How is an Abortion Done?

How is an Abortion Done?

There are a couple of types of abortion done these days.  The procedure can be performed using either a syringe or special type of vacuum machine.  Both methods remove the pregnancy safely and completely in a few minutes time. As the pregnancy advances, other kinds of instruments are used as well.

And, of course, there is the abortion pill, Mifeprex, which has been used in the US for more thana decade now after successful use in Europe, China, and other countries for many decades.

The first thing you should know is that an abortion is a series of steps. Listed below is the common order of those steps.

  1. Confirm the existence of the pregnancy by either a pregnancy test or ultrasound or both.
  2. Confirm the length of the gestation, meaning how far into the pregnancy the woman is, if necessary, by ultrasound.
  3. The doctor does a pelvic exam to become familiar with the size and shape of uterus.
  4. A local anesthetic is injected into the cervix to minimize discomfort during the procedure.
  5. Then, the cervix is gently stretched open, which is called dilation. The exact amount of the dilation depends on how far the pregnancy has progressed. For example, the cervix is dilated to about the size of a woman’s little finger (across the top) for early pregnancies of about 8 weeks. For pregnancies up to 12 weeks, the dilation is about the measurement of the top of woman’s index finger, and then at about 15 weeks, about the size of the top of the thumb. Dilation usually occurs with a series of dilating rods, each one a tiny bit larger than the previous one. In more advanced pregnancies, osmotic dilators are usually used because, although they take much longer, they are safer and gentler for the woman. These osmotic dilators are actually sponge-like substances which slowly swell as they absorb moisture. In this way the cervix is gradually opened up with a minimum of discomfort and a maximum of safety. However, there will be some cramping during this process. In addition to the local anesthetic, additional pain relief is usually available, particularly for the abortions needing the osmotic dilators.
  6. Instruments appropriate to the length of gestational development are then used. For example, in the earliest pregnancies which are about the size of a grain of rice, not much use of instruments is needed, just the vacuum tube. Some clinics even use a simple syringe rather than the vacuum machine in these situations. But in pregnancies that are more advanced, the vacuum machine is used as well as other instruments designed to assure that the procedure will be complete. The above procedures take about 5 minutes for the earliest procedures, with the more advanced taking about 15 minutes. Pregnancies that are even more advanced are done in a number of ways, depending on the physician and sometimes, the woman or couple’s preference. By that I mean that sometimes when a pregnancy has to be terminated in later gestations, particularly for medical reasons, the couple may ask that the fetus be allowed to remain whole, or intact, so that they may hold it, or bury it. There is no scientific evidence that pregnancies of less than 22 weeks have any ability to feel any pain since that part of the brain is not yet developed. However, most abortions over 20 weeks will begin with an injection to the fetus that causes its immediate demise so that it will not feel any pain just in case.
  7. Medication is sometimes given to help the uterus return to its normal shape and size, but different clinics approach this individually.
  8. The woman then goes to a recovery room for 30-60 minutes depending on the type of procedure she has had and also whether she has had anesthesia from which she needs to wake up. During her time in the recovery room, her vital signs will be checked a few times, her bleeding will be checked, and then before she leaves, she is given her instructions and usually birth control. She will be told to call her clinic immediately if she develops a fever so that additional antibiotics can be ordered for her.
  9. During the next two weeks, she may be given some restrictions in her activities. The instructions she brings home with her should tell her what those restrictions are since they may vary according to how far into the pregnancy she was. But all will state that she may not have sex for two weeks.
  10. She will need a check up in about 3 weeks to be certain that she is healing properly and that she is no longer pregnant.
  11. Although most birth control is started within a few days, it is wise to keep in mind that the hormonal birth control such as the pill, the patch and the ring will not be fully protective for about two weeks.  That means that both foam and condoms must be used to prevent her from immediately becoming pregnant again.  Equally important is the prevention of infection.  Condoms can help with that.  In addition, the injection Depo Provera, plus IUD’s such as Mirena and Paragard, can be offered either at the time of the procedure or later, depending on clinic protocol.

Thanks to Charlotte Taft for her help in description of abortion procedure.

The Abortion Pill

Many clinics now offer the abortion pill, Mifeprex. This medication has been used in other countries such as Europe and China for more than a several decades. The US has been using it for over ten years. It is safe and effective with a failure rate of less than 3%. The infection rate is even lower than the vacuum type of abortion, which itself is very low. You can ask the clinic where you are going to tell you what their experiences have been with the pill if you want to know more.

After an ultrasound to be sure that the pregnancy is indeed in the uterus (since this medication will not end a tubal pregnancy), the woman is given Mifeprex by mouth. She will then be given vaginal suppositories to be inserted at home to complete the process. Generally this induced miscarriage takes about 24-30 hours to be completed and causes more bleeding and cramping than the regular abortion. But it is very safe and some women prefer to have their abortion at home. It is mandatory that an ultrasound be done after the pregnancy has been passed because of the slight risk of failure of this method. Be sure to check if your clinic offers ultrasound free as a part of the procedure or if there is an additional cost.

More information on Mifeprex can be found at the following website, www.pregnancytoptions.info/whichmethod.htm

Emotions Afterwards

Both men and women can experience a wide variety of emotions after an abortion. Often there is some degree of sadness; often there is a feeling of relief as well. Abortion can be very difficult for some people because it can tie into other painful experiences in your life. And sometimes there are relationship issues that get stirred up during the decision making process, the abortion itself, and then again afterwards.

For other people, sometimes the decision is quite clear from the very beginning and, particularly in early pregnancy, there is not yet an emotional bond making for an easier transition back to your regular life. All of this means that abortion is so highly individual that no one can say what you and your partner will feel. Just know that it is normal to have a sense of loss, to feel some sadness. And keep in mind that only you will know if your sadness is going on too long or affecting your eating and sleeping. In that case, please do seek counseling. Remember that abortion is the most frequently performed medical procedure in the US and even though some people are very opposed to it, most are not. Supportive friends are the single most important resource you have in being able to heal emotionally and move on.

For the answers to the most frequently asked questions about abortion, click here.

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