Procedural Abortions
This is usually the type of abortion people think about. Sometimes it’s called “surgical abortion,” but no surgery or cutting happens during the procedure. It takes place in a clinic or doctor’s office via a variety of methods. Because there’s a lot of misinformation swirling around about abortion, you feel nervous, but it’s even safer than having your wisdom teeth removed and lots of people have abortions every day!
Vacuum Aspiration
Vacuum aspiration abortions are a common type of abortion generally available until ~14 weeks into pregnancy. You should follow all pre-procedure instructions from your providers, which can include not eating for several hours prior to coming into the clinic.
The procedure itself usually takes 5-10 minutes, but given the time it takes checking in, sitting in the waiting room, talking to counselors/providers, taking medication, and recovery time, the entire process can last a few hours to an entire day.
Before the abortion procedure, you’ll review your medical history with staff, do some blood tests, have an ultrasound, and you may be required to receive state-mandated materials which are designed by people who do not approve of abortion to prevent you from feeling confident in your decision. You may also be given medications that help pretreat cramping, prevent infection, or lessen anxiety.
When the provider is ready, you’ll be called back into a procedure room that looks similar to a gynecologist’s exam room for a pap smear. You’ll likely be asked to undress from the waist down, lay on a medical table, where a drape will cover your lower half. There will be leg holders below that you can place your legs in. Your IV sedation or use of nitrous oxide will be set up for you before the procedure begins, and your abortion provider will then guide you through their insertion of the speculum—a duck-billed device that opens into your vagina so they can see your cervix and uterus. This shouldn’t hurt but can feel cold and uncomfortable, especially for people with anxiety in medical settings, sexual assault survivors, and trans and gender non-conforming individuals.
Following the insertion of a speculum, a local anesthetic will be injected into your cervix to numb and relax the area. Next, the provider will need to dilate your cervix with the use of a dilating rod, which may feel like mild to intense cramping for a couple of minutes. Then, a thin tube known as a cannula will be inserted through your cervix and into your uterus to remove the pregnancy. The cannula is attached to an electric vacuum machine (or a manual vacuum aspirator) to remove the pregnancy tissue from your uterus. The suctioning can be the most intense part of the procedure for many people, so it’s helpful to expect mild to intense cramping for a couple of minutes during this part, too. You may hear the sound of the machine humming during the procedure, or it may be quiet if the provider uses a manual aspirator. You can bring earbuds and listen to music or talk to the nurse if you are awake and want a distraction from the sound.
Tip from We Storytellers: If you’re going to be awake during the procedure and think it would help you relax, ask if you can listen to music/podcast/guided meditation/etc. through earbuds during the procedure.
This is also a good idea for long waits in the clinic before your procedure.
Dilation and Evacuation (D&E)
A D&E is an abortion procedure for patients during their second trimester, generally between 14 to 24 weeks (depending on your provider and state laws which you can check here).
The procedure itself takes 10-20 minutes, but given the time it takes checking in, sitting in the waiting room, talking to counselors/providers, taking medication, and recovery time, the entire process on the day of your abortion can last a few hours to an entire day. D&E procedures can be performed in a clinic, hospital, or doctor’s office, and usually consist of several visits over the span of two days or more.
At this stage of pregnancy, your uterus needs more time to dilate, so there is a bit more preparation involved. The same methods are used (laminaria, misoprostol, dilator rods), but they may be used in combination with one another or you may have to spend more time waiting for them to work, which may be several hours or overnight. Before your procedure, you will also be given antibiotics to prevent infection. You may also receive pain medicine to pretreat cramping beforehand. Many clinics require the use of IV sedation for D&E’s, so having someone that is able to take you home afterward is important. Local anesthesia, general anesthesia, or sedation may be used for the procedure.
Before your abortion, if the doctor is inserting laminaria, this will be done prior to the abortion procedure. Laminaria is medical-grade seaweed that is inserted into the cervix to absorb moisture and slowly dilate it overnight, and secure with the insertion of sterile gauze. You’ll return to the clinic the following day for the procedure, but in some cases, additional insertion of laminaria may be used. The clinic may provide you with pain and anxiety medication as you wait to return to the clinic, and it’s important to bring any laminaria, gauze, or products of conception that may come out during this time. When you return, the laminaria will be removed, and the abortion will proceed by injecting your cervix with a local anesthetic, further dilation using dilation rods, and the removal of the pregnancy through suction and other instruments, like medical forceps.
Not So Fun Fact: “Late-term abortion” is actually a made-up, non-medical phrase by people who want to stigmatize and ban abortion. For someone to be “late-term” they’d have to be more than 41 weeks into their pregnancy. The phrasing has nothing to do with abortion but with stigma. The correct terminology is later abortion or just abortion.
Induction Abortions
After the 21st week of pregnancy, patients often have what’s called an induction abortion. This is usually what people refer to as later abortions. Induction abortions share some similarities with D&E and vacuum aspiration abortions.
Induction abortions usually take place in hospitals or surgical clinics and usually take four to five days.
Your first appointments will consist of counseling and other pre-op procedures, including having dilators, often laminaria, placed in your cervix that swells and open your cervix overnight. The day you have the procedure, you will be offered IV pain medication; because of this, an adult will need to drive you home afterward (a friend, loved one, car service, clinic volunteer) because you can’t drive yourself home or take public transit.
Once you’re comfortable on the examination table in the procedure room, the medical staff will place your legs in stirrups. Your provider will start by placing a speculum in your vagina, then they will remove the dilators placed the day(s) before. They will use a suction cannula to remove fluid from the pregnancy, and then graspers to remove the pregnancy tissue and the fetus. During the entire procedure, they will use an ultrasound for guidance, which ensures they can see inside your uterus.
For the days, and perhaps weeks, after your procedure, you will experience cramping, soreness, bleeding and spotting, and milk leakage from your nipples. Your body is adjusting to not being pregnant anymore, so it can take some time.
Remember: you have just had a lengthy procedure, so you should be prepared to take some time to rest and let your body heal.
Tip from We Storytellers: You might feel quite sore after the procedure, so have some cool compresses at home to help. It’s also possible that your body may still be preparing to lactate, so you might experience some milk leaking from your nipples. Place some frozen cabbage leaves on your nipples to suppress the milk or talk to your provider about additional medical options.
You can also ask your provider about including a milk suppressant in with your IV drip.