In-Clinic Abortion

Whether you’re thinking about having an in-clinic abortion, you’re concerned about a woman who may be having one, or you’re someone who’s just curious about abortion methods, you may have many questions. Here are some of the most common questions we hear women ask about in-clinic abortions. We hope you find the answers helpful. And if you’re thinking of having an in-clinic abortion procedure, we hope they help you decide what is best for you.

Highlights

• What Are the Methods of Abortion?
• How Effective Are These Methods of Abortion?
• What Happens During an In-Clinic Abortion?
• How Safe Are In-Clinic Abortions?
• What Can I Expect After an In-Clinic Abortion?
• Where Can I Get an In-Clinic Abortion? How Much Does It Cost?

There are two abortion methods to end pregnancy. In one, health care providers do an in-clinic abortion with medical instruments. The other method is the abortion pill. It is done only with medication.

There is more than one kind of in-clinic abortion procedure. The most common is called aspiration. It is also known as vacuum aspiration. Aspiration is usually used up to 16 weeks after a woman’s last period. More than 9 out of 10 abortions in the United States happen during this time.

D&E — dilation and evacuation — is another kind of in-clinic abortion. D&E is usually performed later than 16 weeks after a woman's last period. Less than 1 out of 10 abortions in the United States happen during this time. After 24 weeks of pregnancy, abortions are performed only for serious health reasons. 

You can feel confident in knowing that these abortion methods are very effective. They work almost every time they are done. You’ll follow up with your health care provider after your abortion so you can be sure that it worked and that you are well.

It’s common for women to be nervous about having an abortion — or any other medical procedure. But most of us feel better if we know what to expect. Your health care provider will talk with you and answer your questions. But here’s a general idea of how it works and what to expect.

Before the abortion procedure, you will need to

• discuss your options
• talk about your medical history
• have laboratory tests
• have a physical exam — which may include an ultrasound
• read and sign papers

ASPIRATION ABORTION — THE MOST COMMON KIND OF IN-CLINIC ABORTION

During an aspiration abortion

• Your health care provider will examine your uterus.
• You will get medicine for pain. You may be offered sedation — a medicine that allows you to be awake but deeply relaxed.
• A speculum will be inserted into your vagina.
• Your health care provider may inject a numbing medication into or near your cervix.
• The opening of your cervix may be stretched with dilators — a series of increasingly thick rods. Or you may have absorbent dilators inserted a day or a few hours before the procedure. They will absorb fluid and get bigger. This slowly stretches open your cervix. Medication may also be used with or without the dilators to help open your cervix.
• You will be given antibiotics to prevent infection.
• A tube is inserted through the cervix into the uterus.
• Either a hand-held suction device or a suction machine gently empties your uterus.
• Sometimes, an instrument called a curette is used to remove any remaining tissue that lines the uterus. It may also be used to check that the uterus is empty. When a curette is used, people often call the abortion a D&C — dilation and curettage.

An aspiration procedure takes about 5 to 10 minutes. But more time may be needed to prepare your cervix. Time is also needed for talking with your provider about the procedure, a physical exam, reading and signing forms, and a recovery period of about one hour.

D&E

During a D&E

• Your health care provider will examine you and check your uterus.
• You will get medication for pain. You may be offered sedation or IV medication to make you more comfortable.
• A speculum will be inserted into your vagina.
• Your cervix will be prepared for the procedure. You may be given medication or have absorbent dilators inserted a day or a few hours before the procedure.  They will absorb fluid and grow bigger. This slowly stretches open your cervix.
• You will be given antibiotics to prevent infection.
• In later second-trimester procedures, you may also need a shot through your abdomen to make sure there is fetal demise before the procedure begins.
• Your health care provider will inject a numbing medication into or near your cervix.
• Medical instruments and a suction machine gently empty your uterus.

A D&E usually takes between 10 and 20 minutes. But more time is needed to prepare your cervix. Time is also needed for talking with your provider about the procedure, a physical exam, reading and signing forms, and a recovery period of about one hour.

How Do In-Clinic Abortions Feel? You may have concerns about how an abortion will feel. Most women feel pain similar to menstrual cramps with both of these abortion methods. For others, it is more uncomfortable. Your health care provider will help to make it as comfortable as possible. You will be given pain medication. Local numbing medicines are usually used. Some clinics offer sedation. Rarely, general anesthesia may be offered for certain procedures. It allows a woman to sleep through the procedure — but it increases the medical risks and how long you must remain at the clinic. You may have cramps after an abortion. You will probably want to relax for the rest of the day.

BLEEDING AFTER IN-CLINIC ABORTION PROCEDURES

You may have some bleeding after your abortion. This is normal. You may pass a few clots about the size of a quarter. It’s normal to have

• spotting that lasts up to six weeks
• heavy bleeding for a few days
• bleeding that stops and starts again

It’s OK to use pads or tampons, but using pads makes it easier to keep track of your bleeding. 

It’s also normal to have no bleeding after an abortion.

If you are concerned about your bleeding after an abortion, give your health care provider a call.

Safety is an important and common concern for women. In-clinic abortion procedures are very safe. But there are risks with any medical procedure. The risks increase the longer you are pregnant. They also increase if you have sedation or general anesthesia. Possible risks include

• an allergic reaction
• blood clots in the uterus
• incomplete abortion — part of the pregnancy is left inside the uterus
• infection
• injury to the cervix or other organs
• undetected ectopic pregnancy
• very heavy bleeding

Most often, these complications are simple to treat with medicine or other treatments.

In extremely rare cases, very serious complications may be fatal.

• The risk of death from childbirth is 11 times greater than the risk of death from an abortion procedure during the first 20 weeks of pregnancy.
• After 20 weeks, the risk of death from childbirth and abortion are about the same.
• Overall, the risk of death from abortion increases the longer a woman has been pregnant.

Serious complications may have warning signs. Call your health care provider right away if you have

• very heavy bleeding — if you pass clots larger than a lemon or soak through more than two maxi pads an hour, for two hours or more in a row
• pain or discomfort that is not helped by medication, rest, a hot water bottle, or a heating pad
• a fever
• vomiting for more than four to six hours and you are not able to keep anything down
• an unpleasant, smelly discharge from your vagina
• signs that you are still pregnant

Your health care provider will let you know what to do and what not to do after your abortion. Many of us feel shy about asking questions, but your provider is there to help you. Feel free to get answers to all of your questions. You might even find it helpful to make a list before you see your health care provider so you remember the questions you want to ask.

Right after your abortion ...

• You will rest in a recovery area. 
• If you have an Rh-negative blood type, you will receive a shot to protect your future pregnancies.
• You will receive written after-care instructions and a 24-hour-a-day, seven-days-a-week telephone number you can call if you have any questions or concerns.
• You can get birth control.  (You can have an IUD inserted at the same time as your abortion procedure. If you want an IUD, let the clinic know when you schedule your abortion procedure.) 
• You will make a follow-up appointment to come back in 2 to 4 weeks.
• Do not drive after the procedure if you've had sedation.
• You can usually return to work or other normal activities the next day. Recovery after D&E may take longer.
• You may bathe as soon as you wish. Do not douche or use medicines in your vagina.

YOUR FEELINGS AFTER AN ABORTION

You may have a wide range of feelings after your abortion. Most women ultimately feel relief after an abortion. Some women feel anger, regret, guilt, or sadness for a little while.

Serious, long-term emotional problems after abortion are about as uncommon as they are after giving birth. You may be more likely to have emotional problems after abortion for certain reasons. Some of these reasons are

• having a history of emotional problems before your abortion
• having important people in your life who aren’t supportive of your decision to have an abortion
• having to terminate a wanted pregnancy because your health or the health of your fetus is in danger

If you want to talk with someone after an abortion, abortion providers can talk with you or refer you to a licensed counselor or to nonjudgmental support groups.

GETTING YOUR PERIOD AFTER AN IN-CLINIC ABORTION PROCEDURE

Abortion begins a new menstrual cycle. You should have a regular period in 4 to 8 weeks.

SEX AND BIRTH CONTROL AFTER AN IN-CLINIC ABORTION PROCEDURE

Many health care providers recommend that you not have vaginal intercourse or insert anything except a tampon into your vagina for one week after the abortion.

You can get pregnant very soon after an abortion. So, birth control is an important and common concern for many women after abortion. Talk with your health care provider about getting a birth control method that’s best for you.

Visit a Planned Parenthood health center, a clinic, or a private health care provider to find out about where you can get an abortion. Planned Parenthood health centers that do not provide abortion can refer you to someone who does.

Nationwide, the cost at health centers ranges from about $350 to $900 for abortion in the first trimester. The cost is usually more for a second-trimester abortion. Costs vary depending on how long you've been pregnant and where you go. Hospitals generally cost more.

A short video about abortion procedures is under production.