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There are several options a woman can choose from when she needs to terminate a pregnancy. Options include medical abortions, which involve taking medications, and surgical abortions.
Surgical abortions are also called in-clinic abortions. They are typically more effective than a medical abortion, with a lower risk of an incomplete procedure. The two types of surgical abortions are:
aspiration abortions (the most common type of surgical abortion)
dilation and evacuation (D&E) abortions
The type of abortion a woman has often depends on how long it’s been since her last period. Both medical and surgical terminations are safe and effective when done in appropriate patients. The choice of what type of abortion depends on availability, or access, how far along the pregnancy is, and patient preference. Medical terminations are not as effective after 70 days, or 10 weeks, of pregnancy.
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Abortion types
If a woman is 10 or more weeks into her pregnancy, she is no longer eligible for a medical abortion. Women up to 15 weeks pregnant can have an aspiration abortion, while D&E abortions are typically performed at 15 weeks or after.
Aspiration abortions
Aspiration abortions
The average clinic visit will last up to three to four hours for an aspiration abortion. The procedure itself should take five to 10 minutes.
Aspiration abortions, also called vacuum aspirations, are the most common type of surgical abortion. During this procedure, you’ll be given pain medication, which can include a numbing medication that is injected into the cervix. You may also be given a sedative, which will allow you to stay awake but be extremely relaxed.
Your doctor will first insert a speculum and examine your uterus. Your cervix will be stretched open with dilators either before or during the procedure. Your doctor will insert a tube through the cervix into the uterus, which is attached to a suction device. This will empty the uterus. Many women will feel mild to moderate cramping during this portion of the procedure. The cramping typically decreases after the tube is removed from the uterus.
Immediately after the procedure, your doctor may check your uterus to ensure that it is completely empty. You’ll be given antibiotics to prevent infection.
The actual aspiration procedure takes approximately five to 10 minutes, though more time may be needed for dilation.
D&E
D&E
A D&E abortion is typically used after the 15th week of pregnancy. The procedure takes between 10 and 20 minutes, with more time potentially being needed for dilation.
This procedure starts the same way as an aspiration abortion, with the doctor applying pain medication, checking your uterus, and dilating your cervix. Like the aspiration abortion, the doctor inserts a tube attached to a suction machine to the uterus through the cervix and, combined with other medical tools, it will gently empty the uterus.
After the tube has been removed, your doctor will use a small, metal loop-shaped tool called a curette to remove any remaining tissue that is lining the uterus. This will ensure that the uterus is completely empty.
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Preparation
Before your surgical abortion, you’ll meet with a healthcare provider who will go over all of your options with you to help you find the right one. Before the appointment for your abortion, there will be some preparation required, including:
Arrange for someone to drive you home after the procedure.
You can’t eat for a certain amount of time before the procedure, which will be specified by your doctor.
If your doctor gives you pain or dilation medication at an appointment before the procedure, follow the instructions carefully.
Don’t take any medications or drugs for 48 hours before the procedure without discussing it with your doctor first. This includes aspirin and alcohol, which can thin the blood.
Cost and effectiveness
In-clinic abortions are highly effective. They are more effective than medical abortions, which have an effectiveness rate of over 90 percent. You will have a follow-up appointment with your doctor or the clinic to ensure that the procedure was completely successful.
The cost of surgical abortions varies depending on several factors. Aspiration abortions are typically less expensive than D&E abortions.According to Planned Parenthood, it can cost up to $1,500 for a surgical abortion within the first trimester, with second trimester abortions costing more on average.
Common side effects
Common side effects
Immediately after the procedure and during the recovery period, you may experience some side effects. Common side effects of surgical abortions include:
bleeding, including blood clots
cramping
nausea and vomiting
sweating
feeling faint
Once your healthcare provider ensures that your health is stable, you will be discharged home. Most women experience vaginal bleeding and cramping similar to a menstrual cycle for two to four days.
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When to see your doctor
When to see your doctor
Some side effects are symptoms of potentially emergent conditions. You should call your clinic or seek immediate medical attention if you experience the following symptoms:
passing blood clots that are larger than a lemon for more than two hours
bleeding that is heavy enough that you have to change your pad twice in one hour for two hours straight
foul-smelling vaginal discharge
fever
pain or cramping that gets worse instead of better, especially after 48 hours
pregnancy symptoms that persist after one week
Menstruation and sex
Menstruation and sex
Your period should return four to eight weeks following your abortion. Ovulation can occur without noticeable signs or symptoms, and often before you resume normal menstrual cycles, so you should always use contraception. You should wait to have sex for at least one to two weeks after the abortion, which can help reduce the risk of infection. You also should wait for this period of time to use tampons, or insert anything into the vagina.
Potential risks and complications
While abortions are typically extremely safe and most women have no complications outside of common side effects, the likelihood of complications increases slightly as the gestational period increases.
Potential complications from surgical abortions include:
Infection: can be serious and may require hospitalization. Symptoms include fever, abdominal pain, and unpleasant-smelling vaginal discharge. The chance of infection increases if you have a sexually transmitted infection.
Cervical tears or lacerations: can often be resolved with stitches after the procedure if necessary.
Uterine perforation: which can occur when an instrument punctures the uterine wall.
Hemorrhaging: which can result in bleeding sufficient enough that a blood transfusion or hospitalization is needed.
Retained products of conception: when part of the pregnancy is not removed.
Allergic or adverse reactions to medications: including pain medication, sedatives, anesthesia, antibiotics, and/or dilation medication.
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Surgical Abortion (First Trimester)
Surgical Abortion (First Trimester)
Surgical abortion, also known as suction aspiration abortion, can be performed in a one-day procedure if less than 14 weeks have passed since the first day of your last menstrual period. The procedure is done in the doctor's office with local anesthesia and oral pain-relieving medications.
You will be in a private room during your health education, exam, procedure and recovery. The entire visit will take around three hours if you are less than 12 weeks pregnant. If you are 12 to 14 weeks pregnant, your visit will last five to six hours. In either case, you will need to arrange for someone to drive you home after the procedure.
The standard method is vacuum aspiration (also called suction curettage). Usually, a local anaesthetic (freezing) is used, but sometimes hospitals use a general anaesthetic instead. Here's an example of the usual procedure:
A nurse will take a short medical history, and possibly ask you to take some antibiotics. An IV (tube placed in your vein) may be started. Sometimes, a medication is injected into the IV or a muscle to reduce discomfort and help you to relax. A medication called misoprostol is sometimes given which dissolves in your mouth and causes the uterus to cramp (like menstrual cramps), its purpose is to soften the cervix and prepare it for the procedure.
A local anaesthetic (freezing) is usually injected into or around your cervix (the lower part of your uterus). Like a Pap exam, a speculum is used to see your cervix. Your cervix is gradually stretched by a series of narrow rods (dilators), each a little wider than the one before. The largest dilator is about as thick as your index finger.
A second method of dilating the cervix is to insert a sterile type of seaweed (laminaria) that gradually absorbs moisture and expands and gradually opens the cervix. Dilation happens over several hours for first trimester termination, or one to two days for mid-term termination.
A tube (called a cannula) goes into your uterus through your widened cervix. This tube is attached to a suction machine, which is then turned on. After the uterus has been emptied by gentle suction, a spoon-shaped instrument (called a curette) may be used to check that the uterus has been emptied completely. This procedure takes 5 to 10 minutes.
What about after the abortion?
What about after the abortion?
Spend as much time as you need resting at the clinic, under observation.
When you feel stable and ready to leave, you will get follow-up instructions, including what you should do in the event of any complication.
You may experience some bleeding (no heavier than a regular period), cramping, and breast tenderness.
Have someone available who can drive you home.
Avoid tampons, douching, baths, swimming, sexual penetration, and strenuous exercise for two weeks.
You may want to rest the next day but you can resume most of your normal activities within a couple of days
Most forms of contraception, including the pill, patch, ring, and IUDs can be started the day of or the day after your procedure.
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What are the risks?
What are the risks?
Early abortion by vacuum aspiration is one of the safest operations in all of medicine. However, as with any medical procedure, complications can happen.
Less than 1 woman in 100 will have any serious complications (blood clots in the uterus, infection, haemorrhaging [bleeding in the uterus], cervical tear, perforation of the uterus, anaesthetic reaction or an incomplete abortion).
Possible treatments for complications may include further antibiotics, repeat vacuum aspiration, medication, transfusion or rarely surgery. Early abortion is one of the safest operations in all of medicine. The risk of a woman having complications or dying from full term pregnancy and childbirth is many times greater than that from an early abortion.
In-clinic abortion works by using suction to take a pregnancy out of your uterus. There are a couple of kinds of in-clinic abortion procedures. Your doctor or nurse will know which type is right for you, depending on how far you are into your pregnancy.
Suction abortion (also called vacuum aspiration) is the most common type of in-clinic abortion. It uses gentle suction to empty your uterus. It’s usually used until about 14-16 weeks after your last period.
Dilation and Evacuation (D&E) is another kind of in-clinic abortion procedure. It uses suction and medical tools to empty your uterus. You can get a D&E later in a pregnancy than aspiration abortion -- usually if it has been 16 weeks or longer since your last period.
Why do people choose an in-clinic abortion?
Why do people choose an in-clinic abortion?
Which kind of abortion you choose all depends on your personal preference and situation. Some people choose in-clinic abortion because they want to to have their procedure done at a health center, with nurses, doctors, and trained support staff there the whole time. (With the abortion pill, you have the abortion at home.)
In-clinic abortions are also much faster than the abortion pill: most in-clinic abortions only take about 5-10 minutes, while a medication abortion may take up to 24 hours to complete.
Your nurse, doctor, or health center counselor can help you decide which kind of abortion is best for you.
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