Professional procedures for procuring safe abortion


An abortion (termination) is when a pregnancy is ended by taking medicines or having an operation.

An abortion (termination) is when a pregnancy is ended by taking medicines or having an operation.

You will meet the doctor or nurse carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs. Details of the procedure may also vary from country to country.

About abortion

Having an abortion is a personal choice and there can be many medical and social reasons for having one.

There are two main types of abortion – medical and surgical.

The World Health Organization recommends that medical abortion is carried out in the early stages of pregnancy (usually up to nine weeks). However, it can also be carried out after this time.

Medical abortion involves taking medicines to end the pregnancy.

Two different procedures can be used to perform a surgical abortion.

• Vacuum aspiration. This is usually used if you are 12 to 14 weeks pregnant.

• Dilation and evacuation (D&E). This can be used if you are more than 12 to 14 weeks pregnant.

Both procedures use suction to empty your womb (uterus).

Deciding to have an abortion

Making a decision about having an abortion is often difficult. You may find that talking to someone you trust can help – for example, your partner, a family member or a close friend. Alternatively, you may prefer to speak to a doctor or a professional counsellor.

Laws and policies about having an abortion vary in different countries. Most countries agree that abortion may be carried out to decrease any risks to your physical and mental health.

Where possible, you will be offered a choice of procedure, but this will depend on how many weeks pregnant you are and whether you have any pre-existing medical conditions.

Preparing for an abortion

Before you have an abortion, your doctor may carry out examinations, scans and tests to determine how many weeks pregnant you are and may ask you about your medical history.

You may have urine and blood tests, and swabs taken from your vagina to check for sexually transmitted infections (STIs).

Your doctor or nurse will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

Your doctor may prescribe antibiotics before, during or after your abortion to prevent or treat infection.

If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your doctor or anaesthetist's advice.

What happens during medical abortion

In a medical abortion, you will need to attend the clinic or hospital on two separate days. On your first visit, you will be given a medicine to take by mouth called mifepristone. This blocks the hormone progesterone that is needed for a pregnancy to continue. After you have taken mifepristone, you may have some vaginal bleeding.

At your second visit, one to two days later, you will be given a medicine called prostaglandin, either taken as tablets or placed into your vagina (a pessary). This makes your womb contract.

Within four to six hours of receiving the prostaglandin, you will have some vaginal bleeding and cramping (similar to period pains), as the lining of your womb starts to break down, ending the pregnancy.

If the abortion doesn’t happen within four hours of receiving the prostaglandin, you may need another dose. This will be given either as a tablet or as a pessary. Alternatively, you may have the abortion completed by surgical abortion.

If you are over 12 weeks pregnant, you may need to stay in hospital until the abortion is complete.

You will be offered pain relief for medical abortion such as ibuprofen.

What happens during surgical abortion

Before the operation, you may be given a prostaglandin as a pessary. This will make it easier for your doctor to open your cervix and will reduce the risk of damage occurring during the operation.
Vacuum aspiration

This procedure is usually carried out under local anaesthesia. Your doctor will inject a local anaesthetic into the entrance to your womb (cervix) to reduce any discomfort or pain. You may also have a sedative for this procedure, which will help you to relax and feel less anxious. Your doctor will then insert a tube into your womb and apply gentle suction, ending the pregnancy. This procedure takes about five to 10 minutes and you will usually be able to go home a few hours after.

Alternatively, the procedure may be carried out under general anaesthesia, which means you will be asleep during the procedure. Talk to your doctor about the best option for you.

Dilation and evacuation (D&E)

D&E is carried out if you are more than 12 weeks pregnant. You will usually have a local anaesthetic for this procedure, though it can also be carried our under general anaesthetic.

Your surgeon will open your cervix and end the pregnancy with a suction tube and forceps. If there is any tissue left in your womb, it will be removed by suction with vacuum aspiration.

This procedure takes less than 30 minutes and you will usually be able to go home on the same day.

If you have a D&E procedure with a general anaesthetic, you may need to stay in the clinic or hospital over night

You will be offered pain relief throughout a surgical abortion, such as ibuprofen. This may be given to you through a drip in your arm and you may also be given tablets to take home to ease any further discomfort.

Recovering from an abortion

If you have had a general anaesthetic, you will need to rest until the effects of the anaesthetic have passed.

Before you leave the clinic or hospital, your doctor or nurse will check how you are feeling and talk you through any aftercare you may need. You may also be given some information to take with you and advice about how to contact a counsellor if you need more help.

If you need pain relief, you can take over-the-counter painkillers such as ibuprofen. Your doctor may also prescribe antibiotics to prevent or treat infection. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You may be invited to have a check-up after your abortion. You may be able to go to the clinic or hospital where the abortion took place, or you may go to your doctor’s surgery or a sexual health clinic.

After your abortion

After your abortion, you may go through a number of different emotions. Some women feel relieved; some feel sadness and grief, whereas others may have mixed feelings.

There is no right or wrong way to feel, but if you’re finding things particularly difficult, try talking to someone close to you such as a friend or relative. Alternatively, you may wish to speak to a health professional for further advice.

What are the risks of abortion?

Abortions are commonly performed and generally safe. However, you need to be aware of the possible side-effects and the risk of complications of this procedure.
Side-effects of abortion

Side-effects are the unwanted, but mostly temporary effects you may get after having the procedure.

You will have some pain in your abdomen and some vaginal bleeding after your abortion, which may feel like strong period pains. This is normal and to be expected.

Bleeding can last for several weeks after a medical abortion, and about two weeks after a surgical abortion. Occasionally, light bleeding, spotting or discharge can continue for up to a month.

However, if your bleeding is very heavy, you should seek medical advice immediately.

Complications of abortion

Complications are when problems occur during or after the procedure.

In a small number of women,some tissue is left in the womb after a medical abortion. This is called an incomplete abortion. You may therefore need to have the remaining tissue removed surgically with vacuum aspiration.

Other specific complications of surgical abortion are uncommon but can include:

• accidental damage to your womb or cervix - this can lead to bleeding and infection, which may require further surgery or, very rarely, a hysterectomy

• infection of your reproductive organs, known as pelvic inflammatory disease (PID) – this can lead to infertility or an ectopic pregnancy (a fertilised egg implanting outside the womb) and may require treatment with antibiotics

You may develop an infection after your abortion. Contact your doctor if you have any of the following symptoms.

• Heavy vaginal bleeding with large clots.

• Severe lower abdominal pain.

• High temperature and generally feeling unwell.

• Unusual or unpleasant smelling vaginal discharge.

If you have an infection, you may need further treatment, which may include a course of antibiotics, or you may need to be admitted to hospital and given antibiotics through a drip in your arm.