First Trimester Surgical Abortions
Learn More About Abortion Procedures
88% of all abortions in this country are performed in the first trimester (within 13 weeks since your last menstrual period). More than half are performed at 8 weeks or less. The most common method for first trimester surgical abortions is called vacuum aspiration or suction curettage.
At most clinics or abortion facilities, you will have some lab work to make sure you are pregnant and to test your blood type for the Rh factor (the negative or positive after your blood type). You should have a chance to talk about your decision with a counselor or other staff member and go over an informed consent to be sure of your decision and understand the possible risks and complications. An ultrasound may also be performed to confirm how far along you are.
Inside the procedure room you will be positioned just like a regular GYN examination. An instrument called a speculum is placed inside your vagina and adjusted to hold the sides apart so that the physician can see directly to your cervix (the opening to your uterus). Another instrument is then used to hold your cervix in place throughout the procedure. Next, your cervix is numbed with local anesthesia. (If available, you may choose IV sedation or general anesthesia). The physician will then gradually widen (dilate) the cervix. When the cervix has been dilated to the width appropriate for your stage of pregnancy, usually the width of a pen, the physician will insert a small tube (cannula) that is attached to a suction machine. The suctioning empties the uterus, which includes the lining of the uterus, the gestational sac, and pregnancy through the tube. Then the doctor carefully checks the walls of the uterus with a spoon-shaped instrument (curette) to be sure no tissue remains.
Cramping is a normal and healthy process to get your uterus back to its normal size and stop the bleeding. The entire procedure takes just a few minutes and the cramps will usually get better within 5- 30 minutes. Most doctors use suctioning created by a machine, but some doctors use Manual Vacuum Aspiration (MVA), which is quieter, but takes longer. A D&C (Dilation and curettage) is a similar procedure, but the suctioning makes it go faster with less pain.
Second Trimester Abortions
After 13 weeks, second trimester abortions are typically available up to 24-25 weeks. The risk of complications increases slightly every week past 13, but never approaches the risk of a full term pregnancy. 12% of all abortions are done after 13 weeks, but only 2% are done past 21 weeks. Abortion at 26 weeks or longer are extremely rare and are done to protect the health of the mother or because the fetus has a condition that would be severely disabling or would cause death.
Dilation and Evacuation (D & E)
Second trimester abortions involve more dilation (widening) of the cervix, which is done by inserting “laminaria” which enlarge when wet. This is done over the course of one to three days, depending on the length of pregnancy. A medication to soften the cervix may also be used.
When the cervix is open, the doctor removes the pregnancy with forceps and suctioning. It takes about 10-20 minutes and general anesthesia is often offered for pain management.
In some situations, labor is induced with a medication called prostaglandins and the woman delivers an intact fetus. This is often done when there is a severe fetal defect or the baby has died inside the uterus, so that there can be an autopsy.
Dilation and Extraction (D & X) or Intact D&X
The method is sometimes used after 20 weeks, and often when there is a fetal defect and doctors --or the parents-- want an intact fetus to examine or hold. With this method, the head is collapsed with suctioning and the rest of the body is delivered. It is advantageous because the woman does not need to be as fully dilated as with induction.
Congress has banned this procedure in 2003. However, the ban is suspended while the Courts decide whether the ban is legal. Previous bans were not upheld by the Supreme Court.
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