What Are The Different Types Of Medically Prescribed Abortion Methods?

Aborting a pregnancy is one of the hardest decisions any woman may have to face. For many, an abortion is necessary due to complications that put the life of the pregnant woman at risk, or because of serious developmental issues with the fetus that make chances of survival slim at best. Sometimes, abortion is a personal choice that may be made because of serious disabilities or illnesses in the fetus.

What follows is not an evaluation of the ethics or morality of aborting a pregnancy. Instead, we will be providing valuable information on the alternatives available for any woman facing the excruciating decision of having an abortion. Remember, these are options that can be explored under the direction of a trained medical practitioner only in states where such procedures are legal. After understanding your options, it’s important that you also read up on the side effects of each.

1. Abortion Options By Trimester

According to the Centers for Disease Control data on legal abortions in 2013, about 91.6 percent were done before the pregnancy reached 13 weeks of gestation; 7.1 percent took place between weeks 14 and 20; and just 1.3 percent occurred beyond 21 weeks.¹

• During the first trimester, a woman can undergo a surgical abortion or take medication to induce abortion.
• During the second trimester, surgical methods, like Dilation And Curettage (D&C) or Dilation And Evacuation (D&E), are the only options.
• Beyond the second trimester, abortions are illegal in most states in the United States. Even where it is permitted, the procedure is only allowed in exceptional cases due to severe medical reasons.
• Beyond 24 weeks of gestation, the fetus is considered “viable” or able to survive outside the womb. Procedures at this point and beyond are considered late-term abortions. If, for some reason, an abortion at this point is absolutely necessary, a D&E procedure is normally done or, in some instances, a labor induction abortion.²

2. Abortion With Pills

This surgery-free option can only be used very early in the pregnancy. Two medications, taken over a few days, are usually prescribed. The medicine can be taken in the privacy of your own home. However, this process is only effective if done within 63 days or 9 weeks of your last menstrual period. Some research has found it works as late as 70 days or 10 weeks after the last period.³

• First, 200 mg of mifepristone is prescribed to block progesterone – without this hormone, the uterine lining thins, preventing the embryo from remaining implanted.
• Next, about 800 mg of prostaglandin misoprostol is to be taken. This causes cramps and heavy bleeding as the uterus contracts, expelling the pregnancy via the vagina. This may happen within 4–5 hours or may take a few days.
• A follow-up must be done within 14 days of taking the first pill to make sure the procedure has worked effectively.⁴

3. Vacuum Aspiration/Suction Curettage/Dilation And Curettage

This surgical option is available up to 16 weeks from a woman’s last period.⁵ It takes around 5 to 10 minutes for the actual procedure and 30 to 60 minutes of rest in the hospital or clinic’s recovery area. After local or general anesthesia is administered, the cervix is opened using dilators (thin rods). A tube is inserted into the uterus via the cervix. The doctor then uses a hand-held suction machine to empty the uterus. During the procedure, you may feel menstrual-like cramps.⁶

4. Dilation And Evacuation

This surgical procedure is usually done to terminate pregnancies between 15 and 24 weeks of gestation. The cervical preparation needed is done either a day before or earlier on the day of surgery.

• General anesthesia is administered intravenously before the doctor can examine the uterus.
• Next, a speculum is inserted into the vagina, with dilators used to stretch the cervix if need be.
• Narrow forceps are used to remove the pregnancy, after which a tube is inserted and a suction machine used to evacuate the pregnancy.
• After going under general anesthesia, the actual procedure takes 10 to 20 minutes, but you will need to stay in observation and recovery for a couple of hours before you’re allowed to go home.
• You should also refrain from driving for 24 hours after the procedure.

For those who are 23 weeks into their pregnancy or beyond, an injection is administered to the fetus to stop its heartbeat before the surgery begins. This additional step can be especially difficult emotionally, so it’s best to have someone with you before and after the procedure.⁷

5. Labor Induction

During this process, uterine contractions are stimulated so that the body can expel the fetus along with the placenta. This is done using medical agents.

• About 400 mcg of misoprostol is administered every 3 hours in order for it to work efficiently while limiting side effects.⁸
• According to the Society of Family Planning, when done in the second trimester, labor induction abortion should ideally use a combination of misoprostol and mifepristone for a quicker and more effective process.⁹