Methods of abortion

• Safe and Unsafe Abortion

• Non-surgical or medical abortion

• Later Abortion

• Early Abortion

• Safe & Unsafe Abortion

Unsafe AbortionUnsafe abortion is performed by untrained people using  dangerous methods, which often fail, in unsterile conditions.

Methods used include:

• herbs or drugs, including alcohol.

• physical damage e.g. massage, falls.

• pushing substances into the uterus  e.g. soap, bleach.

• pushing objects into the uterus  e.g. a stick, rubber tubing, wire, coat hangers.

Women who have abortions in this way can suffer:

• incomplete abortion leading to septicaemia

• infection

• severe bleeding

• infertility

• psychological damage

• death (the WHO estimates that 200 women  a day die from unsafe abortions)

Safe Abortion

Safe abortion is performed by trained  professionals using safe, effective methods in sterile conditions.

Methods used include:

• drugs

• simple operations

• induced labour

• Non-surgical or medical abortion

Non-surgical or medical abortion is used for early abortion up to nine weeks. Mifepristone and prostaglandin are also used for termination of pregnancy 13 – 24 weeks gestation.The drug used for medical abortion, mifepristone, also known as RU 486, was first developed in France in the 1980’s and is currently on the market in the UK, France, Sweden, Israel, the US and China. As of January 2004, 29 countries had approved its use, including: Austria, Belgium, Denmark, Finland, Germany, Greece, the Netherlands, New Zealand, Norway, Spain, South Africa and Switzerland.

Extensive testing and research have shown it to be a very safe and effective method. Women who have undergone the procedure found it highly suitable and a good alternative to surgical abortion. Although the use of the ‘abortion pill’ makes the procedure easier to perform without the need for special facilities, women who opt  for a medical abortion, in the early stages of pregnancy (up to 9 weeks), are still faced with three separate visits to the clinic. Much still needs to be done to improve access  to medical abortion and offer women a real choice in terms of method.

• Later Abortion

You will see that there is overlap in the different methods that can be used at the different stages of later term abortions. Each woman will discuss her options with her doctor, who will take her medical circumstances into account.Medical induction (induced miscarriage)*

When: 13-24 weeks

Where: Clinic / Hospital. Up to two nights’ stay, depending on gestation.

What happens: The patient is under local anaesthetic to reduce pain. The heart of the fetus is stopped. A combination of hormones is used to soften the cervix, cause contractions and bring on labour. Contractions can last 6-12 hours. The next day the doctor checks the abortion is complete. If not, the patient will be given a local  anaesthetic and any remaining tissue will be removed with a small suction pump.

*Mifepristone and prostaglandin, the drugs used for early medical abortion, can also be used for abortion in later pregnancy.

Surgical dilatation & evacuation (D&E)

When: 15-19 weeks

Where: Clinic / Hospital. Usually carried out as a day-care procedure but may require an overnight stay.

What happens: The patient is given general anaesthetic. Before the procedure a pessary may be put in the vagina to relax the cervix. The cervix is eased open (dilated) so that forceps can be used to remove the fetus and the uterus lining (evacuation). After the fetus has been removed the doctor may have to use suction to remove any remaining tissue.

Surgical two-stage abortion

When: 20-24 weeks

Where: Clinic / Hospital. At least one night’s stay.

What happens: The patient is given a general anaesthetic. The heart of the fetus is stopped. A hormone softens the cervix and the tissues of the pregnancy.  The next day a dilation and evacuation is performed. The patient can  usually leave 4-6 hours after this second procedure.

Abortions after 24 weeks are only performed by the NHS. They are extremely rare, less than 0.1 per cent of the total, and can only be performed if there is:

• risk to the life of the woman,
• evidence of severe fetal abnormality, or
• risk of grave physical and mental injury to the woman.

Methods used are similar to those used between 20 and 24 weeks.

After abortion, at any stage, many women experience some cramping, pain or  discomfort which can be eased by painkillers. There will also be some bleeding.  The clinic will prescribe antibiotics to prevent infection and the patient will be  advised on possible side effects.

• Early Abortion

Each stage of pregnancy requires a different method of abortion. When performed  by trained professionals in sterile conditions early procedures are virtually risk-free. Later abortion may involve some risk to the woman’s health. In order to make informed decisions women must be made aware of the possible risks  and complications.New methods of abortion and adaptations to make procedures more effective are constantly being developed. In July 1991 the UK Licensing Authority approved a hormone pill called mifepristone for use in early abortion. Recently more abortions have been provided in day-care settings, an innovation pioneered by Marie Stopes International (MSI). More women have been able to have a local anaesthetic or conscious sedation rather than general anaesthetic. However, the methods available and the exact procedures will depend on the service provider.

Medical abortion
When: up to 9 weeksWhere: Clinic / Hospital. Three visits (including the assessment visit).What happens: The patient is prescribed the hormone pill, mifepristone, which causes the uterus lining to start breaking down. A second hormone pill or vaginal pessary, prostaglandin, taken two days later, increases contractions and bleeding and helps expel the pregnancy, as in an early natural miscarriage. Bleeding may be heavy for one or two days before settling down.

Vacuum aspiration

When: up to 14 weeks

Where: Clinic / Hospital. Usually requires a stay of a few hours after the procedure.

What happens: The patient is usually given a general or a local anaesthetic.  The procedure takes 10-15 minutes. A speculum is used to open the vagina so that the cervix can be reached. The cervix is gently eased open and a thin tube, attached to a small pump, is passed through it into the uterus; the small pump is used to draw the contents of the uterus into the tube. In some centres a procedure called Manual Vacuum Aspiration (MVA) is offered, using a hand held syringe to gently evacuate the contents of the uterus. This method was pioneered in the UK by MSI.