Understanding Abortion Procedures
What Happens During an Abortion?
If abortion is one of the options you are considering, you deserve clear, complete information about what each procedure involves—including how the pregnancy is ended, what you may experience physically, and the possible risks, side effects, and complications.
Which procedure may be used can depend on how far along you are, embryonic or fetal development, your health, and your medical history. Knowing these details can help you understand what to expect, recognize important questions to ask, and make sure you have the information you need before deciding.
Medication Abortion
Medication abortion, commonly called the abortion pill, generally involves two drugs during early pregnancy.
Mifepristone is taken first. It blocks progesterone, a hormone needed for the pregnancy to continue developing. Misoprostol is then taken, typically 24 to 48 hours later. It causes the uterus to contract, leading to cramping, bleeding, and the expulsion of the developing embryo or fetus and pregnancy tissue.
Bleeding and cramping are expected and may be heavier than a menstrual period. Other possible effects include nausea, vomiting, diarrhea, chills, weakness, headache, and a temporary fever. Bleeding or spotting may continue after the embryo or fetus and pregnancy tissue have passed.
Follow-up may include contact with a healthcare provider, a pregnancy test, bloodwork, or an ultrasound to confirm that the abortion is complete. Additional treatment may be needed if the pregnancy continues, tissue remains in the uterus, or heavy bleeding or infection develops.
Surgical Abortion
Surgical abortion is performed in a medical setting. The technique used varies according to how far along the pregnancy is.
Vacuum aspiration is commonly used earlier in pregnancy. The cervix is opened, and a narrow tube attached to suction is passed into the uterus to remove the developing embryo or fetus and pregnancy tissue.
Later in pregnancy, dilation and evacuation (D&E) may be used. The cervix is opened more gradually, sometimes beginning several hours or a day before the abortion. Suction and surgical instruments are then used to remove the fetus and pregnancy tissue from the uterus.
Pain management may include local anesthesia, oral medication, intravenous sedation, or general anesthesia, depending on the procedure, gestational age, provider, and medical setting.
Possible complications may include:
- Heavy or prolonged bleeding
- Incomplete abortion or retained tissue
- Infection
- Ongoing pregnancy after medication abortion
- Injury to the cervix or uterus
- A reaction to medication, sedation, or anesthesia
- The need for additional medication, another procedure, or emergency treatment
Please don’t hesitate to seek immediate medical attention if you experience very heavy bleeding, severe or worsening pain, fainting, difficulty breathing, a persistent fever, foul-smelling vaginal discharge, or if you feel seriously unwell or are concerned about your symptoms. Your health and safety matter. Please also follow any emergency or aftercare instructions provided by the healthcare professional who prescribed your medication or performed your procedure.
Questions to Ask Before an Abortion
Before moving forward, it is important to know exactly what will happen, who will provide the abortion, what risks may be involved, and what support will be available if complications occur.
The questions below can help you identify what you still need to know.
As you consider your options, it is important to have clear answers to these questions:
Ultrasound & Pregnancy Information
- Is an ultrasound performed before the abortion?
- Will I have the choice to see the ultrasound images?
- Is the ultrasound reviewed by a physician or radiologist?
- Can I receive a copy of my ultrasound images or report?
- How was my gestational age determined?
- Am I at risk for an ectopic pregnancy?
Medication & Surgical Abortion
- Why might a surgical abortion be recommended instead of a medication abortion?
- Are there situations when a second dose of misoprostol may be needed?
- How will I know whether the abortion is complete?
- What happens if the abortion medication does not work and the pregnancy continues?
- Why is a surgical abortion being recommended instead of medication?
- What possible risks, side effects, and complications can occur with a medication or surgical abortion?
Safety, Follow-Up & Emergency Care
- How will I know if I am experiencing a complication?
- What symptoms require immediate medical attention?
- What follow-up care is provided after the abortion?
- Who do I contact after hours if I have questions or concerns?
- If complications occur, who will be responsible for my follow-up care?
Provider & Facility Information
- Who will be performing the procedure or prescribing the medication?
- Is the provider a licensed physician?
- What training and experience does the provider have?
- Have emergency medical services or an ambulance ever been called to the facility?
- Have any lawsuits, malpractice claims, disciplinary actions, license restrictions, formal complaints, or safety concerns been filed against the provider or facility?
Understanding Abortion Procedures: A Visual Explanation
After reading about medication and surgical abortion, you may find it helpful to also see a visual explanation of how these procedures are performed. The following video provides another way to understand the information above and how abortion procedures differ depending on the stage of pregnancy.
Dr. Anthony Levatino, an OB-GYN and former abortion provider, explains abortion procedures used during the first, second, and third trimesters of pregnancy. Earlier in his medical career, Dr. Levatino performed approximately 1,200 abortions, giving him firsthand experience with these procedures.
In this educational video, he explains how different abortion procedures are performed and how they vary depending on the stage of pregnancy.
Questions About Abortion
Every experience is different. After taking misoprostol, the second medication commonly used in a medication abortion, bleeding and cramping are expected as the uterus contracts and the pregnancy passes.
Bleeding is often heavier than a menstrual period and may include blood clots and embryonic tissue. Cramping can be strong and may be more intense than typical menstrual cramps. Bleeding and cramping often begin within several hours after taking misoprostol, although the timing and intensity can vary.
The heaviest bleeding generally occurs while the tissue is passing and should decrease afterward. Lighter bleeding or spotting may continue on and off for several weeks.
Misoprostol may also cause nausea, vomiting, diarrhea, headache, dizziness, fatigue, fever, or chills. These side effects are usually temporary. Pregnancy symptoms such as breast tenderness may take longer to go away as pregnancy hormone levels decline.
What you see can depend on how far along the pregnancy is. You may see blood clots, the gestational sac, or embryonic tissue.
Earlier in pregnancy, the pregnancy tissue is very small and may be difficult to distinguish from blood and clots. As pregnancy advances, the tissue may become more recognizable.
Follow-up testing or medical evaluation may be needed to confirm that the pregnancy has ended.
Bleeding and cramping usually decrease after the embryonic passes, and pregnancy symptoms should gradually improve. However, symptoms and bleeding alone cannot always confirm that the abortion is complete.
Depending on your circumstances, confirmation may involve a follow-up pregnancy test, blood testing to measure hCG levels, an ultrasound, or evaluation by a healthcare professional.
Pregnancy tests can remain positive for a period of time after a successful medication abortion because hCG does not disappear immediately.
Yes. In some circumstances, additional misoprostol may be recommended, such as when the pregnancy has not passed completely or when the medication regimen being used calls for additional doses. Whether another dose is appropriate depends on factors such as gestational age, symptoms, the medication regimen used, and clinical findings.