.
Seek treatment for substance use disorder. There are programs, clinics, and OBGYNs that specialize in and support pregnant women struggling with substance use.
Additional resources include:
SAFE Locator – helps find substance use treatment and support options.
Planned Parenthood – provides affordable sexual and reproductive healthcare.
Local family planning organizations
If you ever feel stuck or unsure, reach out to our Baby Steps helpline by texting BABY to 55753. Our helpline specialists are people who care and want to support—without judgment.