The Operation
 There are several different ways of doing an abortion. These are explained below. The pregnancy is dated from the first day of your last menstrual period. This is called your LMP.
First Trimester Abortions (up To 12 Weeks)
Vacuum Aspiration or Suction
This is the most common method of abortion. It is usually done between 7 and 12 weeks, but some doctors are skilled enough to perform it up to 14 weeks. The cervix is dilated in stages and then a tube is passed into the uterus and the contents are removed by the use of an electric pump. Some clinics combine suction with a scrape of the uterus, using a spoon like instrument. The procedure usually takes about 10 minutes and is most often done under a general anaesthetic (the woman is not awake). Some clinics will do this type of abortion using local anaesthetic (the woman is awake).
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Abortions up to 14 weeks are usually done on a daycare basis. This means that you go into the hospital/clinic about an hour before the termination and go home up to two hours after the procedure. You must have a responsible adult escort and you must have fasted beforehand if you are having a general anaesthetic. Your GP must also be available to call if needed, and must be informed of the abortion.
If you are not having a daycare abortion, you will be required to stay overnight in hospital/at the clinic and you can go home the following morning.
Second Trimester Abortions (after 12/14 Weeks)
There are different techniques for performing abortions after the 12/14-week stage. Each is used according to the skill and/or preference of the gynaecologist doing the operation. Time limits vary too, with each hospital/clinic setting its own guidelines. Some clinics won't do abortions between 14 and 17 weeks, but may refer you to one which does. There are three main methods in use at the moment:
Dilatation And Curettage (D&C)
This technique is used between 12 and 16 weeks and is often combined with a vacuum aspiration. The contents of the uterus are removed with a scraping instrument called a curette, after the cervix has been dilated. A general anaesthetic is used.
Dilatation and Evacuation (D&E)
This technique is usually used between 12 and 16 weeks, but some skilled clinicians can perform it up to 24 weeks. The cervix is dilated and the doctor uses forceps, a curette and vacuum suction to remove the contents of the uterus.
The BPAS offers a two-stage procedure for late abortions. This takes two days. Under general anaesthetic the fluid sac around the fetus is broken and a substance derived from seaweed is inserted into the cervix. This gradually expands over the following day, opening the cervix. The evacuation of the uterus is then carried out under a second general anaesthetic.
Prostaglandins
Prostaglandins are normally used from 15 weeks onwards, especially in NHS clinics.
Prostaglandins are hormones, similar to those produced during labour, which cause the uterus to contract. The drug is given either as a vaginal pessary or as an injection either through the cervix into the uterus or through the abdomen. The fetus is delivered in the same way as a woman gives birth. This method can be quite painful and no anaesthetic is used although women can receive sedatives and pain relief tablets. A D&C usually follows this, with anaesthetic.
Whether you have an early or late abortion, you may want to have a friend come with you to the clinic or meet you after the operation.
The Abortion Pill - RU486 "Medical Abortion"
In 1991 a drug called mifepristone, also known as RU486, was licensed for use in abortions up to 63 days (nine weeks) of pregnancy. In mid-1995 it was licensed for use up to 20 weeks. When using mifepristone for abortion, doctors must still follow all the rules of the 1967 Abortion Act. It is not available from a GP surgery or a chemist.
Progesterone is the hormone which maintains early pregnancy. Mifepristone stops progesterone from working.
Not all women are medically suitable for a mifepristone abortion and a detailed medical history will be taken before proceeding.
Studies show that mifepristone abortions have a success rate of 94%. A follow up suction abortion is done for the small percentage of women who do not have a complete abortion with mifepristone.
Abortion using mifepristone involves three visits to a hospital/clinic, except when going to a private clinic, when there often is another initial appointment for counselling and medical examination. Some centres may also require you to have an ultrasound scan before proceeding. This is to date the pregnancy and to make sure the pregnancy is not ectopic (occurring outside the womb), in which case mifepristone would not be used.
At the first visit for the actual abortion, three mifepristone pills are taken. You will need to rest in the clinic for a couple of hours to make sure that the tablets are properly absorbed. Forty eight hours later, you return to have a vaginal pessary of prostaglandin inserted. Prostaglandin causes the uterus to contract and expel the contents.
Bleeding can begin any time after the pills are taken. It is usually like a heavy period. Some women may have period like pains at this time. Sometimes bleeding does not start until the prostaglandin pessary is given.
After the pessary is inserted, uterine contractions start. Women must remain in the hospital/clinic for four to six hours after pessary insertion. Differing amounts of pain are experienced with these contractions. Pain medication will be offered. The majority of women will abort within this time, expelling a large blood clot.
The last visit involves having a medical exam to make sure the abortion is complete and there are no problems.
Following abortion with mifepristone, bleeding usually continues for ten to twelve days. A small percentage of women bleed very heavily.
It is important to note that once the mifepristone tablets are taken, women are strongly advised to carry through with the entire procedure. This is because the effects of the drugs on the outcome of any continuing pregnancy have not been fully evaluated.
Clinical studies have been done to find out how women feel about having a mifepristone abortion. Some women experience heavy bleeding and considerable pain while others do not. Some women have also experienced side effects such as nausea, vomiting and diarrhoea.
When asked why the choice was made to have mifepristone, reasons given included:
- feeling more in control of what was happening to them
- mifepristone seemed more natural and more private than surgical abortion
- avoiding general anaesthetic
Studies have found that medical abortion is no more distressing psychologically than suction abortion.
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