Although the number of women in the United States choosing medication abortion (abortion with pills) is increasing each year, aspiration abortion (also called surgical or suction abortion) is currently the most common method used for abortions during the first twelve weeks of pregnancy. In 2010, about 72% of all first trimester abortions were aspiration abortions.
Some of the reasons women choose aspiration abortion over medication abortion are easier access and higher success rates. In addition, a surgical abortion is shorter and completed in a predictable period and fewer office visits are needed.
In aspiration abortion, the uterine contents are removed by suction (aspiration), which is applied through a cannula, a thin tube that is inserted into the uterus and connected to a source of suction, either an electric pump or a handheld syringe. (If no electric pump is used, the abortion is a manual vacuum aspiration, or MVA.)
Aspiration abortion is a safe medical procedure. Fewer than 1 in 200 women who have an aspiration abortion in the first 12 weeks of pregnancy experience a complication that requires hospitalization. The risk of death from abortion is always lower than the risk of death involved in carrying a pregnancy to term.
I was really nervous about being awake during the abortion, especially because I’m afraid of needles. But the numbing part felt more like pressure than pain, and the cramps were bad for only a few minutes. I held my partner’s hand, did some deep breathing, and I couldn’t believe how fast it was over.
However, gestational age is the most important risk factor in death from abortion. According to the Guttmacher Institute, for abortions at under eight weeks, the risk of death is less than one in one million, compared one per 29,000 at 16–20 weeks—and one per 11,000 at 21 weeks or later.
Aspiration abortion is successful at ending a first trimester pregnancy 99.5% of the time. For the 0.5% times the procedure fails, it is repeated.
What to Expect
Before starting the procedure, the clinician will perform a pelvic exam to check the size and position of your uterus. In some clinics, ultrasound may be used before the procedure to confirm how far along you are in the pregnancy. (Read more about ultrasounds and viewing the image in What to Expect at the Clinic.) An ultrasound may also be done during or after the procedure to ensure that the uterus has been emptied.
Next, the clinician will insert a speculum into your vagina to separate the vaginal walls and bring your cervix into view. Although you may feel pressure, this should not hurt. Ask the clinician to adjust the speculum if it pinches.
After washing the cervix with antiseptic solution, the clinician will place a tenaculum (a long-handled, slender instrument) on the cervix. This instrument allows the clinician to hold the cervix in the proper position during the abortion; you may feel a pinch or a cramp when it is applied.
Next, the local anesthetic solution is injected around the cervix in two or more places. Although many women are apprehensive about this step, injections into the cervix are usually less painful than injections in other parts of the body. You may feel pressure or a pinch, or nothing at all. You may also feel a slight burning sensation as the medicine is injected into the cervix and brief cramping and nausea. Some women also experience ringing in the ears and tingling in the lips or tongue.
I experienced some pain with the procedure, but mostly, it was just a series of new sensations. I had never been so aware of my uterus. I spent an hour lying down to recover. I remember being elated—it was over! The only way to describe it was relief!”
Once the cervix is numb, the provider will gradually stretch the opening of the cervix by inserting and removing dilators (tapered rods) of increasing size. You will probably feel pressure and perhaps some cramps on and off. Dilating typically takes less than two minutes.
Next, the cannula — a sterile strawlike tube — is inserted through the cervix into the uterus. The size of the cannula depends on how pregnant you are; it may range from the size of a small drinking straw to that of a large pen (half an inch). The clinician connects the cannula to a handheld vacuum device (manual vacuum aspiration) or an electric vacuum device and then moves the cannula back and forth to draw out the pregnancy tissue.
If the clinician uses a vacuum machine (electric vacuum aspiration), you may hear the humming of the machine and a whooshing noise when the cannula is removed. The aspiration by handheld or electric vacuum usually takes only a few minutes.
You’ll likely feel some cramping as the uterus contracts and empties. The contractions are important, because they squeeze shut the blood vessels of the uterus. The cramps may range from mild to intense, but they usually lessen immediately after the cannula is removed or within the next several minutes.
After wiping out your vagina and checking for bleeding, the practitioner will remove the speculum and examine the tissue to be sure the pregnancy has been fully removed. You can ask to see the pregnancy tissue, if you’d like.
A staff person will make sure you are feeling okay. Then you can move into a more comfortable room to sit or lie down for a while.
For more information on recovering from an abortion, see Aftercare.