Abortions can only be carried out under the care of hospitals or licensed clinics, by qualified doctors.If you’re less than 10 weeks pregnant and having a medical abortion, the hospital or clinic can usually give you the second dose of self medication to take at home.Most people having an abortion do not usually need to stay in the clinic or hospital overnight, but you may need to go to appointments on different days.
Before an abortion
Before having an abortion, you’ll need to have an assessment appointment. This usually happens at the hospital or clinic, but you may be offered a phone or video assessment.
During this assessment, you may:
- discuss your reasons for considering an abortion and whether you’re sure about your decision
- be offered the chance to talk things over with a trained counsellor if you think it might help
- talk to a nurse or doctor about the abortion methods available, including any associated risks and complications
- get an ultrasound scan to check how many weeks pregnant you are
- be offered testing for sexually transmitted infections (STIs)
- need to have other tests such as a blood test, depending on any medical conditions you have or the stage you’re at in the pregnancy
When you’re sure you want to have an abortion, you’ll be asked to sign a consent form and the clinic or hospital will arrange a date for the abortion.
You can change your mind at any point up to the start of the abortion.
There are 2 main types of abortion:
- medical abortion (“abortion pill”) – taking medicine to terminate the pregnancy
- surgical abortion – a procedure to terminate the pregnancy
Medical abortion involves taking pills (2 different medicines) to end the pregnancy. The effects of abortion pills result in a process similar to a miscarriage. Abortion pills (mifepristone and misoprostol) are a safe and effective way to end a pregnancy in the first 12 weeks of pregnancy. The term “medication abortion” refers to the use of either the combination of mifepristone plus misoprostol or misoprostol taken alone to end a pregnancy. Medication abortion works better, is quicker and has less risk of complications when done earlier in pregnancy, so women who decide to have an abortion should do so as early as possible.
Medication abortion usually involves taking a combination of the two medicines mifepristone and misoprostol. If mifepristone is not available, misoprostol can also be used alone. In the absence of mifepristone, a woman will need to take more misoprostol pills, the process tends to be longer, and she may experience more side effects to achieve comparable success.
Depending on the setting and context, a woman can have a medication abortion in a health facility, at home (or another private place where she feels secure and comfortable), or in a combination of the two. Women can have a successful abortion if they have accurate information, access to quality medications, and know the signs of complications for which they should seek immediate medical care. Medication abortion is suitable for women of all ages and sizes, including adolescents. An uncomplicated medication abortion will not affect a woman’s ability to carry future pregnancies.
A visit to a health facility is not usually necessary following an uncomplicated medication abortion. If a woman is unsure that the abortion was successful, she may choose to visit a health facility to confirm that she is no longer pregnant.
Surgical abortion involves an operation to remove the pregnancy from the womb. It may be done with:
- local anaesthetic (to numb the cervix)
- conscious sedation (where you’re relaxed but awake)
- deep sedation or general anaesthetic (where you’re asleep)
Most people having deep sedation will not remember anything and will not be aware during the operation. If you have a general anaesthetic, you’ll be fully asleep during the operation and will not remember anything.
What kind of anaesthetic or sedation you have depends on your circumstances, how many weeks pregnant you are and your own preference.
Before a surgical abortion, you’ll be asked to have a medicine to open the cervix. This happens either a few hours or 1 to 2 days before the operation, depending on the medicine used.
There are 2 methods of surgical abortion.
- Vacuum or suction aspiration
This can be used up to 14 weeks of pregnancy. Vacuum aspiration involves a small tube (cannula) which is inserted into the vagina, through the cervix (the mouth of the uterus) and into the uterus. The contents of the uterus are then suctioned out. Vacuum aspiration is a simple and very safe procedure that should only take about 5-10 minutes. It is highly effective for both abortion and treatment of incomplete abortion (when an abortion has started but the contents of the uterus have not been fully expelled) and can be used from early to later pregnancy. - Dilatation and evacuation (D&E) This is used after 14 weeks of pregnancy. D&E is a form of abortion that uses a combination of specialized forceps and vacuum aspiration to empty the uterus, it involves inserting special instruments called forceps through the cervix and into the womb to remove the pregnancy. The procedure can be used for an abortion in later stages of pregnancy than the MVA procedure, and for treatment of incomplete abortion or postabortion care. D&E is usually carried out under sedation or general anaesthetic. It normally takes about 10 to 20 minutes and you’re usually able to go home the same day.
After an abortion
You do not usually need to have any other tests or appointments after a surgical abortion, or a medical abortion in hospital.
If you have a medical abortion at home, you may need to have a special kind of pregnancy test or scan to make sure the pregnancy has ended.
If you have a medical abortion, you may have short-lived side effects from the medicines, such as diarrhoea and feeling sick.
If you have a surgical abortion, the general anaesthetic and sedation medicines can also have side effects.
For all types of abortion, it’s likely you’ll have some stomach cramps (pain) and vaginal bleeding. Bleeding usually lasts a week or two. Sometimes light vaginal bleeding after a medical abortion can last up to a month.
After an abortion, you can:
- take painkillers like ibuprofen or paracetamol to help with any pain or discomfort
- use sanitary towels or pads rather than tampons until the bleeding has stopped
- have sex as soon as you feel ready, but use contraception if you do not want to get pregnant again as you’ll usually be fertile immediately after an abortion.
You can usually return to normal activities as soon as you feel comfortable to, including having a bath or shower, using tampons, exercising (including swimming) and heavy lifting.
When to get medical help
Get advice if you:
- have pain or bleeding that does not get better in a few days
- still feel pregnant after about a week
- have a temperature, flu-like feelings or unusual vaginal discharge – these could be signs of infection
- have any other worries
You may experience a range of emotions after an abortion. This is common.
If you need to discuss how you’re feeling, contact the provider or your general doctor.
They will be able to provide counselling or refer you for counselling if you need it.
