Informational Resources Book of Choices

Ending a Pregnancy: Abortion Care

Types of Abortion Services Available

In this section, you will find information and answers for many of the questions you may have about abortion care. However, it is important to note that most abortion providers do not offer every abortion method to patients. If you have additional questions regarding a procedure, the abortion provider is the best resource.


What Types of Abortion Procedures Are There?

Vacuum Aspiration (Suction Curettage): This is one of the most common first-trimester abortion methods (used within the first three months of pregnancy). A suction machine is used to empty the uterus with a mild suction. The physician may then use a spoon-shaped instrument, called a curette, to ensure that the abortion is complete. This method is used when a pregnancy is between 6 and 15 weeks. The procedure itself takes between 5 and 10 minutes. A local anesthesia is administered to alleviate the pain of the procedure, but some providers offer patients stronger anesthesia, such as conscious sedation or general anesthesia Side effects associated with vacuum aspiration include abdominal cramping and vaginal bleeding.

Manual Vacuum Aspiration (MVA): MVA is a first trimester abortion method that empties the uterus using non-electric suction instruments. MVA is similar in function to the vacuum aspiration method, but without electricity and the electrical suction noise. Some patients prefer MVA because it is quieter. However, the procedure takes slightly longer and is not as widely available to patients as the electrical version. The method is used when a pregnancy is up to 12 weeks. A local anesthesia is all that is required to alleviate the pain of the procedure, but some providers offer patients stronger anesthesia, such as conscious sedation or general anesthesia. Side effects associated with manual vacuum aspiration include abdominal cramping and vaginal bleeding.

Medication Abortion: Medication abortion is a non-surgical method used to induce abortion up to 49 days of a pregnancy (seven weeks). During a medication abortion, a physician does not enter the uterus. Instead, a medication—either Mifeprex (also known as RU486, the early option pill, or mifepristone) or Methotrexate—is administered, either orally or by an injection, to induce the abortion. At a second appointment, one to two days later, the woman must take a second medication (called misoprostol), which is inserted into the vagina or taken orally, which causes the uterus to contract and empty, effectively ending the pregnancy. Follow-up visits are extremely important with medication abortion to ensure that the abortion has been completed. The benefit of medication abortion is that it can be used earlier than common first-trimester surgical methods and is an alternative for patients uncomfortable with surgery and anesthesia. Since medication abortions are less effective as the number of weeks of pregnancy increases, they are usually not performed when more than seven weeks have passed since your last menstrual period. After seven weeks, a surgical abortion is often the best option. Side effects associated with medication abortion include nausea, diarrhea, abdominal cramping or pain, hot flashes, vomiting, fatigue, or vaginal bleeding. Medical abortion usually takes several hours to complete; mifepristone generally works faster than methotraxate. It can take up to three or four weeks after taking the first medication for the abortion to be completed. One to two weeks after taking the drug, women must see their doctor for a follow-up exam to ensure that the abortion was completed and there are no complications.

Dilation and Evacuation (D&E): Dilation and Evacuation is the most common second trimester abortion procedure. D&E involves vaginally inserting laminaria (sterilized seaweed) into the cervix, causing the cervix to gradually dilate or widen. This insertion is typically done one day before the procedure. Once the cervix is sufficiently dilated, a surgical procedure is performed that involves suctioning the uterus by vacuum aspiration. Conscious sedation is used to alleviate the pain of the procedure, but some providers offer patients stronger anesthesia, such as general anesthesia. After the cervix is dilated, which can take anywhere from a few minutes to two days, the surgical procedure itself takes about 10 to 20 minutes to complete.

Pain Relief Methods

Like any surgical procedure, the surgical abortion procedure is painful. The pain feels similar to or sometimes stronger than menstrual cramps. As the uterus is emptied, and begins to contract to its regular, non-pregnancy size the pain from the contractions can range from barely noticeable to very painful. There are several pain relief methods used for abortion procedures. The usual methods are local anesthesia and conscious sedation, though sometimes general anesthesia is used. Not all abortion providers have all pain relief methods available for use by a patient, and sometimes the strongest pain relief method is not necessary and may increase the risk of the procedure.

Below are descriptions of the different anesthesia methods available to women during an abortion procedure:

Local Anesthesia: An injection that numbs the cervix, usually providing sufficient pain relief for most women. With local anesthesia, the patient is alert and awake throughout the procedure. Local anesthesia lasts for less than an hour. There are no side effects associated with local anesthesia.
Conscious Sedation: The intravenous (into the vein) administration of an analgesic (pain relief medication), such as Demerol, with a sedative, such as Valium, resulting in deep relaxation without loss of consciousness. Conscious sedation creates an altered state of awareness, relieving patients from anxiety and discomfort, but allowing patients to breathe on their own, respond physically and answer questions. Conscious sedation may be administered by a physician or a nurse trained in the procedure. Conscious sedation is increasingly used as an alternative to local anesthesia (not strong enough for some women) and general anesthesia (unnecessarily strong for many abortion procedures). Conscious sedation lasts from one to four hours, and requires that a patient have someone accompany or drive her home if she leaves during the time that the anesthesia is still effective. Side effects associated with conscious sedation include nausea, vomiting, headache, dizziness, dry mouth, sweating, hiccups, coughing and drowsiness. Patients who have asthma, severe respiratory allergies, or who have used drugs or alcohol within the 24 hours before the procedure should not use conscious sedation as a pain relief method.

General Anesthesia: An intravenous (into a vein) injection of a drug, or an inhalation drug (an inhaled gas) or a combination of both. This technique causes the patient to be unconscious, deeply relaxed (sleep-like), to feel no pain, be totally unaware of the surgery and have no memory of the surgery later. Often, a breathing tube is placed down the patient’s throat to ensure that proper breathing continues through the surgery. Monitors are used to check breathing, heart rate and other vital signs. General anesthesia may be administered by an anesthesiologist, a doctor or nurse trained in the procedure. Side effects associated with general anesthesia include nausea, sore throat, headache, muscle aches and a general “hangover” feeling. Once the anesthesia has worn off (usually 10 to 20 minutes after the procedure) the patient will feel as if they have “woken up.” However, the body reflexes can continue to be influenced by general anesthesia for at least 24 hours, and a patient will need someone to accompany or drive her home after the surgery. Sometimes patients are advised by their provider not to drive or operate any heavy machinery for a certain time period after having general anesthesia.


Abortion Safety and Follow-Up Care

Abortion is one of the safest medical procedures available. Each year, more than one million American women have an abortion. Less than one percent of all abortion patients experience a major complication associated with the procedure. The risk of the procedure, however, increases if the abortion is performed later on in the pregnancy. It is important for you to:

  • Inform the abortion provider of any past or present health problems you may have.
  • Tell your provider of any current medications, supplements, or street drugs that you use, as well as allergies to medications or pain relief methods.
  • Follow all post-operative instructions and return for a follow-up examination.
  • Ask questions if you are unsure of anything about the procedure.

As with all surgical or medical procedures, it is important to recognize and quickly react to signs of potential complications. Your abortion provider will inform you of what to expect and what would be unusual after an abortion procedure.

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