How are Abortions Done?

An abortion is a procedure that expels or removes the developing fetus from the woman’s uterus. Some abortions are done by surgery and some with medication. A medication that results in an abortion is known as an abortifacient. The type of procedure used will depend upon several factors, including the stage of the woman’s pregnancy.

The following is a description of various types of surgical and chemical abortion procedures performed in the United States. Click on a link below to learn about that procedure.

Manual Vacuum Aspiration | Suction Curettage | Dilation and Curettage (D & C) Dilation and Evacuation (D & E) | Dilation and Extraction (D & X) | RU-486 (Mifepristone) | Methotrexate | Emergency Contraception

Manual Vacuum Aspiration (performed within 7 weeks after last menstrual period)
This surgical abortion is done early in the pregnancy up until 7 weeks after the woman’s last menstrual period (LMP). The cervical muscle is stretched with dilators (metal rods) until the opening is wide enough to allow abortion instruments to pass into the uterus. A hand-held syringe is attached to tubing that is inserted into the uterus, and the embryo is sucked out. When an early abortion such as this is performed before there is a medical diagnosis of pregnancy, the procedure is sometimes euphemistically referred to as a menstrual extraction.

Conducting such invasive surgery without a confirmation of pregnancy is a controversial procedure even for abortion physicians. One cited advantage of such a procedure is that it helps a woman avoid the trauma of ever knowing that she was pregnant. According to abortion physician Warren Hern, the disadvantages of such an early abortion include the fact that the chances of a continued pregnancy and “retained tissue” are higher. Also, this early abortion procedure is much more painful than a later abortion, according to Dr. Hern.

Suction Curettage (performed within 6 to 14 weeks after LMP)
This is the most common abortion procedure performed. Either local or general anesthetic may be used. In this procedure, the abortion physician opens the cervix with a dilator (metal rod) or laminaria (thin sticks of seaweed). When the cervix is sufficiently dilated, the abortion procedure is ready to proceed. The abortion physician grasps the lips of the cervix with a tenaculum, then inserts tubing known as a suction cannula into the uterus and connects the tubing to a vacuum aspiration machine. The abortion physician manually rotates the suction cannula inside the uterus. The force of the suction from the vacuum aspiration machine pulls the fetal body apart, tears the placenta from the uterine wall and sucks the fetal parts and placenta out of the uterus. This abortion procedure is considered relatively safe. Immediate complications occur in less than 1 out of every 100 procedures. Possible physical complications may include bleeding, infection, tearing of the cervix, incompetent cervix, or uterus, perforation of the uterus, and complications from anesthesia.

Dilation and Currettage, or D&C (performed within 6 to 14 weeks after LMP)
This is a variation of the suction currettage procedure. It is used much less frequently. Anesthesia is given, the cervix is dilated, and a curette, or loop shaped knife, is inserted to cut up the fetal parts and to scrape the uterine lining to detach the placenta. The fetal parts and other tissue are then scraped out of the woman’s body. The same risks present in a suction currettage procedure are also present with this procedure but at a higher rate of incidence. This is because this procedure requires more dilation, more time, and general anesthesia.

Dilation and Evacuation, or D&E (performed within 13 to 24 weeks after LMP)
This surgical abortion is done during the second trimester of pregnancy. Because the developing fetus doubles in size between the eleventh and twelfth weeks of pregnancy, the body of the fetus is too large to be broken up by the suction and will not pass through the suction tubing. In this procedure, the cervix must be opened wider than in a first trimester abortion. This is done by inserting laminaria in a day or two before the abortion. After opening the cervix, the abortion physician pulls out the fetal parts with forceps. The fetal skull is crushed to ease removal. According to Dr. Hern, in D&E procedures performed near the end of the second trimester, “a long curved Mayo scissors may be necessary to decapitate and dismember the fetus.” Abortion physician, Martin Haskell, advocates the use of other steps to bring about early fetal demise in a second trimester abortion.

According to Dr. Haskell, “Most surgeons find dismemberment at 20 weeks or beyond to be difficult due to the toughness of fetal tissue at this stage of development…. Approaches to late second trimester D&E rely upon the means to induce early fetal demise to soften tissues making dismemberment easier.”

There is a higher rate of potential physical complications in this second trimester of abortion procedure. Such complications may occur as frequently as in 1 out of every 50 cases. Also, abortion physician Warren Hern acknowledges that one of the disadvantages of this procedure is that medical staff may find it objectionable for “aesthetic” reasons.

Dilation and Extraction, or D&X (performed from 20 weeks after LMP)
This procedure is commonly known as a partial-birth abortion. This procedure takes three days. During the first two days, the cervix is dilated and medication is given for cramping. On the third day, the woman receives medication to start labor. After labor begins, the abortion doctor uses ultrasound to locate the baby’s legs. Grasping a leg with forceps, the doctor delivers the baby up to the baby’s head. Next scissors are inserted into the base of the skull to create an opening. A suction catheter is placed into the opening to remove the baby’s brain. Without the brain, the baby’s skull collapses, and the baby is removed. Finally the abortion physician removes the placenta with forceps and scrapes the uterine wall with a suction currette.

There were other abortion methods that were more commonly used in the past, including saline abortions and prostaglandin abortions. Those procedures involved injecting either a salt solution or a prostaglandin hormone into the amniotic sac, which, in turn, caused the abortion. These procedures are rarely used today.

Following is a description of medical abortion procedures that rely upon medication (rather than the surgical procedures previously presented).

RU-486, Mifepristone (used within 4 to 7 weeks after LMP)
This medical abortion is commonly known as “the abortion pill”. It is used for women who are within 30 to 49 days after the first day of their LMP. This procedure usually requires repeated office visits. During the first visit, the RU-486 (mifepristone) pills are given to the woman. This medication blocks the embryo from staying implanted and growing. The woman then returns two days later for a second medication called misprostol. This second medication causes the uterus to contract and to expel the embryo.

Methotrexate (used within 72 hours after sexual intercourse)
This type of abortion pill was approved by the FDA for the treatment of cancer but has also been used to end pregnancies. This procedure requires repeated office visits. Initially, a woman receives a methotrexate injection that stops embryonic cells from dividing. The woman then returns 5 to 7 days later to receive a second medication called misprostol. This second medication causes the uterus to expel the embryo.

Emergency Contraception (used within 72 hours after sexual intercourse)
This type of abortion is commonly known as “the morning-after pill.” After an episode of unprotected sex, the woman takes a higher than normal dose of birth control pills. This prevents the implantation of the already fertilized egg. According to persons who define pregnancy as beginning at implantation, as opposed to fertilization, the morning-after pill is not an abortifacient but a contraceptive.