Abortion Procedures – Medical and Surgical

Discussion with medical provider

Before you decide to have an abortion, 1 it is important to know what to expect and to become informed on all the procedures and risks involved. This way when you make your decision, it will be totally your decision. You want to be able to own the outcome and live with the results.

You want to be able to own the outcome and live with the results.

Medical Abortion

Medical abortion uses medication to terminate a pregnancy during the first trimester. This procedure typically takes a few days and has several steps. First, the woman will visit a participating doctor’s office or clinic.

The Abortion Pill

The most common form of medical abortions is “The Abortion Pill” (Mifepristone 2 plus Misoprostol). It was approved by the Food & Drug Administration (FDA) for use in women up to 10 weeks after the last menstrual period (LMP). At her first office visit, she will be given the first pill (Mifepristone) to be swallowed, which eventually causes the death of the baby over the next few days. One to two days later, the woman will take Misoprostol tablets which causes cramping that will expel the embryo.3

Although she will not be given anesthesia, she may be given medications to help control the pain during and after the medical abortion.4 In addition, antibiotics may be given to help prevent an infection.5

It is very important to follow up with the provider after a medical abortion. This is necessary to make sure she is healing and to check for complications. The abortion provider will decide if the follow-up should include a phone call, blood test, office visit, and/or ultrasound.6

If the doctor thinks that the procedure failed, or was not complete, she will need to make a decision. She can either take more pills to induce abortion, undergo a surgical abortion, or continue her pregnancy.7

It is possible to reverse the Abortion Pill after the first pill has been taken. Many women regret their initial decision and take this course of action.

Emotional Effects

She may experience a range of emotions after an abortion. She may feel relief, sadness, guilt, or all three.8 The long-term psychological impact of medical pregnancy termination on women is largely unknown since information is lacking.

Surgical Abortion

Surgical abortions are done by opening the cervix and passing instruments into the uterus to suction, grasp, pull, and scrape the developing baby and placenta out.9 The size of the baby will determine the exact procedure.

Aspiration/Suction Abortion

Most first trimester surgical abortions are performed using the aspiration/suction method. This is performed up to 14 weeks after the last menstrual period (LMP). Local anesthesia is typically offered to reduce pain. The abortion involves opening the cervix, passing a tube inside the uterus, and attaching it to a suction device which pulls the baby’s body apart and out.10

D and E Abortion

Most second trimester abortions are performed using the dilation and evacuation (D&E) method. This is performed at about 15 weeks LMP and up. Local anesthesia, pain medications (orally or through IV), and sedation are commonly used. Besides the need to open the cervix much wider, the main difference between this procedure and a first-trimester aspiration/suction abortion is the use of forceps to grasp fetal parts and remove the baby in pieces. D&E is associated with a much higher risk of complications compared to a first-trimester aspiration/suction abortion.11

D and E After Viability

The D&E after viability abortion method is performed at 24 weeks LMP and up. This procedure typically takes 2-3 days and is associated with increased risk to the life and health of the mother. General anesthesia is usually recommended, if available. Drugs are usually injected into either the fetus or the amniotic fluid to stop the baby’s heart before starting the procedure.12 First, the cervix is opened wide, then the amniotic sac is broken, and forceps are used to dismember the fetus.

An alternative procedure, called “Intact D&E” attempts to remove the fetus in one piece, reducing the risk of leaving parts behind or causing damage to the woman’s body. The doctor pulls the fetus out legs first, delivering most of the baby’s body through the cervix, and then crushes the fetus’ skull. This is done because it is difficult to open the cervix wide enough to bring the head out intact.13,14

Is Abortion for Me?

It is a serious decision to have an abortion because of the potential for significant physical and psychological consequences. 15,16,17,18 You deserve to get answers to your questions, consider your options, and process how this procedure can impact the rest of your life.

Talk with your partner, trusted family members, or friends about this decision before you go through with the procedure. Further, make sure to get all the facts from a medical professional. Some people seek the support of a spiritual advisor or professional counselor.

Talk with your partner, trusted family members, or friends about this decision before you go through with the procedure.

Consider calling Pregnancy Decision Line if you would like to talk to somebody about your situation and ask further questions. You can also find a local care center for more help in this complex decision. These are places where help is available at no cost to you.

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Sources

  1. U.S. National Library of Medicine. (2018, March 6). Abortion | Medical Abortion | MedlinePlus. Retrieved November 7, 2018, from https://medlineplus.gov/abortion.html
  2. U.S. Food & Drug Administration. (2016, March 30). Mifeprex (mifepristone) Information. Retrieved November 7, 2018, from http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111323.htm.
  3. Ibid
  4. American College of Obstetricians & Gynecologists. (2016). Medical Management of First-Trimester Abortion – ACOG. Retrieved November 7, 2018, from https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Medical-Management-of-First-Trimester-Abortion
  5. Ibid
  6. U,S. Food & Drug Administration. (2016, March). Mifeprex Full Prescribing Information: Post-treatment assessment: Day 7 to 14. Retrieved November 7, 2018, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020687s020lbl.pdf
  7. Food & Drug Administration. (2016, March). Mifeprex Full Prescribing Information. Retrieved November 7, 2018, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020687s020lbl.pdf
  8. Mayo Clinic, “Medical Abortion”: https://www.mayoclinic.org/tests-procedures/medical-abortion/about/pac-20394687?p=1 (Accessed October 5, 2018
  9. Paul, M., Lichtenberg, S., Borgatta, L., Grimes, D., Stubblefield, P., Creinin, M. (2009). Management of unintended and abnormal pregnancy comprehensive abortion care: Chapter 10 first-trimester aspiration abortion. (1st ed., pp. 135–56). West Sussex: Wiley-Blackwell.
  10. Ibid
  11. Paul, M., Lichtenberg, E. S., Borgatta, L., Grimes, D. A., Stubblefield, P. G., & Creinin, M. D. (2009). Dilation and Evacuation. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 157-74). Chichester, UK: Wiley-Blackwell.
  12. Pasquini, L., et al. Intracardiac injection of potassium chloride as method for feticide: Experience from a single U.K. tertiary centre. Br J Obstet Gynaecol. 2008;115(4):528–31.
  13. Ibid
  14. American College of Obstetrics and Gynecology. (2013). Practice Bulletin: Second-Trimester Abortion (135).
  15. Thorp, J.M., Hartmann, K.E., Shadigian, E. Long-term physical and psychological health consequences of induced abortion: Review of the evidence. Obstet Gynecol Surv. 2003;58(1):67–79.
  16. Mayo Clinic. (2017, July 19). Abortion: Does it affect subsequent pregnancies? Retrieved November 7, 2018, from https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/expert-answers/abortion/faq-20058551
  17. Coleman, P.K. (2011). Abortion and mental health: Quantitative synthesis and analysis of research published 1995–2009. The British Journal of Psychiatry, 199, 180–86. doi: 10.1192/bjp.bp.110.077230.
  18. Swingle, H. M., Colaizy, T. T., Zimmerman, M. B., Morriss, F. H. (2009). Abortion and the risk of subsequent preterm birth: A systematic review with meta-analyses. The Journal of Reproductive Medicine, 54(2), 95–108.