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Abortion: Methods And Post-Procedure Care

by — 2013-09-24 in Pregnancy
How much do you know about the different abortion methods, when they are carried out, and how women who have just had an abortion need to care for themselves? This article covers the basics everyone who wants to find out more needs to know.

Are you looking for information about abortion and post-abortive care, whether for yourself or someone you care about? This article offers a brief overview of the abortion basics everyone can benefit from knowing. That includes your different options and aftercare instructions.

Ending Pregnancy With Medication

Medical abortion is the induction of miscarriage with medication, most commonly a combination of mifepristone and either misoprostol or gemeprost. In the United States, medical abortions are performed only up to nine weeks pregnancy in the vast majority of cases. In other countries (Canada, some European countries, India, China), medical abortion is also available during the second trimester of pregnancy.

Read More: Abortion: Yes Or No?

What is the advantage of a medical abortion regimen over the more well-known surgical abortion? To some women, taking medication feels less invasive and more natural.

Medical abortion allows women to complete their abortion in the privacy of their own home, without doctors around.

On the other hand, the process of a medical abortion can take a long time to complete — unlike surgical abortion methods that are finished within a predetermined amount of time, you will not know for sure when the process is done. After taking the second medical abortion pill, the abortion may be take anywhere from six hours to a full week to happen. This can be agonizing mentally and may require a woman to take time off work because a medical abortion can be painful, just like a natural miscarriage or heavy period cramps.

The other disadvantage of medical abortion is the fact that women will still require a surgical abortion if — for some reason — the medication fails to induce a miscarriage or expel all the contents of the uterus. Carrying on a pregnancy after the attempt to have a medical abortion carries a significant risk of birth defects, and is not recommended.

Surgical Abortion

In a surgical abortion, instruments are used to physically enter the uterus to remove its contents and end the pregnancy. There are three types of surgical abortion: vacuum aspiration, dilation and evacuation (D&E), and dilation and extraction (D&X).

The type of abortion a woman will have depends on the stage of pregnancy she is in, something that will be confirmed by ultrasound.

A vacuum aspiration essentially suctions out the contents of the uterus, after the cervix is opened. This type of abortion can be performed up to 16 weeks gestation (14 weeks after fertilization). The procedure lasts up to 15 minutes, and local anesthesia is usually used.

A D&E is an abortion method that is used after 16 weeks gestation and requires gradual dilation of the cervix before removing the contents of the uterus with instruments and scraping its lining to ensure no tissues are left, thereby helping to prevent infection after the procedure. This procedure takes up to 30 minutes and carries a higher risk of infection and post-abortive complications such as cervical damage than a vacuum aspiration does. Antibiotics are offered after the procedure to limit this risk.

A dilation and extraction, D&X, is a more invasive procedure because it is used after 21 weeks of pregnancy, when fetal development is more advanced. It is a lengthy procedure in which requires dilation of the cervix two days prior to the extraction of the fetus. When the patient's water breaks, she returns to the clinic, and the fetus is rotated, an incision made in the skull to allow a suction catheter inside, and the skull is collapsed to facilitate removal. The fetal remnants are then removed from the uterus with the help of medical instruments.

The latter two abortion types can be carried out under local anesthesia, with an epidural, or under general anesthesia, depending on the clinic's policies and abilities, and the patient's wishes. If you are offered general anesthesia, make sure to discuss the risks and benefits with your doctor before the procedure.

Pre And Post-Abortion Care

Before having an abortion, the abortion provider should discuss the details of the procedure with the patient in detail and ensure that she understands and gives her consent. This pre-abortion care varies from country to country and also from clinic to clinic. In some cases, it is a mere formality. In others, the pre-abortion appointment involves psychological screening.

If the patient is under 18, she may also be required to obtain the consent of a parent, both parents, or an adult in her family — again, depending on the jurisdiction. Some states in the US have no regulation on this, whereas others do.

Read More: Is Post-Abortion Syndrome Real?
Post-abortive women are likely to experience a range of emotions, from relief, hope, and liberty to sadness, regret, depression and suicidal thoughts. If, at any point after an abortion, you feel that you would benefit from counseling, it is a good idea to pursue that, as it can help you process your emotions.
 
After the abortion, the woman will be given post-procedure care instructions. They need to be followed closely to prevent complications. Women who have had an abortion are likely to bleed for around three weeks, and they should avoid inserting anything into their vagina (including tampons or having sexual intercourse) for the duration of this bleeding. Vaginal douches, baths, hot tubs and other forms of immersion are strictly discouraged as well, as they can lead to infection. Heavy lifting and strenuous exercise should also be avoided.
 
After an abortion, it is also important to watch out for excessive bleeding and signs of infection.

Excessive bleeding is passing large clots and soaking more than two pads within an hour, bleeding heavily for more than 12 hours, and bleeding heavily while suffering from heavy abdominal cramps. Fever, pain and abdominal tenderness, foul-smelling discharge and nausea or vomiting are signs of infection. Women who suffer from either excessive bleeding or signs of infection should call their abortion provider or head to the ER immediately.

The post-abortion period offers a good opportunity to discuss birth control options with a healthcare provider, for those women who would like to take steps to prevent pregnancy in the future. Women who want to try to become pregnant again are generally advised to wait two full menstrual cycles before doing so.  

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