What Actually Happens When You Get An Abortion?
The Debrief: I'm pretty well versed in pro-choice arguments but, in a recent wine-fuelled debate, a couple of mates and I got into the nitty gritty of how abortions actually happen, and I realised we're all actually a bit clueless. So naturally I decided to ask an adult...
Wine, eh? One minute you and your best mates are chatting about Orphan Black; the next thing you know, you’re passionately debating the rights and wrongs of abortion law.
I’m pretty well versed in pro-choice arguments but, in a recent wine-fuelled debate, a couple of mates and I got into the nitty gritty of how abortions actually happen, and I realised we’re all actually a bit clueless. I’ve never had an abortion and, beyond the basics, I wasn’t actually sure what to expect if I ever do have one. Naturally, it was time to ask some adults…
What happens when you decide to have an abortion?
You can be referred through your GP or contact an abortion provider directly. You’ll have an initial consultation, run through your medical history and long-term contraceptive options, and be offered a scan, a blood test and STI screening. Then you’ll discuss the different options (medical or surgical), before making an appointment for your termination.
How does the abortion actually work?
Early medical abortions (up to nine weeks)
A medical abortion involves taking pills in two stages to induce a miscarriage. The first, mifepristone, stops the pregnancy by interacting with the hormone progesterone, and enhances the effectiveness of the second pill.
Afterwards, you’ll probably be fine to carry on with normal life, explains nurse Jon Fenton, clinical team leader for Marie Stopes in central London. ‘Some women feel mild cramping, very similar to period pain, but they’re absolutely fine with some Ibuprofen and a hot water bottle,’ he says.
The second pill, misoprostol, is placed in the mouth or vagina between six and 48 hours later, and left to dissolve.
‘This starts contractions to expel the pregnancy. The average experience is like a really unpleasant, heavy, painful period, although the pain is quite variable,’ explains Dr Tracey Masters, a consultant in sexual and reproductive health, and spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG).
You’ll experience painful cramping and heavy bleeding, and side effects can include fever, vomiting and diarrhea. You should wear pads, not tampons, and Jon advises bleeding into the toilet when it feels most heavy, if you can.
The bleeding and cramps generally subside after four to eight hours, and you’re usually advised to be at home and have someone with you during this time – although some abortion providers may keep you in for a few hours.
‘At this stage in the pregnancy, you’re not going to see anything graphic, just a lot of clotting and bleeding,’ Jon adds.
Medical induction (10-24 weeks)
Some abortion providers, including the British Pregnancy Advisory Service (bpas), also use abortion pills in later pregnancy. Like in an early medical abortion, mifepristone is given first and, if you’re over 22 weeks pregnant, you’ll also be given an injection into the foetus to stop its heartbeat.
You’ll then return to the clinic a day or two later, and misoprostol pills are inserted into your vagina every few hours to induce contractions until the abortion is completed. This usually takes around six hours, although it can take longer and involve an overnight stay.
Surgical abortion (up to 24 weeks)
For pregnancies up to 14 weeks, you’ll often be offered a choice of being awake (under local anaesthetic), asleep (under general anaesthetic), or sedated (awake but drowsy) during a surgical abortion. For pregnancies of 15 weeks or more, you’ll usually be put to sleep. You can’t eat, drink or smoke for six hours before a general anaesthetic, but otherwise there’s no preparation involved.
Emily* was 26 and already had two children when she had a termination. ‘I was nine weeks pregnant and opted for a surgical abortion under general anaesthesia, despite it meaning having to travel to London. I wanted to go to sleep and wake up with it all over and done with,’ she says.
Gemma*, 22, tells me she chose to have a surgical abortion at 19, when she was six weeks pregnant. She waited three hours to be seen at her local clinic, which she says was ‘a bit frustrating’. Then she was scanned, asked to change into a robe, and led into the procedure room. ‘There were about four people there. It was a bit scary,’ she adds.
There will generally be at least a doctor and a nurse in the room. You’ll lay on a couch, with your legs in stirrups, and sedated if that’s what you’ve chosen. If you’re awake, Jon says, ‘There will be a nurse by your side, talking you through the process and making sure everything’s fine.’
The procedure itself involves ‘a gentle suction method,’ he says. ‘A small tube is placed through the cervix, into the uterus, and the pregnancy is expelled under a gentle suction. It’s not noisy, just a syringe that we draw back, and that produces enough suction to expel the pregnancy.’
If you’re having the procedure under a local anaesthetic, you’re likely to experience ‘a cramp, like a very strong period cramp, when the suction removes the pregnancy and the womb contracts,’ Dr Tracey says. ‘But because it lasts just a very short time, some women would rather have that as it means they can go home sooner afterwards.’
For pregnancies beyond 14 weeks, she adds, ‘We need to use not just suction but also a very tiny pair of forceps, so we need to open the neck of the womb a little bit more. The woman is often given a very small dose of misoprostol, placed in either the vagina or mouth, to soften the cervix before the operation.’
Before the procedure, you’ll also be offered the option of having a contraceptive coil fitted at the same time, ‘so when you wake up you’ve got a nice reliable method of contraception until you decide you don’t want it anymore,’ Dr Tracey says.
What happens afterwards?
There’s a small chance (less than one per cent) of a medical abortion failing, so you may be asked to go back for a scan or pregnancy test to check it’s worked. If the abortion does fail, you’ll usually be referred for a surgical abortion, as the risk of failure is much lower.
With a surgical abortion – ‘If somebody’s had a local anaesthetic, they usually go home within 20-30 minutes,’ Dr Tracey says. ‘With a general anaesthetic, most people stay [a few hours]. We’ll make sure you’ve recovered well, and had something to eat and drink before you’re ready to go home.’
It’s also common to be given painkillers, anti-sickness tablets, contraceptive pills or another long-term contraceptive, as well as antibiotics to minimise the risk of developing an infection.
After her termination, Emily says: ‘I felt nothing but relief, and the pregnancy sickness that I’d suffered with for weeks was gone.’
Gemma says: ‘I had a little pain, a bit stronger than period pain, but I was given some painkillers and told I could go home when I was ready.’
Some bleeding, like a period, is normal, but this will settle down, and doctors advise against heavy lifting, tampons and swimming for a couple of weeks afterwards. For later term abortions, it’s also recommended that someone collects you and takes you home.
With both types of abortion, there’s a small risk of infection or retained foetal product in the uterus, and you should get checked out if you’re worried about any unusual pain, discharge or heavy bleeding.
Marie Stopes and bpas both have abortion helplines. Call Marie Stopes on 0345 300 8090 (24/7) or bpas on 03457 30 40 30 for advice and information.
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