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Regardless of the reasons for having one, an abortion can be a stressful and confusing experience. It can help to know what to expect from the different abortion options. This article will guide you through the different types of abortion procedures and what to expect.
What is an abortion?
A medical abortion is a method used to end a pregnancy. These can be done through surgical procedures or medications. It’s estimated that about one out of every four women will have an abortion during their lives (Ajmal, 2021).
The options for the types of abortion available may vary based on the stage of pregnancy. In many cases, early stage pregnancies can be terminated with medication that induces a miscarriage. Beyond the early weeks, a procedure may be done to remove the fetus and tissue from the uterus.
Types of abortions
Sometimes you will be given an option about the type of abortion you would like to have. The options available will depend on how many weeks pregnant you are, your health risk level, and where you would like the abortion to take place (in a clinic or at home).
A medication abortion, sometimes referred to as the abortion pill, uses medication to induce a miscarriage. You can use this option from the first day of conception until around 10–12 weeks of gestation. Depending on where you live, this option may continue to be available later.
The medications usually used for this type of abortion are mifepristone and misoprostol (Ajmal, 2021).
A surgical abortion involves a procedure in a clinic, doctor’s office, or hospital to remove the fetus and other tissues in the uterus. A few different types of procedures may be recommended depending on how far along the pregnancy is.
- Vacuum aspiration, sometimes called a suction aspiration, uses a vacuum tool to remove the fetus and other tissues from the uterus. The device is inserted through the vagina and opening of the cervix to remove the tissue. This type of procedure is usually only done for first-trimester abortions (Ajmal, 2021).
- Dilation and evacuation (D&E) involves dilating the cervix and using tools to complete the abortion. Healthcare providers use a combination of surgical instruments and vacuum suction to remove the fetus and pregnancy tissue from the uterus. This procedure is typically used during the second trimester (Ajmal, 2021).
- Dilation and extraction (D&X) may be recommended during the latter parts of the second trimester or the third trimester. This medical procedure may not be an option depending on where you live and usually is reserved for when there is a severe medical problem with the fetus or mother.
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What to expect before an abortion
It’s possible to get an abortion through your healthcare provider or some health clinics. Some healthcare providers don’t offer abortion services, in which case they typically should be able to refer you to a provider who does.
Your healthcare provider will provide instructions for you to follow before your abortion and help you choose the right option for your health concerns.
Your healthcare provider will complete a pre-abortion health screen which may include a review of your medical history, a physical exam, pregnancy test, blood work, screening for sexually transmitted infections (STIs), and other tests as needed. Some providers may use an ultrasound test to look for any abnormalities and confirm how far along the pregnancy is.
Once the testing is done, your healthcare provider will review the abortion options with you, pain management options, and discuss any possible risks.
What happens during an abortion?
Here is what you may expect during different types of abortions:
For most medication abortions, you will take two pills. Usually, you’ll take the first in a clinic and the second at home. Sometimes you may take both pills in the clinic.
The first medication is called mifepristone which blocks the hormone progesterone. When progesterone is blocked, it disrupts the uterine lining to promote the shedding of the lining and the termination of the fetus (Autry, 2021). The second medication, misoprostol, is usually taken 24–48 hours after the first (your healthcare provider will tell you what time to take it). Misoprostol causes the uterus to cramp and the cervix to dilate (Krugh, 2021).
Here’s what you can expect after taking the medication (Autry, 2021; Krugh, 2021):
- Bleeding typically starts within a few hours after taking the second pill.
- For several hours you will likely experience heavy vaginal bleeding with clots and heavy cramping.
- Some people may experience low fever, diarrhea, dizziness, and tiredness.
Surgical abortion: vacuum aspiration
If you opt for a surgical abortion during your first trimester, you will likely have a vacuum aspiration (also called a suction curettage or D&C) done in a clinic or hospital. Usually, your cervix won’t need to be dilated for this procedure.
During the procedure, you’ll lay back with your feet in stirrups, similar to a pelvic exam. Your healthcare provider will use a swab with an antiseptic solution to gently clean your vagina and cervix (Ajmal, 2021).
They will use an anesthetic to numb your cervix if you’re awake for the procedure. If you have general anesthesia, you will wake up in a recovery room once the surgery is over. The surgeon may use a tool called a speculum to hold the vagina open. They’ll insert a small tube with a hand-held syringe or a suction machine through your vagina into your uterus (Ajmal, 2021).
Suctioning is then used to clear out your uterus, which will likely take several minutes. Once the procedure is over, your healthcare provider will ensure the procedure was successful and that you’re doing well.
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You’ll rest for about 30 minutes under observation to make sure you tolerated the procedure well. If you had general anesthesia, you may need to stay under observation for longer.
Surgical abortion: D&E
If you’re further along than 12 weeks or completing a second-trimester abortion, you’ll likely have a D&E procedure done. This procedure is also done on an exam table with your legs in stirrups and you will be swabbed with an antiseptic (Ajmal, 2021).
An anesthetic will be injected into your cervix to numb the area, and the healthcare provider will use a tool to hold your cervix in place. Medication will be given to dilate the cervix, and they may use tools to help dilate the cervix.
During this procedure, they may use a vacuum tool to remove some of the contents of the uterus. They will also use medical instruments, like forceps, to scrape and remove tissue from the uterus lining (Ajmal, 2021).
This procedure may last around 10–20 minutes. After the procedure, your healthcare provider will monitor you, and you’ll rest 30–60 minutes in the clinic, depending on the type of sedation you received.
What happens after an abortion
Plan to rest for at least a day or two after your abortion. Depending on the type of abortion you’ve had, you may experience symptoms like cramping, light bleeding, and abdominal pain for a few days after your abortion.
Most providers will have you come in for a follow-up appointment a few weeks after your abortion to ensure you’re recovering well and that the abortion was successful.
For a few days to a couple of weeks after the abortion, you could experience some light bleeding or spotting.
You’ll likely have to avoid lifting heavy objects for a few days while you recover. Most likely, you will have to wait a few weeks to a month after your abortion to have sex or use a tampon. There may be a risk for infection after the abortion while your body is healing.
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Follow your healthcare provider’s instructions for recovery and pay attention to any symptoms that could indicate a complication.
Contact your healthcare provider right away or seek medical attention if you experience side effects like:
- Severe pain or cramping
- Fever over 100° F
- Bleeding through more than two pads per hour
The decision to end a pregnancy is very personal, and it’s often challenging emotionally. If you’re thinking about having an abortion or have had one already, you may wish to consider talking with a counselor or therapist. They can offer emotional support to help you cope with any stress you may experience before and after an abortion.
- Ajmal, M., Sunder, M., & Akinbinu, R. (2021). Abortion. [Updated Jul 25, 2021]. In: StatPearls [Internet]. Retrieved on Sep. 7, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK518961/
- Autry, B. M. & Wadhwa, R. (2021). Mifepristone. [Updated May 10, 2021]. In: StatPearls [Internet]. Retrieved on Sep. 7, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK557612/
- Krugh, M. & Maani, C. V. (2021). Misoprostol. [Updated Jul 13, 2021]. In: StatPearls [Internet]. Retrieved on Sep. 7, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK539873/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.