The D&C is performed like the vacuum aspiration except no suction is used. After the stage of the pregnancy is determined by pelvic exam and/or ultrasound, the patient remains on her back with her legs in strirrups or foot holders. The doctor inserts the speculum inside the vagina so that the vagina and cervix are visible. A shot is injected inside the vagina to numb the cervix to control for pain. Then the cervix is opened using tapered dilators. When the cervix is sufficiently dilated, the doctor will use a small spoon-shaped instrument called a curette to scrape the walls of the uterus and separate and remove the fetus, placenta, and membranes from it.
The vacuum aspiration method is generally used instead of the D&C and is considered much safer.
Approximately 8 weeks menstrual is considered the safest time to have an abortion. The complication rate doubles with each two-week delay after that time. Women who have a vacuum aspiration, dilation and evacuation, or labor induction do not usually have problems getting pregnant later in life.
According to data from the Centers for Disease Control and Prevention (CDC), the risk of dying as a direct result of a legally induced abortion is less than 1 per 100,000. This risk increases with the length of pregnancy. For example:
1 death for every 530,000 abortions at 8 or fewer weeks
1 death per 17,000 at 16-20 weeks
1 death per 6,000 at 21 or more weeks
The risk of dying in childbirth is less than 1 in 10,000 live births. The risk is higher however, for African American women and stands at 22 in 100,000.
According to Virginia law, in the first trimester an abortion can be safely performed by a licensed physician in an office or clinic.
If a woman has made an informed decision and chosen to have an abortion, she and her doctor must first determine how far her pregnancy has progressed. The stage of a woman's pregnancy will directly affect the appropriateness or method of abortion. The doctor will use a different method for women at different stages of pregnancy. In order to determine the gestational age of the embryo or fetus, the doctor will perform a pelvic exam and an ultrasound.
There are two distinct ways in which a doctor may count a pregnancy: weeks after fertilization and menstrual weeks. When noted (in this information), the weeks when each type of abortion may be performed are measured as menstrual weeks. In general, the 'weeks after fertilization' count is two weeks behind 'menstrual weeks.'
CATHETER: A small suction tube used to remove the fetus and placenta from a woman's uterus.
CAESAREAN: When a doctor must cut open a woman's belly to remove the unborn child or fetus.
CURETTE: A small spoon-shaped instrument used to scrape the walls of a woman's uterus, separating and removing the fetus from the mother.
CERVIX: The opening of a woman's uterus.
EMBOLI: Blood clots to the heart and brain.
EVACUATE: To empty a woman's uterus.
EMBRYO: After fertilization, the combined egg and sperm is called a zygote. The zygote quickly divides into a cluster of different types of cells which form the embryo. The developing embryo becomes a fetus which becomes a baby when born.
FETAL DEVELOPMENT: The growth process of a fetus inside a woman.
FETUS: From eleven weeks after the woman's last menstrual period (nine weeks after fertilization) the developing embryo is now called a fetus.
FIRST TRIMESTER: The first three months of a woman's pregnancy.
FULL TERM: A fetus is considered full term, ready for birth, at 40 weeks after the last menstrual period (38 weeks after fertilization).
GESTATIONAL AGE: The age of a developing embryo or fetus, stated in either menstrual weeks or weeks after fertilization.
INDUCE: To cause a woman to begin labor.
LABOR: The contractions of the uterus that deliver the baby.
MENSTRUAL WEEKS: The age of an embryo or fetus measured from the first day of the mother's last normal menstrual period. Fertilization usually occurs about two weeks after a woman's last menstrual period began. This method of measuring is most often used by practicing doctors and other health care providers.
PLACENTA: The organ attached to the uterus that provides nourishment from the woman to the embryo, then fetus, through the umbilical cord.
SECOND TRIMESTER: The fourth, fifth, and sixth month of a woman's pregnancy.
SPECULUM: An instrument used in order to look at the opening of a woman's uterus or her cervix.
THIRD TRIMESTER: The seventh, eighth, and final month of a woman's pregnancy.
ULTRASOUND: A machine producing ultrasonic waves that can picture the baby inside the woman. It can sometimes determine the sex or abnormalities and is used to determine the gestational age of a fetus.
UTERUS: The muscular organ inside a female where the embryo and fetus develop.
WEEKS AFTER FERTILIZATION: The age of an unborn child measured from the estimated day of fertilization.
After an abortion, the woman will need to stay at the clinic or hospital where the procedure was performed so her doctor can check for complications. The length of time she will be observed will depend on the type of procedure performed and the anesthesia used during that procedure. For example, after a vacuum aspiration or D&C with local anesthesia, a woman will usually remain at the clinic for about 30 minutes to an hour. After a D&E, a woman will usually be observed for 2 to 4 hours.
After the doctor observes the woman and allows her to go home, she will be given an antibiotic to prevent infection and another drug to contract her uterus to reduce bleeding. The doctor will tell her how long she must wait before having intercourse again and discuss birth control methods which are safer than abortion. She will receive a prescription for pain medication. After having an abortion, a woman should not drive herself home. It is normal for a woman to have some cramping and a small amount of bleeding after having any type of abortion. The cramping is caused by her uterus contracting back to its normal size.
If heavy bleeding occurs (two sanitary pads per hour for two hours) or if in severe pain not controlled by pain medication, a woman should contact the clinic or doctor where the procedure was performed or go to an emergency room. Most women can return to their daily activities within a day or so after a procedure. It is important that a woman return to her doctor for a check-up two to three weeks after an abortion.
If the gestational age is late in the second trimester or after sixteen weeks, the doctor may choose to perform a labor induction abortion.
Using this method, the doctor will cause the woman to begin labor. The doctor will usually place a substance in the woman's cervix 24 to 48 hours before the procedure to soften the cervix and open it. The doctor may place a drug that helps to dilate the cerix directly into the uterus or into the vagina. The doctor may then inject a chemical such as urea, potassium, or digitoxin into the uterus by placing a needled through the woman's belly or again, in her vagina. These drugs will cause the death of the fetus. A drug called pitocin may be given in the woman's vein to start the contractions of her uterus.
If the abortion is performed at a later fetal development stage, the doctor may inject the medicines or saline directly into the fetus to cause death before inducing labor. If the placenta is not removed with the fetus during labor induction, the doctor must open the cervix and suction the uterus using the vacuum aspiration method.
Risks are similar to childbirth.
In the state of Virginia, an abortion performed after the first trimester must be performed in a hospital.
DILATION AND EVACUATION
If an abortion is performed between 13 and 21 weeks of a woman's pregnancy, her doctor may use the Dilation and Evacuation (D&E) method to abort the fetus. The doctor must first perform an ultrasound to determine the age of the fetus. The doctor will need to open the woman's cervix wider in order to perform a D&E. The doctor may soften the cervix with a hormone or insert small pieces of seaweed or a sponge-like material into the woman's cervix to do so. This material may be inserted up to 24 to 48 hours ahead of the procedure. Once the woman's cervix is opened, the doctor will use large vacuum catheters to remove as much of the pregnancy as possible. It may be necessary to use special forceps to remove the fetus, fetal parts, or the placenta. Some doctors may use medication to start a woman's contractions and limit blood loss.
Abortions performed at a later stage such as this carry a higher risk of complication.
If a woman is in the first trimester, or first three months of her pregnancy, her doctor may choose to perform a vacuum aspiration abortion. The gestational age of the fetus must first be determined by a pelvic exam or ultrasound.
The doctor will ask the woman to lie on her back with knees bent and her feet placed in stirrups or foot holds. This position allows the doctor access to the woman's cervix. The doctor will insert an instrument called the speculum into the woman so that he can see the cervix. He will then give the woman a shot inside the vagina to numb the cervix to control pain. Because the procedure is safer with the woman awake, the doctor will rarely put the woman to sleep.
Using dilators, the doctor will open the cervix, then place a catheter in the woman's uterus. The catheter will be connected to an electrical or manual suction that will pull the fetus, placenta, and membranes from the woman's uterus. The size of the catheter tube used depends on the size of the fetus. A larger tube will be used when a fetus is larger and further along in its development.