There are two common, very safe methods for terminating a pregnancy: medication abortion, in which you ingest pills, or a procedural abortion, in which a clinician uses techniques such as suction to empty your uterus. The decision of which method to choose is completely personal. Here's what you can expect no matter which method you choose.

Before the abortion, you will fill out paperwork, including a medical history. Your clinic may perform an ultrasound to help confirm how far along you are in the pregnancy, a pregnancy test, and/or other lab tests to check for anemia and blood type. A health care professional will talk to you about your options, and describe each available abortion method and its benefits and risks. You will sign consent forms for the abortion. The health care professional may also talk with you about options for birth control once the procedure is finished.

Depending on where you get care and a number of other factors, and particularly during the COVID-19 pandemic, your health care clinic may be able to use telehealth to provide some or all of your services, with you at home. If you choose a medication abortion, you may be able to receive your medications by mail. If you have an in-clinic procedure, the abortion itself will most likely be short, but because of tests, counseling, consent, and recovery, you will likely spend two to four hours in the clinic, and sometimes longer. The clinic will provide more detail about what to expect and how long you should plan to be at the clinic.

What to expect during an abortion?

  • Oct 11, 2019

    Medication Abortion

    For people who are early in pregnancy, usually below 10 to 11 weeks, you may be offered a choice of medication abortion or an aspiration abortion procedure. 

    For a medication abortion, you will take one pill called mifepristone to begin the abortion process and then a second dose of pills called misoprostol one to two days later at home. 

    After taking the second set of pills, most people experience heavy bleeding and cramping, and pass the pregnancy over the next few hours. The experience is like a miscarriage. 

    The clinic will check to make sure that the pregnancy has passed completely over the next week to two weeks, either with an ultrasound, blood test, or other type of follow-up. You can start birth control immediately after taking the second dose of pills and will be protected the next time you have sex. For a medication abortion, more than 95% of people have a successful abortion without the need for any more treatment.

    Some people prefer medication abortion because it is private, they can be at home, and they don’t have to have a procedure. The abortion pills work to end the pregnancy over 98% of the time. Around 2% of people will still need a uterine aspiration after using the pills if their pregnancy doesn’t end or if they have heavy bleeding.

  • Oct 11, 2019

    In-Clinic Abortions

  • Oct 11, 2019

    Suction/Aspiration Abortion

    The suction abortion procedure takes place in the clinic. It uses gentle suction to empty your uterus and usually lasts about five to 10 minutes. A suction abortion can be done with minimal, moderate, or deep sedation depending on the clinic and your preferences. A suction abortion can be provided until about 14-16 weeks after your last period and is safer than a dental procedure.  

    If you choose a suction abortion, you will go to a room that may look like an operating room or an exam room at a gynecologist’s office. You may have an IV inserted in your arm for sedation. You will lie down on the bed with your feet in footrests or stirrups. 

    The provider will insert a speculum into your vagina and will give numbing medicine around the cervix. Using small dilators, the provider will open the cervix to allow the suction to pass into the uterus. The suction looks like a thin plastic straw. Using a hand-held aspirator or electric suction, the provider will remove the pregnancy. Most people feel strong cramping during the procedure, but this passes very quickly afterwards. 

    Once the abortion procedure is complete, you will go to a recovery area. There, you will be monitored to make sure your pain and bleeding are under control. You may be given a little juice or water to drink and a snack to eat. Once your anesthesia has worn off and you are feeling well, you will leave the clinic.
    You can start birth control immediately after the aspiration abortion, including having an IUD or implant inserted, and will be protected the next time you have sex.

  • Oct 11, 2019

    Dilation and Evacuation (D&E) Abortion

    Later in pregnancy, usually after 14 to 16 weeks, most people have a dilation and evacuation (D&E) procedure. D&E procedures use suction and medical tools to safely empty your uterus and usually last about 10-15 minutes.

    Because the pregnancy is more advanced, people may need to have a two-day procedure so that the cervix can be gradually dilated overnight. This may be done with osmotic dilators—which are small dilators that are placed in the cervix and swell gradually to open the cervix—or with medications.

    Once cervical dilation is complete, you will go to a room that may look like an operating room or an exam room in a gynecologists’ office. You may have an IV inserted in your arm for sedation. You will lie down on the bed with your feet in the footrests or stirrups. The provider will insert a speculum into your vagina and give numbing medicine around the cervix. If osmotic dilators were placed, they will be removed first. The provider will check to make sure the cervix is dilated enough and may use tapered dilators to open the cervix more so that they can safely do the procedure. Using a combination of suction and instruments, the provider will remove the pregnancy. The entire process takes about 10-15 minutes. Most people feel strong cramping during the procedure, but this passes very quickly afterwards.

    Once the abortion procedure is complete, you will go to a recovery area. There, you will be monitored to make sure your pain and bleeding are under control. You may be given a little juice or water to drink and a snack to eat. Once your anesthesia has worn off and you are feeling well, you will leave the clinic.

    You can start birth control immediately after the dilation and evacuation procedure, including having an IUD or implant inserted, and will be protected the next time you have sex.

Frequently Asked Questions

Abortion Safety & Procedures

According to the best medical evidence available, abortion is safer than getting a dental procedure or cosmetic surgery [6], and much safer than childbirth. According to that evidence, in the United States, a woman is about 15 to 25 times more likely to die in childbirth than she is during an abortion [7-10].

Most people seeking an abortion are early in the pregnancy. 2/3 of women are 8 weeks pregnant or less [3]. Under 10 to 11 weeks, a person has choice of either a medication abortion at home or a short, in-clinic procedure called a uterine aspiration. They are different, but both are very effective, and which one you choose is really a very personal choice.

In a medication abortion, a person takes two sets of pills. The first pill is called mifepristone. This pill blocks the hormones that allow the pregnancy to develop. Either a few hours or 1-2 days later, they take a second set of pills called misoprostol. These pills cause the uterus to contract to expel the pregnancy. The experience most people have is like having a miscarriage or a very heavy period.

Some people prefer medication abortion because it is private, they can be at home, and they don’t have to have a procedure. The abortion pills work to end the pregnancy over 98% of the time. Around 2% of people will still need a uterine aspiration after using the pills if their pregnancy doesn’t end or if they have heavy bleeding.

A uterine aspiration is done in a clinic or office. In a uterine aspiration, the patient gets undressed from the waist down. The provider places a speculum, like when you get a pap smear done, and then gives some numbing medicine around the cervix. The cervix is opened gently to allow a small plastic straw, or cannula, to pass into the uterus. Suction, either a handheld one like the one in the picture or an electric suction, is used to remove the pregnancy. The entire procedure lasts about 5 to 10 minutes. There are no cuts or incisions – it’s not a big surgery. 

Anesthesia depends on where a person has a procedure and their own preference. Some patients have moderate sedation through an intravenous line. In moderate sedation, the person is responsive but sleepy and has good pain control. However, many patients take just an ibuprofen by mouth before the procedure and have numbing medicine in the cervix and they do just fine. Some patients prefer oral medication only because they may need to drive home or are more worried about sedation than the procedure. The choice of sedation is made between you and the clinic staff.

A few patients have deep sedation or general anesthesia where they are completely asleep. Deep sedation or general anesthesia are not needed in most abortion cases but may be offered for patient comfort or if a person has medical reasons where they need to be asleep. 

Most people who get moderate sedation or sedation by mouth will feel some cramping or strong contractions as the cervix is dilated and the aspiration happens. However, the procedure is very fast, lasting about five to ten minutes, and the medications help to ease discomfort. By the time people leave the clinic, they should be feeling much better. Most people can go back to their regular activities the next day. 

It’s really up to each person. Some prefer a medication abortion because they can take the pills in the privacy of their own home, with their own support people around them. They don’t have to get undressed in the doctor’s office or have the aspiration done. To some people, medication abortion feels more natural, like a miscarriage. They are OK with having bleeding and cramping and are able to follow-up if there is a concern. Other people  would rather have the uterine aspiration because it’s quick and once it’s over, they know they are done and not pregnant – it’s a big relief to walk out of the clinic with the abortion complete. Every person is different, and the choice is theirs to make!

Less than 10% of abortion care is provided after 14 weeks in the U.S. and in Canada [11]. This abortion procedure is done slightly differently. Peole may take medications or have overnight dilators placed to open the cervix. The procedure is completed using either suction or suction combined with instruments. Although the entire process takes a bit longer, still the abortion procedure itself is short, takes about 10 minutes, and there is no incision or cutting. Later procedures can take place safely in a clinic or office – they do not need to be in a hospital or operating room [12]. Some of these later abortions are done using medications only, although this is rare in the US and Canada.

Tell the clinic staff about yourself. Tell them the name you want to be called, what pronouns you use, and important things to know about you. Tell them if you have had a previous experience with abortion – good or bad! Tell them if you want a friend, family member, or partner with you. Tell them if you want to be told everything that they are doing, or if you would rather listen to music or chat about movies. Tell them how you want to be treated.

Let go of shame, guilt, or fear. Know that you are making the best decision for you and your life. You are not alone – many people just like you have walked this path. Sometimes reading or hearing about other people’s experience with abortion can be helpful. A great website for abortion stories is wetestify.org.

People decide to have an abortion after concluding that it is the right choice for themselves and their lives. According to the best evidence, if you ask people who had an abortion five years later whether abortion was the right choice, over 99% of them will say that it was [13]. The story that women regret their abortions is one that is mostly made up by people who are against abortion. 

According to the best medical evidence, abortion is extremely safe in terms of a person’s ability to get pregnant again in the future. In fact, fertility often returns quickly after an abortion. If a person wants to delay pregnancy, they should use a reliable method of birth control starting immediately after an abortion.

Abortion is safer than having a child, so having more than one abortion is definitely safer than having more than one child. There is no “maximum” number of times that a person can have an abortion in her lifetime.

Abortion Access

In 2014, the last year where data is available, about a million abortions were obtained in the United States and 100,000 in Canada [1, 2]. In the US and in Canada, this number is a historic low with abortion dropping 20% since 2005 in the US [3]. The reason for this drop is most likely better access to affordable, effective birth control [4].

The majority of people who have abortions in the US are in their 20s, have had a child before, are unmarried, and are white [3]. Although this is the MAJORITY, people from all walks of life seek abortion care. People from communities with higher levels of unintended pregnancy, including adolescents, poor people, people of color, and those who identify as lesbian, gay, bisexual, or transgender, disproportionately seek abortion care [5].

In some states and provinces, advanced practice clinicians like midwives, nurse practitioners and physician assistants can provide medication abortion. With a few exceptions including Vermont, California, and Montana, uterine aspiration is limited to physicians only. However, in studies of abortion safety, abortion – either medication abortion or uterine aspiration - is as safe and effective when it is provided by a trained clinician as when it is provided by a doctor [14].

In many other countries around the world, especially where the health work force is limited, nurses, nurse midwives and other trained clinicians are the primary abortion providers. To find a provider in the United States, Mexico, Canada or Colombia, please visit the NAF website at prochoice.org.

Most abortion care in the United States and Canada is provided in clinics and doctor’s offices. Because abortion is so safe, there is no need to provide abortion care at any stage in pregnancy in a hospital or surgical center unless, in the opinion of her doctor or clinician, the patient needs a higher level of care. There is no increase in complications when abortion care is provided in clinics compared to when it is provided in a surgical center [12]. Attempts to restrict abortion to surgical centers does not increase the safety of abortion and only serves to limit abortion access [12, 15].

Search and find a provider in your area here or call the NAF Hotline referral line 1-877-257-0012, which provides referrals to high-quality clinics in the U.S. and Canada (no funding assistance provided on this line).

References

  1. Jones, R.K. and J. Jerman, Abortion Incidence and Service Availability In the United States, 2014. Perspect Sex Reprod Health, 2017. 49(1): p. 17-27.
  2. Canadian Institute for Health Information, Induced abortions reported in Canada in 2016. 2016.
  3. Jatlaoui, T.C., et al., Abortion Surveillance - United States, 2014. MMWR Surveill Summ, 2017. 66(24): p. 1-48.
  4. Kavanaugh, M.L. and J. Jerman, Contraceptive method use in the United States: trends and characteristics between 2008, 2012 and 2014. Contraception, 2018. 97(1): p. 14- 21.
  5. Tornello, S.L., R.G. Riskind, and C.J. Patterson, Sexual orientation and sexual and reproductive health among adolescent young women in the United States. J Adolesc Health, 2014. 54(2): p. 160-8.
  6. Raymond, E.G., et al., Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States. Contraception, 2014. 90(5): p. 476-9.
  7. Zane, S., et al., Abortion-Related Mortality in the United States: 1998–2010. Obstetrics & Gynecology, 2015. 126(2): p. 258-265.
  8. Creanga, A.A., et al., Pregnancy-related mortality in the United States, 2006-2010. Obstet Gynecol, 2015. 125(1): p. 5-12.
  9. Raymond, E.G. and D.A. Grimes, The Comparative Safety of Legal Induced Abortion and Childbirth in the United States. Obstetrics and Gynecology, 2012. 119(2, Part 1): p. 215-219.
  10. Collaborators, G.M.M., Global, regional, and national levels of maternal mortality, 1990- 2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 2016. 388(10053): p. 1775-1812.
  11. Abortion Rights Coalition of Canada. Statistics - Abortion in Canada. 2018 August 8, 2018]; Available from: www.arcc-cdac.ca/backrounders/statistics-abortion-in- canada.pdf.
  12. Roberts, S.C.M., et al., Association of Facility Type With Procedural-Related Morbidities and Adverse Events Among Patients Undergoing Induced Abortions. JAMA, 2018. 319(24): p. 2497-2506.
  13. Rocca, C.H., Samari, G., Foster, D.G., Gould, H. and K. Kimport. Emotions and decision rightness over five years following an abortion: an examination of decision difficulty and abortion stigma. Soc Sci Med, 2020. 248:112704.
  14. Renner, R.M., D. Brahmi, and N. Kapp, Who can provide effective and safe termination of pregnancy care? A systematic review*. BJOG, 2013. 120(1): p. 23-31.
  15. Rosen, J.D., Finding Strength in Numbers: The Critical Role of Data in Whole Woman's Health v. Hellerstedt. Obstet Gynecol, 2017. 129(1): p. 195-196.