What is involved during the abortion process will vary, depending on exactly which type of abortion is being performed. There are different procedures that may be used for each trimester. In the first trimester, a woman has the option of a medication abortion or a surgical vacuum aspiration, sometimes called a suction aspiration. The surgical abortion procedures, dilation and curettage (D&C) and dilation and extraction (D&X) may be used during the second or third trimesters, respectively. Before carrying out any type of abortion, the doctor may perform an ultrasound scan and a vaginal examination on the patient.
To avoid a surgical abortion, a woman may use a medication abortion no later than nine weeks from the beginning of her last period. The medication used is called mifepristone, although it is sometimes referred to as RU-486. A first dose will be administered at the clinic, along with antibiotics. This pill causes the lining of the uterus to begin to break down due to interference with a hormone, called progesterone.
The second pill must be taken 48 hours after the first dose and it will take effect within four to six hours, causing the womb's lining to be completely broken down and expelled. The embryo is also removed in this manner. Typically, the patient will be given an additional medication to relieve pain during this time. Bleeding and cramps will occur, and occasional spotting may continue for up to a month. The patient must return to the clinic for a follow-up visit within two weeks to ensure that the abortion was complete.
If a medication abortion process is not ideal for a particular patient, she may undergo a surgical vacuum aspiration between weeks six to 12 of the pregnancy. The patient will receive medication, including a painkiller and a local anesthetic, prior to the procedure. Instruments are used to widen the cervix and then a device, called a cannula, is inserted into the uterus. The device will use a suction action to remove both the embryo and the placenta.
Patients should expect to recover for several hours in the clinic. This type of abortion process can often cause side effects, such as nausea, cramping, and feeling faint. Rarely, some women may experience damage to the cervix or uterus, heavy bleeding, and infection. Those who notice a fever or abdominal tenderness should alert the doctor.
Another surgical abortion process is a dilation and curettage, which may be performed no later than the first 12 to 15 weeks of pregnancy. This procedure is just like a vacuum aspiration, with the addition of another instrument called a curette, which is a looped, surgical knife. The curette is used to scrape the fetus, placenta, and lining away from the walls of the uterus. A cannula is also used to suction out any remaining matter. Patients can expect the risk of the same side effects and an in-clinic recovery time of about five hours.
A dilation and extraction may be used no later than 21 weeks from the beginning of the pregnancy. This type of surgical abortion process requires the insertion of a synthetic dilator, called a laminaria, two days prior to the procedure. A woman's water will typically break on the third day, upon which the doctor will use forceps to grasp the fetus and pull it through the birth canal. The doctor will insert a suction catheter through an incision in the fetus's skull to remove cerebral material before completely removing the fetus. Patients may expect the same potential side effects as other surgical abortions.