If you’re in your first trimester, you’ll likely have a vacuum aspiration. If you’re in your second trimester (meaning that it’s been more than 13 weeks since your last menstrual period), you’ll likely have a dilation and evacuation, or D&E. If you’re further along than that, you might have a dilation and extraction, or D&X.
Almost all abortion procedures are out-patient, which means you won’t have to stay overnight in the doctor’s office, clinic, or hospital afterward.
Before the Procedure
When you schedule your appointment, your health care provider will probably give you some instructions over the phone. Because in-clinic abortions are considered surgeries, you may have to fast starting around midnight the night before your procedure.
When you arrive at the clinic, you’ll fill out some paperwork and answer questions about your medical history. You’ll then get a pre-abortion workup, which includes a physical examination, pregnancy test, blood test, screening for sexually transmitted infections, and possibly additional testing, if your case warrants it. Many providers will also use an ultrasound to confirm how far along you are in your pregnancy and check for uterine, fetal, or placental abnormalities.
All of this information, which your doctor will discuss with you during a short counseling session, will help them determine which procedure is right for you.
Your doctor will also talk to you about different types of pain management available to you during the procedure.
For an in-clinic abortion, you’ll probably get local anesthesia, meaning that your cervix will be numbed but you’ll be awake. While 600 to 800 milligrams of ibuprofen usually provides enough pain relief, your doctor might also offer you an oral medication to calm you down or mildly sedate you, so you’re awake but relaxed. If you prefer heavy sedation, meaning you’re in a light sleep throughout the procedure, you can ask if a sedative medication can be given to you through an IV.
Vacuum Aspiration (Suction Abortion)
Most abortions done in the U.S. take place in the first 12 to 13 weeks of pregnancy. If you opt for an in-clinic abortion in your first trimester, you’ll have a vacuum aspiration, which you may also hear called a “suction abortion.”
In most cases, your cervix doesn’t need to be prepped or dilated for this procedure. But if you’re more than about 10 to 12 weeks pregnant, your health care provider may take steps to open your cervix a bit before getting started so that the medical tools can access your uterus. They’ll likely insert little sticks made of sterilized seaweed that absorb moisture and expand, called laminaria.
When you’re comfortable and sedated, if you so choose, your health care provider will insert a medical tool called a speculum into your vagina to keep it open, and swab your vagina and cervix with an antiseptic solution called Betadine.
They’ll inject an anesthetic into the cervix to numb it, holding your cervix in place with a grasping instrument. They’ll then insert a small tube attached to either a hand-held syringe or a suction machine into your uterus, and clear out its contents. From start to finish, the procedure takes several minutes.
Afterward, your doctor will check to make sure that the procedure was successful, and then let you rest for about 30 minutes under observation.
Second Trimester: Dilation and Evacuation
If you’re more than 12 weeks pregnant, your provider will use an ultrasound to date your pregnancy. The farther along you are, the more prep work you may have to undergo to prepare your body for the procedure.
While doctors can do vacuum aspirations until about 14 weeks, the most common type of second-trimester abortion is called dilation and evacuation, or D&E.
The first step a provider will take before this procedure is to prepare and dilate your cervix so that it’s not injured in the procedure. They will likely use laminaria sticks, which might be left in overnight. They might also give you a dose of a medication such as misoprostol, either by mouth or through your vagina, to soften your uterus. They may also use tools to help dilate your cervix.
Like a first-trimester abortion, you’ll lie on an exam table with your feet in stirrups, and your health care provider will swab your vagina and cervix with Betadine, inject anesthesia into your cervix, and then use a gripping tool to hold your cervix in place.
The main difference is that in addition to using a vacuum suction in your uterus, they’ll also use forceps and other medical tools, including one called a curette to scrape the inside of your uterus. Your doctor may use ultrasound to guide them, and will likely use a suction or vacuum to make sure everything is cleared out. Some providers may use a medication, which you would get as a shot into your abdomen, to stop the fetal heartbeat before the procedure. Afterward, your provider may give you a medication to contract your uterus and reduce bleeding.
This procedure takes 10 to 20 minutes. You’ll rest for 30 minutes to an hour while your health care providers make sure you’re well.
Late-Term Abortion: Dilation and Extraction
If you’re having an abortion further along in your pregnancy, you may have to find a specialized, experienced provider to do a dilation and extraction procedure, or D&X. This is a procedure that doctors usually reserve for when there is a serious problem with the fetus or medical complications related to the mother.
All the steps leading up to the procedure and steps taken after the procedure are the same as for a D&E, including the ultrasound to date your pregnancy and prep work to soften and dilate your cervix.
For sedation, you might be offered a general IV anesthesia, especially if the procedure is done in a hospital.
There are a few other options, like labor induction, hysterotomy and hysterectomy. But because they are riskier, doctors only do them if medically necessary.
What Happens Next?
Once your procedure is done, you’ll rest at the clinic under supervision for about 30 minutes. You can then continue to relax in a recovery area until you’re ready to head home. If you’ve had any sedation, you’ll need someone to drive you. You’ll get a prescription for an antibiotic, too.
You’ll probably have some cramping for a few days and light bleeding for up to 2 weeks. Most pain and cramping is effectively treated with an over the counter or prescription painkiller like acetaminophen, ibuprofen, or codeine.
Plan to rest on the day of your procedure. You may need a few more days of rest if you had a D&E or D&X. You shouldn’t lift anything heavy for a few days. Ask your doctor when it would be OK to have sex or use a tampon again -- it may be up to a month before you can have anything in your vagina.
If you have severe pain, a fever over 100 F, or soak through more than two pads per hour, you should call your provider or the emergency contact they gave you right away.
Most providers will have you come back for a follow-up appointment in 1 to 4 weeks to make sure that you’ve physically recovered and are no longer pregnant.