What is an induced abortion?

Induced abortion is the act of ending a pregnancy, either through surgery or by taking medication.

Dealing with an unplanned or unwanted pregnancy is very difficult. Talking with your partner, family, clergy, friends, and health care provider may all be helpful in your decision about what action you should take. Your choices include continuing the pregnancy and you or your family raising the child, finding adoptive parents, or ending the pregnancy by having a legal abortion. The goal of abortion counselling is to provide information that enables you to make the best decision for you, and to offer support in that decision.

What happens before the abortion?

First you will talk with a specially trained counselor to explore your options, answer your questions, and discuss your decision. Then your health care provider will take a medical history and perform a physical exam, including a pelvic exam. Cells from your cervix (a Pap smear) and samples of your urine and blood will be taken for lab tests. You may have an ultrasound exam to determine your stage of pregnancy.

Your health care provider will tell you about any special steps you should take before the abortion procedure.

What types of procedures may be performed?

The type of procedure used for an abortion depends on the stage of pregnancy:

• If it has been just 1 or 2 weeks since your period should have started, a menstrual extraction might be done. The oral medication RU 486 is another method used in other countries during this stage of pregnancy, but it has not yet been approved by the U.S. Food and Drug Administration (FDA).

• If you are less than 13 weeks pregnant (it has been less than 13 weeks since the first day of your last menstrual period), the most common procedure is vacuum curettage.

• The procedure most often used between the 13th and 21st weeks of pregnancy is a dilation and evacuation (D&E). However, there are also methods of using medications to cause the uterus (womb) to contract and deliver the fetus and placenta (afterbirth).

How are these procedures performed?

Menstrual extraction

Menstrual extraction is a procedure that can be done only very early in pregnancy (1 or 2 weeks after your period should have started). It can be performed in your health care provider's office.

To do a menstrual extraction, your health care provider inserts a speculum into your vagina. He or she then places a small tube into the womb through the cervix (the opening to the womb). The tube is used to remove the pregnancy tissue from the womb with a syringe.

RU486

RU486 is an oral medication that is currently being tested in the U.S. It has not yet received FDA approval for abortion. When taken in the first month of pregnancy, especially when taken with another drug called prostaglandin E2, it causes a miscarriage.

Vacuum curettage

A vacuum curettage (also called a suction dilation and curettage, or suction D&C) is a surgical procedure performed in an operating room. Before the procedure you are given either local or general anesthesia. For local anesthesia you are given a shot deep inside the vagina into your cervix to make your cervix numb. In addition to the local anesthesia, you may be given a sedative through an IV to make you drowsy. If general anesthesia is used, you will be asleep during the procedure.

After the anesthetic has taken effect, your health care provider gently stretches the cervix so a small plastic tube can be placed through it into the womb. This tube is attached to a vacuum pump, which suctions the pregnancy tissue from the womb. Your provider then uses a dull spoonlike instrument (a curette) to scrape the walls of the womb and be sure that all of the tissue has been removed. The procedure generally takes 10 to 20 minutes, and then you will spend some time in the recovery room.

Dilation and evacuation (D&E)

A D&E is a surgical procedure performed if you are 13 to 21 weeks pregnant. Because the fetus is larger, the cervix needs to be opened more than for a vacuum curettage. To do this safely, the cervix needs to be prepared 24 to 48 hours before the procedure. This is done in the office, where your health care provider gently places some sticks into the cervix. The sticks, usually made from a type of seaweed called laminaria, absorb water from the body and cause the cervix to open up. After placement of the sticks, you will go home. Your cervix will be examined the next day. If it has opened enough, the D&E will be performed. If not, a second set of sticks will be inserted and the D&E will be done the following day.

The D&E is performed in the operating room, usually using general anesthesia so you are asleep during the procedure. The procedure is similar to a suction curettage. After the sticks are removed, the cervix may be gently opened more with metal rods. The pregnancy tissue is removed with forceps and suction. You are given medication through an IV to contract the uterus. The uterus is scraped to be sure all the tissue has been removed. The procedure takes about 30 minutes. Afterward you will spend time in the recovery room.

Medically induced second-trimester abortions

Certain medications may be used for abortions after the 14th to 16th weeks of pregnancy. These medications cause contractions that lead to labor and delivery. Medically induced abortions are usually done in the hospital.

The most commonly used medication is prostaglandin E2 (PGE2). Your health care provider places a suppository of the medicine in your vagina. After the medication is given, in addition to contractions, you may have nausea, fever, and diarrhea, but these side effects can be controlled with medications.

A less commonly used procedure is a saline abortion, which, like PGE2, causes labor and delivery. With this procedure your abdomen is numbed with a local anesthetic. Then saline (a salt solution) or another medication is injected through the skin of your abdomen and into the amniotic fluid in the womb to start contractions.

After the fetus is delivered by any of these procedures, you may need to have a dilation and curretage (D&C) to remove any pregnancy tissue remaining in the womb.

These procedures will require you to be in the clinic 6 to 24 hours for labor, delivery, and recovery.

What happens after the procedure?

After each of these procedures, you are observed for one or more hours to check for complications. The length of time in recovery depends on the type of procedure you had and the method of anesthesia. In general, you are observed for about 2 hours after a suction curettage, 4 hours after a dilation and evacuation, and 6 hours after a medically induced second-trimester abortion.

When you are ready to go home, you will be given an antibiotic to prevent infection and a drug to contract the uterus. Your health care provider will tell you how long to wait until you have intercourse again. Someone in the office will probably also discuss methods for preventing pregnancy and may prescribe a method for you.

It is normal to have some cramping after the abortion while the uterus contracts to its normal size. It is also normal to have some small amounts of bleeding from the vagina for several days. Most women are able to return to their normal daily activities within a day or so after the abortion if there are no complications.

Make sure you follow all of your health care provider's instructions for care after the abortion, including seeing your provider for a follow-up appointment 2 to 3 weeks after the abortion.

What are the possible complications of an abortion?

Abortions performed by licensed health care providers are generally very safe. The rate of complications from abortions done by licensed health care providers is very low. Possible complications include:

• perforation (a result of a surgical instrument going through the uterus and possible injuring an abdominal organ)

• infection

• excessive bleeding

• failure to end the pregnancy

• difficulty becoming pregnant after several abortions.

Report any of the following symptoms of possible complications to your health care provider promptly:

• severe abdominal pain

• fever

• foul-smelling discharge from the vagina

• bleeding that is more than a heavy period or consists of large blood clots

• signs of continued pregnancy such as breast tenderness, fatigue, and nausea.

Some women experience depression after having an abortion. This may occur immediately after the abortion or weeks or months later. If you are feeling depressed, your health care provider will find support and counselling for you.