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The Science Behind Common Abortion Techniques

Abortion is a common medical procedure that is far too often shrouded in mystery. Here are the facts about the most common abortion techniques.

From the abortion pill to partial birth abortions, there are a lot of myths about the different ways to terminate a pregnancy. But the science of abortion is clear. This procedure is precise, practiced every day all around the world, and it doesn’t have to be shrouded in mystery.

Abortion is a family planning tool. Two of the most commonly cited reasons for seeking an abortion are that the pregnant person is not financially prepared to take care of a baby, or that they want to focus on the children they already have. Nearly 60 percent of people who get abortions are already parents, according to the Guttmacher Institute. That’s why it’s important for parents to know their options in case they do end up with a pregnancy they don’t want to or can’t carry to term.

There isn’t just one type of abortion procedure; there are many different ways to end a pregnancy. The biggest deciding factor on which one a person gets is how far along they are in their pregnancy. Other factors also play a role, such as whether the person wants to have an abortion at home or in a clinic. 

Surgical Abortion

Surgical abortions, also known as in-clinic abortions, use suction to remove the fetus from the uterus. They’re successful 99 times out of 100, according to Planned Parenthood. Surgical abortions take five to 30 minutes and are often done in-clinic with trained staff present for the whole procedure. 

Some medical providers will perform a surgical abortion as soon as a pregnancy test comes back positive. Others prefer to wait until five to six weeks after the person’s last period. In the first trimester, pregnant people receive a type of surgical abortion called a suction abortion. In the second trimester, they get a dilation and evacuation abortion. 

Before a surgical abortion, the patient takes antibiotics to fight infection, medication to open up the cervix, and pain meds to help with cramps. The person may have the option of being sedated during the procedure. Afterward, they wait in a recovery room for about an hour. If they were sedated, someone will need to pick them up.

After the abortion, the person may experience bleeding and cramping and should relax for the rest of the day. Pain meds are okay, but avoid aspirin because it can lead to heavier bleeding. The person should be able to return to their normal daily activities the following day, but they should finish their full course of antibiotics no matter how they feel.

Suction Abortion and Vacuum Abortion

Performed in the first trimester, suction abortions are the most common type of in-clinic abortion.

The procedure starts with a medical provider examining the uterus. They insert a speculum into the vagina to see inside of it and inject a numbing medication into the cervix or nearby. Dilators then stretch the cervix, if they haven’t already been used before the procedure. The nurse or doctor slides a thin tube through the cervix and into the uterus, then gently sucks out the pregnancy tissue with a small hand-held device or machine. They may remove any remaining pregnancy tissue — the fetus, placenta, and placenta sac — from the uterus with a small surgical tool.

A suction abortion, also called a vacuum abortion, takes about five to ten minutes. Although it’s common, it can be risky for people with an abnormally shaped or functioning uterus, a blood clotting disorder, pelvic infection, or other serious health problems. It isn’t painful, but the contraction of the uterus as tissue is removed from it can cause cramping. The total cost is usually between $600 and $1,000, with abortions later in pregnancy costing more, according to Healthline. Some insurance plans cover all or part of the cost.

Dilation and Evacuation

A dilation and evacuation abortion is performed in the second trimester, or at least 16 weeks since the pregnant person’s last period. It often takes two days to complete. On the first day, the nurse or doctor prepares the cervix, usually with medication to help it open and a small dilator to stretch it. On the second day, the provider removes the pregnancy tissue.

The start of the dilation and evacuation abortion is exactly the same as the start of a suction abortion. The only difference is how the pregnancy tissue is removed. During D&E, the doctor or nurse first removes the pregnancy tissues with forceps, then suctions out the uterus, and finally scrapes out the uterine lining with a scoop-shaped surgical tool. Sometimes the provider crushes the skull of the fetus to make it easier to remove.

The second day of the procedure usually takes 10-20 minutes, and it can be painful. Afterward, the patient may need to take a few days off work. They should wait at least a week to resume heavy exercise and two weeks to have sex, according to Healthline. This type of abortion can cost upwards of $1,500, but some insurance plans cover some or all of it.

At-Home Abortion

There are both safe and unsafe ways to perform abortions at home. The safe way is referred to as a medical abortion, but it is more commonly known as the abortion pill. The unsafe way is a self-induced abortion. Pregnant people throughout history have used a range of methods to end a pregnancy on their own, but one of the most common methods today is the coat hanger abortion.

Medical Abortion: The Abortion Pill

The abortion pill, which is actually two pills, is successful 93-96 percent of the time, according to Planned Parenthood. It can be used up until the 10th week of pregnancy.

First, a doctor or nurse in a clinic gives the pregnant person a medication called mifepristone, which blocks progesterone, a hormone that the embryo needs to grow in the uterus. The patient takes the second medication, misoprostol, at home a few hours to four days later. Misoprostol causes the uterus to contract and push out the pregnancy tissue, usually within four to five hours after taking the second pill. However, the process can take as long as two days.

Medical abortion isn’t appropriate for everyone. It may be dangerous for people with a bleeding disorder, who take a blood thinner, have severe liver, kidney, or lung disease, have an IUD, or have been taking corticosteroids for a while.

Like with surgical abortions, the abortion pill often causes cramping and bleeding, which start one to four hours after taking the second pill. The abortion pill comes with additional side effects, which may include passing small blood clots, nausea and vomiting, diarrhea, tiredness, headache, sweating, and dizziness, according to Healthline. The patient may need to take a couple days off work. The abortion pill costs $300 to $800 and is covered by some insurance plans.

Coat Hanger Abortion

Coat hanger abortions are exactly what they sound like: A pregnant person sticks a sharp metal coat hanger up their vagina to induce an abortion. Some use other materials, such as darning needles, crochet hooks, and soda bottles. Needless to say, using any of these is extremely dangerous. Coat hanger abortions were common in the U.S. before Roe v. Wade, but people who can’t access abortions still use this method today. Some of them are even prosecuted for it. 

Induction Abortion

For pregnant people who need an abortion after the second trimester, an induction abortion may be their only option. However, this procedure is rare in the U.S and is only done if medically necessary.

An induction abortion starts with medications that induce labor. This causes the uterus to contract and push out the pregnancy tissue. Afterwards, a nurse or doctor may use a scooping surgical tool to make sure the uterus is empty. This method can cause intense cramps, so patients are given either sedatives or an epidural.

Induction abortions take several hours to more than a day to complete. Side effects include pain, bleeding, cramping, nausea, vomiting, diarrhea, chills, and headache, according to Healthline. Afterwards, the patient may need to take a day or two off from work. They can resume their regular routine within a couple weeks but shouldn’t have sex for two to six weeks. It costs $3,000 or more and is covered by some insurance plans.

Instillation Abortion and Saline Abortion

One subset of induction abortion is the instillation abortion, which was more common in the 1970s. It generally isn’t performed in the U.S. anymore because it carries a relatively high risk of complications. At the beginning of the procedure, a medical provider injects a substance into the amniotic sac around the fetus. Usually, this substance is a saltwater solution, hence the nickname saline abortion. After a few hours, contractions begin, and the cervix pushes out the pregnancy tissue.

Partial-Birth Abortion

Partial-birth abortion is not a medical term. Rather, it’s a legal term used in abortion bans. It refers to an abortion in which the fetus is removed intact, and it’s most commonly used to mean dilation and evacuation abortions. Three states specifically ban dilation and evacuation, only making exceptions when the pregnant person’s life is at risk or when their physical health is in severe trouble, according to the Guttmacher Institute. Twenty-one states ban partial-birth abortion, and all but one have some form of exceptions. Only seven of these bans remain unchallenged, but they may not be legally enforceable.

“After-Birth Abortion”

After-birth abortion isn’t real. It’s not something that’s practiced by doctors or nurses. It’s a term that was invented by two academics who made a controversial argument that infanticide should be allowed after birth as an abortion technique. The argument was solely philosophical, and infanticide is illegal in all U.S. states.

It’s not being done.

That hasn’t stopped some politicians from running with the idea. Earlier this year, some proposed the Born-Alive Abortion Survivors Act. If a child is born alive after an attempted abortion, the act would require doctors to do everything in their power to keep the child alive. A fetus is able to live outside the womb at about 24 weeks old, but less than one percent of all abortions in the U.S. are done this late in pregnancy, so it’s a rare scenario that a baby is born alive after an abortion.

If a pregnant person’s life is at risk late in their pregnancy, they may induce labor. The baby may or may not survive. If it does, and if it has a low chance of survival, the parents may opt for comfort care, in which they choose to hold the baby until they pass rather than frantically trying to save the child’s life. The act would make comfort care legally risky.