Abortion means you are choosing to end a pregnancy. It is important that you fully consider all of your options when making this decision. Depending on how far along your pregnancy is, you may have different abortion methods available to you.
What Does Having an Abortion Involve?
You will need to make an appointment with a provider, find transportation, and secure funding for your abortion. Although each woman’s abortion options depend on her unique circumstances and preferences, the general information that follows should help you in your decision.
Having an aspiration abortion is a safe, effective option for ending a pregnancy. In the first 14 weeks of pregnancy, surgical abortions are usually provided by a method called vacuum aspiration. This means that suction (from either a machine or a hand-held pump) is used to remove the pregnancy through the cervix (the opening to the uterus). This procedure is very brief, usually 5-15 minutes. Although women’s experiences with aspiration abortion vary, many say that it is “uncomfortable but bearable.” Most women return to their daily activities the day after their abortion.
Your options for abortion care depend upon how far along the pregnancy is. Keep in mind that procedures vary depending on your provider. Your best source of information is always your provider. The NAF Hotline 1-800-772-9100 can also answer your questions.
Up to 12-14 Weeks (First Trimester)
Within approximately the first 12-14 weeks of pregnancy (see How Far Along Am I?), surgical abortions are done using a method called vacuum aspiration or suction curettage.
What to Expect
During a vacuum aspiration, you will lie on an examining table in a clinic or medical office, just as you would for a routine pelvic exam. The provider inserts an instrument called a speculum into the vagina that will hold the vaginal walls apart, and then administers local anesthesia to the cervix. The cervix is a ring of muscles at the opening to the uterus, and it is usually tightly closed. After this, the provider then begins to dilate, or open, the cervix with tapered rods called dilators.
After the cervix is dilated, a narrow tube attached to an aspirator device, either an electric machine or a hand held syringe, is then inserted into the uterus and the contents of the uterus are emptied using suction. (When the hand-held syringe is used, the procedure is sometimes called manual vacuum aspiration or MVA.) The entire procedure usually takes 5 to 15 minutes. Some women experience menstrual-type cramping during the procedure and for up to an hour afterward.
After the Abortion
After an aspirationl abortion is completed, you should expect to rest in the clinic in a recovery area for a minimum of 30 minutes before you go home. During this time, the staff will make sure your blood pressure and heart rate are stable and that you are not having abnormal bleeding or discomfort. (If you have received certain types of anesthesia, such as conscious sedation or general anesthesia, you should not operate a vehicle, therefore you will need to have a companion take you home. You may also have to remain in the recovery area for longer than 30 minutes.)
Following the abortion, you will receive instructions for post-operative care. This will include a 24-hour number to use if you become concerned about your condition. It is very important that you follow the after-care instructions and take any prescriptions you have been given. Read more about aftercare.
After 14 Weeks (Second Trimester)
After about 14 weeks, procedures are generally provided on an outpatient basis, using dilation and evacuation (D&E). Some providers may provide vacuum aspiration slightly later in pregnancy so this may still be an option. A small percentage of abortions in the second trimester are done by inducing labor with medications. This is called induction abortion. Please call the NAF Hotline with any questions.
What to Expect
D&E is an expansion of the vacuum aspiration described above, but it requires further dilation of the cervix. This may be achieved using sterile absorbent fiber rods called laminaria,which are inserted into the cervix, usually the day before, or using a medication called misoprostol which may be taken orally or put in the vagina, usually a few hours before the abortion.
To perform the abortion, the provider uses suction as in a first trimester abortion and additional instruments to remove the pregnancy and pregnancy tissue. The procedure takes from 10 to 45 minutes. Women may experience varying degrees of discomfort. Several anesthesia options may be available.
After the Abortion
After a D&E, you should expect to rest in the clinic in a recovery area for approximately an hour before you go home. During this time, the staff will make sure your blood pressure and heart rate are stable and that you are not having abnormal bleeding or discomfort. (If you have received certain types of anesthesia, such as conscious sedation or general anesthesia, you should not operate a vehicle, therefore you will need to have a companion take you home.)
Following the abortion you will receive instructions for post-operative care. This will include a 24-hour number to use if you become concerned about your condition, and an appointment or referral for a check up 2-4 weeks later. It is very important that you follow the after-care instructions and take any prescriptions you have been given. Read more about aftercare.
After 24 Weeks
Abortions after 24 weeks are generally available only in order to preserve the health and life of a woman or in cases of severe fetal anomaly. There are very few providers of later abortions and the procedures will vary. If you need information about these providers, please call the NAF Hotline.
There are several types of anesthesia used for surgical abortion. The clinic will help you determine which type of anesthesia is right for you.
Local anesthesia (Lidocain, Novacain):
Local sedation is usually an injection that numbs a specific or local area of your body. In this case, your cervix will be numbed. Local anesthesia is commonly used in surgical abortions.
Conscious sedation (IV sedation, twilight sleep):
This is medication given through an IV needle that may cause you to feel drowsy or “out of it.” Conscious sedation may also affect short-term memory, leaving you with no memory of the procedure. Some people have side effects from conscious sedation, including mild upset stomach or grogginess.
Nitrous Oxide (laughing gas):
Nitrous oxide is a short-term anesthetic inhaled through a mask. It causes you to have feelings of euphoria and drowsiness.
General ( “knocked out” or “put under”):
General anesthesia is a controlled state of unconsciousness and requires monitoring by a qualified anesthesia practitioner. Some people have side effects from general anesthesia, including mild upset stomach or grogginess. General anesthesia is less commonly used in first trimester abortions than other anesthesia options.
A medical abortion is another safe and effective method for early abortion. Generally, medical abortion is used only in the first 7-9 weeks of pregnancy. A medical abortion uses two medications to end a pregnancy. The first (either mifepristone or methotrexate) weakens the attachment of the pregnancy to the uterus. The second (misoprostol) makes the uterus cramp and causes bleeding, which expels the pregnancy.
Medical abortions may be provided very early in pregnancy. They are most effective up to about 9 weeks depending on the medications being used. There are two combinations of medications that are used to provide medical abortions – mifepristone and misoprostol, or methotrexate and misoprostol.
Mifepristone (the “abortion pill”, Mifeprex, or RU-486) is a medication that was developed and tested specifically as an abortion-inducing agent. It was first licensed in France in 1988. Since then it has been used safely by millions of women worldwide. It was approved for use in the U.S. in September 2000.
Mifepristone is taken in the form of a pill. It works by blocking the hormone progesterone, which is necessary to sustain pregnancy. Without this hormone, the pregnancy detaches from the uterine wall, the cervix (opening of the uterus or womb) softens, and some uterine cramping can begin.
Methotrexate has been used in the U.S. since 1953 when it was approved by the FDA to treat certain types of cancer. Since that time, medical researchers have discovered other important uses for the drug, including ending unintended pregnancies. Methotrexate has been studied and used as a safe method of medical abortion since the early 1990s.
Methotrexate is usually given to a pregnant woman in the form of an injection, or shot, although it also can be taken orally. It stops the implantation of the embryo that occurs during the first several weeks after conception.
Within a few days after taking either mifepristone or methotrexate, a second drug, misoprostol, is taken. Misoprostol tablets, which are usually inserted in the vagina or taken orally, cause the uterus to contract and empty.
There are three steps involved in a medical abortion.
- You will take the first medication (either mifepristone or methotrexate) at the facility. It is not unusual to have some bleeding after the first medication but the procedure is not complete.
- Within the next few days you will take the misoprostol as directed by the facility. Within a few hours of taking the medication, you will probably start to have strong cramps and bleeding, similar to a heavy period. Pain medicine or a heating pad can help with the cramps. You may also have nausea, vomiting, diarrhea, fever, chills, or feel tired. These symptoms usually last a short time and stop on their own. The facility will give you instructions for your aftercare. If you have questions or concerns related to your recovery you should call the number provided to you by the facility.
- It is important for you to return to the facility for a follow-up to make sure that the abortion is complete. At this visit you will have a pelvic examination, a pregnancy test, or ultrasound. In the rare case that your abortion is incomplete, you may need to take an additional dose of misoprostol or simply wait and return for another visit in a week or two. If the pregnancy is still growing, however, you will need a surgical abortion.
Features of Aspiration and Medical Abortion
How Will I Feel if I Have an Abortion?
You will probably experience a range of emotions. Most women experience relief although there also can be feelings of loss or sadness. The most reliable indicator of whether a woman will experience feelings of distress after an abortion is her emotional stability before the abortion. Choosing to have an abortion is an important decision. The decision-making process may be stressful, even if the outcome is ultimately positive. Take the time you need to examine your feelings about this decision. Some of the questions listed below may help you explore your feelings.
- Who is supporting you in this choice and who opposes your plans? How does their opinion affect you?
- What are your future goals and how would having an abortion impact those goals?
- What are your personal beliefs about abortion?
- What would it mean for you to continue this pregnancy and become a parent or make adoption arrangements?
- How do you think you will feel about your decision in one month, one year, five years?
We recommend calling the NAF Hotline 1-800-772-9100 if you have additional questions about abortion or your options.