The type of surgical abortion procedure used is based on where the woman is in her pregnancy. Before seeking a surgical abortion procedure, you should obtain a sonogram to determine if the pregnancy is viable (uterine, non-ectopic pregnancy) and for an accurate due date of pregnancy. You can contact Her Health Women’s Center to receive a free, limited, first-trimester ultrasound or to discuss the procedures at 712-224-2000.

First Trimester Aspiration Abortion – 5-12 weeks after last menstrual period (LMP)

Often stated as the quickest abortion method, an embryo or fetus can be removed from the client’s uterus in just 15 minutes in a first trimester (first 12 weeks) aspiration abortion.

Although the procedure itself doesn’t take much time, clients who are further into the first trimester need to be dilated several hours and sometimes a day ahead of time. Some clients are given a dose of misoprostol, which is used in medication abortions, to soften the cervix before the abortion.

In the procedure itself, you will lie on your back with your feet in stirrups and a speculum is inserted into the vaginal opening. The abortion provider inserts a plastic tube called a “cannula” through the client’s cervix. Once inside the cervix, the cannula uses suction to pull the embryo or fetus out.

An early-stage aspiration abortion (5-9 weeks) can be done using a hand-held syringe, but a machine-operated pump is often required for an aspiration abortion from 10-14 weeks.1

The suction also empties the placenta from the client’s uterus, making sure no tissue or fetal body parts are left in the uterus, reducing the risk of infection.2
For the most part, first-trimester aspiration abortions require only local anesthesia, although some do require general anesthesia.

Although most states require aspiration abortions to be executed by licensed physicians, new legislation in California has allowed registered nurses, midwives, and physicians assistants to begin performing the procedure.3

Some women get a first-trimester aspiration abortion to finish a failed medication abortion. Some first-trimester aspiration abortions fail as well, requiring a dilation and curettage procedure to complete the abortion.4The procedure usually lasts 10-15 minutes, but recovery can require staying at the clinic for a few hours. Your doctor will also give you antibiotics to help prevent infection.

You deserve to know all you can about abortion, fetal development, and maternal health before you make a decision. Contact Her Health Women’s Center at 1-800-276-0237. You may also call OptionLine at 1-800-712-4357 for 24/7 information.

What are the side effects and risks of suction aspiration

Common side effects of the procedure include cramping, nausea, sweating, and feeling faint. Less frequent side effects include possible heavy or prolong bleeding, blood clots, damage to the cervix and perforation of the uterus.

Infection due to an incomplete abortion or infection caused by an STI or bacteria being introduced to the uterus can cause fever, pain, abdominal tenderness and possibly scar tissue. Contact your health-care provider immediately if your side effects persist or worsen.

  • “Abortion: Methods of Abortion,” Columbia University, accessed March 6, 2015,http://www.columbia.edu/itc/hs/pubhealth/modules/reproductiveHealth/abortion.html.
  • “Manual and Vacuum Aspiration for Abortion,” WebMD, accessed March 6, 2015, http://www.webmd.com/women/manual-and-vacuum-aspiration-for-abortion
  • Shannon Firth, “Nurses, Midwives, and Pas Fill Gap as Abortion Providers: When physician is removed does risk increase” March 3, 2015, MedPage Today, http://www.medpagetoday.com/OBGYN/GeneralOBGYN/50285, last accessed March 10, 2015.
  • “Manual and Vacuum Aspiration for Abortion,” WebMD, accessed March 6, 2015, http://www.webmd.com/women/manual-and-vacuum-aspiration-for-abortion

Dilation and Evacuation (D&E)

A dilation and evacuation (D&E)1 is a method abortion providers use during the second 12 weeks (second trimester) of a pregnancy. A D&E uses a combination of vacuum aspiration, dilation and curettage (D&C), and forceps to remove the fetus from the client’s uterus. A similar procedure known as intact D&E is used to end pregnancies in the final 12 weeks (third trimester).

At least a day before the abortion itself takes place, a client’s cervix is dilated using Misoprostol or a dilation tool called a “laminaria” to allow the provider to introduce the instruments needed to remove the fetus.

In a D&E abortion, the provider first locates the fetus using an ultrasound machine, then determines whether to use a vacuum aspiration or D&C procedure to remove the fetus from the client’s uterus. The decision is based on the size and level of development of the client’s fetus.

Remember, you as the client have the legal right to change your mind about an abortion decision at any time prior to the actual procedure. It is also your choice to decide whether or not your provider will induce fetal demise before he or she begins a D&E procedure.2 Induced fetal demise means a fetus’ heart is injected with a lethal dose of a chemical such as potassium chloride prior to the abortion procedure itself.

If the client is 16 weeks or less into her pregnancy, vacuum aspiration is the procedure most commonly used, where the fetus is removed from the client’s uterus using suction force.

If the fetus is more than 16 weeks old or is slightly above average in size a provider may choose to do a D&C in which a scraping instrument is used to detach the fetus from the patient’s uterus.3   In a D&C, the provider follows his or her initial procedure by introducing forceps through the client’s vagina and cervix, into her uterus. Using an ultrasound to locate the fetus, the provider uses the forceps to pull the fetus out of the uterus piece-by-piece.

The abortion provider keeps track of what fetal parts have been removed so that none are left inside that could cause infection. Finally, a curette4 and/or suction instrument is used to remove any remaining tissue or blood clots to ensure the uterus is empty.

An intact D&E may require the provider to crush the skull of a fetus in order for the body to be removed from a client’s uterus. To do this, a provider uses forceps to make an opening at the base of the skull, then uses suction to pull out the skull’s contents, causing the skull to collapse in the process.

If you are looking for more information to make this decision, call 1-800-276-0237. You may also call OptionLine at 1-800-712-4357 for 24/7 information. You deserve to have all the information and support you need when you are facing an unexpected pregnancy.

What are the side effects and risks of dilation & evacuation?

Common side effects include nausea, bleeding, and cramping which may last for two weeks following the procedure. Although rare, the following are additional risks related to dilation and evacuation: damage to uterine lining or cervix, perforation of the uterus, infection, and blood clots. Contact your health-care provider immediately if your symptoms persist or worsen.

  1. Maureen Paul et al., Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care (United Kingdom: Blackwell Publishing Ltd, 2009), 157-77.
  2. Justin Diedrich and Eleanor Drey, “Induction of fetal demise before abortion, (January 2010), Society of Family Planning,http://www.societyfp.org/_documents/resources/inductionoffetaldemise.pdf, accessed March 6, 2015.
  3. “Dilation and Cutterage (D&C),” WebMD, http://www.webmd.com/hw-popup/dilation-and-curettage-dc, accessed March 6, 2015.
  4. Curette: A sharp, loop-shaped medical instrument.

Labor Induction Abortion (Second and Third Trimester)

Although it is far less common for women to choose to abort using labor induction, some women abort with this procedure during the second or third trimesters of pregnancy.

This abortion procedure ends a pregnancy by first causing the death of a fetus by chemical injection, then birthing the fetus, which can take 10 to 24 hours in a hospital labor and delivery unit.

The first step in the process is what abortion doctors refer to as, “fetal demise.” The doctor injects a lethal dose of potassium chloride directly into the fetus’ heart with a 25-gauge needle, causing fetal death. The client then is induced to labor and delivers the dead fetus.1

Misoprostol and Mifepristone, used in medical abortions, are sometimes given as part of the process of a labor induction abortion. Mifepristone causes the amniotic sac (containing the fetus, placenta, and pregnancy-related tissue) to detach from the uterus, resulting in fetal death. Misoprostol is then given to induce labor to deliver the fetus, placenta and other
pregnancy-related tissue.2

Over 40% of women who abort using labor induction do so because their fetus has been diagnosed with a fetal anomaly.3 If you are facing this situation, you have three legal options: abortion, parenting, or placing for adoption. If you’re looking for more information, call
1-800-276-0237. You may also call OptionLine at 1-800-712-4357 for 24/7 information.

What are the side effects and risks related to a Labor Induction Abortion?

The side effects are the same as dilation and evacuation. However, there is an increased chance of emotional problems from the reality of more advanced fetal development. Contact your healthcare provider immediately if your symptoms persist or worsen.

  1. Anna K. Sfakianaki, et al., “Potassium Chloride”Induced Fetal Demise: A Retrospective Cohort Study of Efficacy and Safety,” Journal of Ultrasound in Medicine: 337-341, accessed March 5, 2015, doi: 10.8763/332337.
  2. Rachel Perry, “Options for second-trimester termination,” Contemporary OBGYN, Nov. 1, 2013,http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/content/tags/abortion/options-second-trimester-t ermination?page=full.
  3. Sfakianaki, et al. “Potassium Chloride-Induced Fetal Demise,” 337-341. See also: Beth Daley, “Oversold and misunderstood: Prenatal screening tests prompt abortions,” accessed March 6, 2015, The New England Center for Investigative Reporting,http://features.necir.org/prenatal-testing.