Abortions by Gestation Period

Introduction

Deciding to have an abortion can be an emotionally and physically challenging experience. It’s important to have comprehensive information about the types of abortion available, the associated procedures, and the considerations at different stages of pregnancy. This guide breaks down abortion options by gestation period, providing a detailed overview to help you make informed decisions and understand what to expect at each stage.

Early Abortion (Up to 9 Weeks)

Medical Abortion (Up to 9 Weeks)

A medical abortion, often called the “abortion pill,” can be performed up to 9 weeks of pregnancy. It involves taking two medications: mifepristone and misoprostol. Mifepristone is taken first, which blocks the hormone progesterone necessary to maintain the pregnancy. Misoprostol is taken 24 to 48 hours later to induce uterine contractions and expel the products of conception.

What to Expect

After taking misoprostol, you may experience cramping, bleeding, nausea, vomiting, and fatigue. Bleeding can range from light spotting to heavier than a regular period, with clots being common. The process usually takes a few hours, but bleeding can last for up to two weeks.

Considerations

Medical abortion is around 95-98% effective when performed within the first 9 weeks. It can be done at home or in a clinical setting, allowing for privacy and control. However, it is not suitable for everyone, including those with certain medical conditions (e.g., severe anaemia or ectopic pregnancy).

Abortion Between 9 to 13 Weeks

Medical Abortion (9 to 10 Weeks)

Medical abortion can still be an option for up to 10 weeks. The process remains similar to that of an abortion up to 9 weeks. However, side effects like cramping and bleeding may be more intense as the pregnancy progresses.

Surgical Abortion (Up to 13 Weeks)

Surgical abortion is a safe and common option for pregnancies between 9 to 13 weeks. The most common surgical method is vacuum aspiration, which involves gently suctioning the pregnancy tissue from the uterus. The procedure is typically performed under local anaesthetic, with or without sedation, and takes about 10 to 15 minutes.

What to Expect

You may experience some cramping during and after the procedure. Light bleeding is also common for a few days to weeks following the abortion.

Considerations

Vacuum aspiration is about 99% effective and is completed in a single visit to a healthcare provider. Recovery is usually quick, with most people resuming normal activities within a day or two.

Abortion Between 13 to 20 Weeks

Surgical Abortion (13 to 20 Weeks)

From 13 to 20 weeks, the most common method of abortion is dilation and evacuation (D&E). This procedure involves dilating the cervix and using surgical instruments along with suction to remove the pregnancy tissue. D&E is usually performed under general or local anaesthesia and takes around 10 to 30 minutes.

What to Expect

Cervical dilation may begin several hours or a day before the procedure to ensure the cervix is adequately open. Cramping, bleeding, and a feeling of heaviness or pressure in the pelvic area are common during and after the procedure. Recovery may take a few days, and some may experience light bleeding or spotting for up to two weeks.

Considerations

D&E is 98-99% effective and is usually completed in one visit. However, this procedure requires a bit more recovery time compared to earlier-stage abortions. It is important to arrange for someone to accompany you and provide support post-procedure, especially if general anaesthesia is used.

Abortion Between 20 to 24 Weeks

Surgical Abortion (20 to 24 Weeks)

Abortions performed between 20 to 24 weeks are usually done using the dilation and evacuation (D&E) method, similar to earlier in the second trimester, but may be more complex due to the size of the foetus. In some cases, medications are given beforehand to soften and dilate the cervix further.

What to Expect

This procedure may require several days, especially if cervical dilation is started beforehand. You may experience stronger cramping and heavier bleeding compared to earlier procedures. Hospitalisation may be necessary depending on the individual case and location.

Considerations

While D&E remains a safe and effective option, the risk of complications, such as infection or injury to the uterus, is slightly higher at this stage. It is important to have access to skilled healthcare providers experienced in later-stage abortion care.

Late-Term Abortion (After 24 Weeks)

Induction Abortion (After 24 Weeks)

In rare cases, abortions after 24 weeks may be necessary due to medical reasons, such as severe fetal anomalies or risks to the mother’s health. Induction abortion involves inducing labour using medications, leading to the delivery of the fetus. This procedure usually takes place in a hospital setting and may take several days to complete.

What to Expect

Induction abortion involves using medication to start contractions, similar to labour induction in childbirth. Pain relief options, such as epidurals, are usually available. The process can be emotionally and physically taxing, and you may require hospitalisation for a few days.

Considerations

This type of abortion is less common and is typically reserved for cases where the foetus has severe abnormalities or when the pregnancy poses a significant risk to the mother’s life. Emotional support and counselling are often recommended due to the complex nature of these situations.

Factors Influencing the Choice of Abortion Method

Gestational Age

The stage of pregnancy is the most significant factor in determining the appropriate abortion method. Generally, the earlier in pregnancy, the wider the range of options available.

Medical History

Pre-existing conditions, such as clotting disorders, anaemia, or a history of certain surgeries, may affect the choice of method.

Personal Preferences

Some people prefer medical abortion for the privacy it offers, while others may opt for surgical methods due to their quickness and higher immediate effectiveness.

Access to Care

The availability of certain procedures varies by region and healthcare provider, impacting what options are realistically accessible.

Emotional and Psychological Factors

The emotional impact of each method can differ. It’s important to consider which option feels most manageable for you emotionally.

Safety and Effectiveness

All abortion methods are considered safe and effective when performed by qualified healthcare providers. Complications are rare, particularly in early abortions, and usually, minor issues like infection or retained tissue can be managed with medical intervention. Abortion does not impact future fertility or increase the risk of breast cancer, contrary to common misconceptions.

Aftercare and Recovery

Recovery varies depending on the type of abortion and your individual circumstances. It’s normal to experience some bleeding, cramping, and emotional changes. It’s crucial to monitor for signs of complications, such as heavy bleeding (soaking more than two pads in an hour), severe pain, fever, or foul-smelling discharge, and seek medical attention if these occur.

Concluding Remarks

Abortion is a deeply personal decision, and understanding your options at each stage of pregnancy can help you feel more confident and prepared. Whether you are considering a medical or surgical abortion, early or later in pregnancy, it is important to consult with a healthcare professional to discuss your circumstances and get the support you need. Remember, you are not alone, and resources are available to help guide you through this challenging time.