Regardless of your stance on what’s probably one of the most polarizing issues in America, clinical abortion and the abortion pill are both still legal, and still something that, every day, women choose to make use of. And yet, for those who have never actually taken the pill, or experienced the procedure, the topic is an amalgamation of talking points, illustrated by images of horrific pre-Roe v. Wade chop-jobs and that scene from Juno when she goes to the clinic and the receptionist offers her a pie-scented condom.
A note: if you’re squeamish (I am, and this was a little difficult to write), you may not want to read the detailed descriptions below. But knowing how the procedure actually progresses may be helpful to women who are considering it, or who have always assumed it was an option (only to realize it may be something they don’t want to go through with).
An in-patient procedure performed at many hospitals and clinics, clinical abortions evacuate the fetus from the uterus to terminate a pregnancy. There are two kinds–aspiration, which uses a vacuum, or the dilation and evacuation method, which is most commonly used for later-term pregnancies, which are relatively rare and performed usually only in an emergency. Fewer than 5% of abortions occur later than 16 weeks. Nearly all states in the US have some sort of ban on late-term abortions.
Prior to any in-clinic abortion (performed legally in the United States, which all of this information is regarding. The discussion about illegal abortions like those which kill thousands of women in developing nations is a discussion for another day), the patient take a series of lab tests to confirm pregnancy and ensure that the procedure will be safe for the patient. This exam may also include an ultrasound. Additionally, the patient will be counseled on her decision, and on her options moving forward. She will then sign the necessary papers and the procedure will begin.
Patients are deeply sedated during an in-clinic abortion, but they aren’t usually put under local anesthetic. This sedative is usually the reason why patients are told to have someone to drive them home. As the sedative sets in, the procedure begins similarly to an annual gynecological visit, with the insertion of a speculum and an examination of the uterus. At this point, the patient’s cervix may be injected with numbing medication.
During an aspiration abortion, the cervix is then stretched to allow entrance into the uterus. Dilating medicine may be given, or dilation may be manually created with the use of several rods. This is often one of the more uncomfortable parts of the procedure.
After the cervix is dilated, a small tube will be inserted, and the contents of the uterus will be emptied, either with a mechanical suction device, or with a hand-operated one. At this time, many patients report feeling pressure, cramping, and some pain, despite sedation.
To prevent infection, the patient will be given antibiotics, which may leave the patient feeling slightly unwell in the following few days.
The actual procedure takes just 5 to 10 minutes.
A dilation and evacuation abortion, however, uses dilation medication to ensure the cervix is enlarged, and may take longer. Otherwise, the procedures are similar.
Following an abortion, rest is recommended, as many women feel fatigued–much like they’re experiencing severe menstrual symptoms. Bleeding after an abortion is common, as is cramping. Spotting may continue for up to six weeks, and irregular periods may take weeks to correct themselves.
Unlike an in-clinic abortion, a medicated abortion requires no actual procedure. However, an abortion pill can only work if a pregnancy is detected early, and is only effective up to 9 weeks after a woman’s last period. Over 60% of abortions occur during this window of time. A medical abortion is actually a three-step process.
Before being prescribed a medicated abortion, the patient will undergo a similar physical and counseling session as an in-clinic abortion. During this time, both options for abortions will be discussed.
Upon making her decision to use a medicated abortion to terminate, the patient will be given a pill to block the creation of progesterone in her body. The lack of progesterone will cause the uterine lining, which houses the fetal cells, to break down and leave the body without being manipulated by a doctor or a vacuum. Some bleeding is usually seen at this point, and some cramping may be felt.
The second step involves a drug called misoprostol. Taken up to 3 days after the progesterone-blocker, misoprostol prompts the uterus to empty itself. At this point, the patient will notice very heavy, very textured bleeding. This is the abortion, and it may last as long as 5 hours. After the actual abortion occurs, many women experience spotting for as long as 6 weeks. Misoprostol may cause nausea, diarrhea, and dizziness. A mild, over-the-counter painkiller is usually recommended.
The final step is a follow-up, during which time the patient will be checked to ensure that her uterus is, indeed, empty. She will receive a blood test, as well as an ultra-sound.
In the US, by the age of 30, it’s predicted that 4 in 10 women will have some form of abortion. Being prepared with information before setting foot in a doctor’s office can help make a difficult decision easier–regardless of what you choose.