The vast majority of abortions in the United States –nearly 92% — take place during the first trimester of pregnancy. (For information on the kinds of abortion performed in the first trimester, see “Early Abortion Options.”)
For women who have a later abortion, the most common method is dilation and evacuation (D&E), which involves removing the fetal and placental tissue with a combination of suction and instruments. A small number of second-trimester abortions are done by inducing labor with drugs, a procedure called induction abortion.
As the name implies, induction abortion involves medications that cause the uterus to contract and expel the pregnancy. After a certain point in pregnancy (usually around 24 weeks), a dilation and evacuation (D&E) procedure can no longer be performed and the only option is an induction abortion.
What to Expect
The experience of an induction abortion is similar to labor, although as the fetus is smaller than a full-term baby the process may last a shorter time. Painful contractions can last for several hours or even a day or so.
The procedure usually takes place in specialized facilities or hospitals, where the quality of care and degree of personal attention vary. Although a few specialized clinics have dedicated space for induction abortion, most general hospitals don’t. Therefore, you may find yourself on a ward with women who are giving birth. If possible, bring a partner or friend to support you and to help ensure that you get the compassionate treatment you deserve.
Preparation for an induction abortion is much the same as for D&E, except that you may need to plan for an overnight stay in the hospital or hotel located near the clinic. You will have blood tests and an ultrasound exam, and the clinician may use osmotic dilators to prepare your cervix.
Medications to induce abortion can be given in a number of ways. Most commonly, prostaglandin suppositories or misoprostol tablets are inserted into your vagina every few hours. Oxytocin (Pitocin) may be given through an IV line. For later abortions, an injection into the abdomen may be given to ensure fetal demise. Although this may sound scary, the abdomen is numbed before the injection, and you will probably feel only a slight cramp when the needle enters your uterus.
The contractions will probably feel like mild cramps at first and then become more intense. Each woman’s experience is different. When the amniotic sac breaks, you will feel a gushing of warm liquid from the vagina. Later, you may experience a lot of pressure in the rectal area as the fetus is expelled. If the placenta does not come out within a few hours, your provider may use suction or a curette (a small, spoon-like instrument) to remove it.
For pain, you may be given strong medications, sedatives, or epidural anesthesia — regional anesthesia commonly used in childbirth) Relaxation exercises, deep breathing, and the support of a friend can help make the contractions easier to tolerate. Medications are also available to control common side effects such as nausea, vomiting and fever. You should be as comfortable as possible during the abortion process, so ask for more pain medication or support if you need it.
For more information on later abortions, including additional links to resources, visit the Later Abortion section developed by Advancing New Standards in Reproductive Health Care, University of California, San Francisco. The site includes resources for women, clinicians, researchers and policymakers.