There are different abortion procedures and the method used depends on how long you have been pregnant. An abortion service should ideally be able to offer you a choice of abortion methods, although this may not always be possible.
Early medical abortion (up to nine weeks of pregnancy)
Early medical abortion (sometimes called EMA) involves taking drugs to cause an early miscarriage. It does not involve surgery or an anaesthetic and you will need three appointments. The first is an assessment – the abortion will not be carried out at this visit. You will then need two appointments on two separate days. You should be able to carry out your usual activities between appointments.
At the second appointment, you will be given a tablet (called mifepristone) to swallow. This blocks the pregnancy hormone that is necessary for the pregnancy to continue.
It is very unlikely that the abortion will happen after taking only the mifepristone, but very occasionally it can happen. Some women change their mind about the abortion after they have taken the mifepristone. Although studies so far do not show that mifepristone is associated with any risk of fetal abnormality, women are advised to continue with the abortion once they have taken mifepristone. You will be given a 24-hour contact telephone number in case you are worried or would like to talk to someone at any time.
At the third visit (one or two days later) you will be given prostaglandin tablets (called misoprostol or gemeprost). Misoprostol can be used in the vagina or taken by mouth; gemeprost can only be used in the vagina. This causes the uterus (womb) lining to break down and you will start to bleed. You may feel cramping pains similar to period pains; you will be offered pain-relieving drugs. The pregnancy is lost with the bleeding just like a miscarriage. This normally happens four to six hours after using the prostaglandin tablets.
Medical abortion after 9 weeks
The drugs used for early medical abortion are also used for abortion later in pregnancy. Because the abortion is being carried out later in the pregnancy it may take longer, and higher and repeat doses of prostaglandin may need to be used, along with pain-relieving drugs. The abortion is like having a late miscarriage and is usually completed in time for you to return home on the same day, but sometimes it is necessary to stay overnight, particularly when the abortion is carried out later in the pregnancy.
Vacuum aspiration from seven to 15 weeks of pregnancy
Vacuum aspiration (sometimes called suction abortion) involves a small tube being inserted into the vagina, through the cervix (entrance to the uterus) and into the uterus to remove the pregnancy by suction.
To make this easier, tablets containing misoprostol are sometimes inserted into the vagina before the procedure is carried out to help soften the cervix. To reduce any discomfort or pain during the abortion there is a choice of pain relief. A local anaesthetic can be injected into the cervix or you can have a light general anaesthetic so you are asleep during the procedure. Some women choose conscious sedation – drugs that make you sleepy but you stay conscious during the abortion procedure – you won't remember everything that happens during the abortion.
Vacuum aspiration takes about 5–10 minutes. You will usually go home on the same day, a few hours after the abortion has been carried out.
Surgical dilatation and evacuation (D&E) from 15 weeks of pregnancy
This method is usually carried out under general anaesthetic. The cervix is gently stretched and opened (known as dilation) to allow special forceps to remove the pregnancy in fragments. Remaining tissue is removed by suction as in vacuum aspiration. This takes 10–20 minutes. You may be able to return home on the same day if you are healthy and there are no complications.
Abortion after 21 weeks
Abortion at this stage is not common. It involves either the surgical dilatation and evacuation method, or medical abortion. Whichever method is used, a doctor will ensure the heart of the fetus is stopped so it is not born alive. The procedure takes time and you will have to stay in the hospital or clinic, sometimes overnight. Having a late medical abortion will involve you going through what is similar to labour to deliver the fetus.
For more information on having an anaesthetic, talk to your doctor.