There are about 1.2 million abortions performed each year in the United States.
Most take place during the first trimester of pregnancy. About 8 percent occur between the 13th and 27th weeks of gestational age, the second trimester of pregnancy. The more accurate term for this is “later-term abortion.” About 1.3 percent of all abortions take place at or after the 21st week.
Most women having a second-trimester abortion undergo surgical abortion, a procedure called dilation and evacuation (D & E).
D & E can usually be done on an outpatient basis in a clinic or hospital.
The first step is to soften and dilate the cervix. This can be initiated the day before the D & E. You’ll be positioned on the table with your feet in the stirrups, much as you would for a pelvic exam. Your doctor will use a speculum to widen your vaginal opening. This allows them to clean your cervix and apply a local anesthetic.
Afterward, your doctor will insert a dilating stick (osmotic dilator) called laminaria into your cervix. This stick absorbs moisture and opens the cervix, as it swells. Alternatively, your doctor can use another type of dilating stick called Dilapan, which can be inserted the same day as the surgery.
Your doctor may also choose to give you a drug called misoprostol (Arthrotec), which can help prepare the cervix.
Just prior to the D & E, you’ll likely be given intravenous sedation or general anesthesia, so you’ll probably sleep through the procedure. You’ll also be given your first dose of antibiotic therapy to help prevent infection.
Your doctor will then remove the dilating stick and scrape the uterus with a sharp-tip instrument called a curette. Vacuum suction and other surgical instruments will be used to extract the fetus and placenta. Ultrasound guidance may be used during the procedure.
It takes about half an hour to complete the procedure.
Circumstances under which second-term abortions are permitted vary from state to state. Currently, 43 states prohibit at least some abortions after a certain point in a pregnancy. Of the 24 states that ban abortion at or after a specific week of gestational age, 17 of these states ban abortion at approximately 20 weeks post-fertilization.
Your doctor will be able to explain the options available in your state.
According to Planned Parenthood, a D & E can cost as much as $1,500 in the first trimester, and second-trimester abortions tend to cost more. Having the procedure done in a hospital may be more expensive than having it done in a clinic.
Some health insurance policies cover abortion in full or in part. Many do not. Your doctor’s office can contact your insurer on your behalf.
Before scheduling the procedure, you’ll have an in-depth meeting with your doctor to discuss:
- your overall health, including any preexisting conditions
- any medications you take and whether or not you need to skip them before the procedure
- the specifics of the procedure
In some cases, you’ll need to see your doctor the day before the surgery to begin having your cervix dilated.
Your doctor’s office will provide instructions for before and after the surgery, which you should follow carefully. You’ll be advised not to eat for about eight hours before the D & E.
It will be helpful if you do these things in advance:
- arrange for transportation home after the surgery, as you won’t be able to drive yourself
- have a supply of sanitary pads ready because you won’t be able to use tampons
- know your birth control options
You’ll need a few hours of observation to make sure you aren’t bleeding too heavily or having other complications. During this time, you may have some cramping and spotting.
When you’re discharged, you’ll be given antibiotic therapy. Be sure to take all of it exactly as prescribed to help prevent infection.
For pain, you can take acetaminophen (Tylenol) or ibuprofen (Advil) as directed, but ask your doctor first. Don’t take aspirin (Bayer), because it can cause you to bleed more.
You might feel just fine the next day or you may need a day off before returning to work or school. Avoid heavy exercise for one week, as it can increase bleeding or cramping.
Follow your doctor’s recommendations for resuming your usual activities. Recovery time can vary significantly from person to person, so listen to your body.
Common side effects
Some potential side effects are:
- cramping, most likely between the third and fifth days following the procedure
- nausea, particularly in the first two days
- breast soreness
- light to heavy bleeding for two to four weeks, tell your doctor if you soak through more than two maxi-pads an hour for two or more hours in a row
- clots that can be as large as a lemon, notify your doctor if they’re larger than that)
- low-grade fever, call your doctor if it rises above 100.4°F (38°C)
What to expect from menstruation and ovulation
Your body will begin preparing for ovulation immediately. You can expect your first menstrual period within four to eight weeks after the procedure.
Your cycle may return to normal right away. For some women, periods are irregular and lighter or heavier they were before. It may be several months before they return to normal.
Because of the risk of infection, you’ll be advised not to use tampons for a week following the procedure.
What to expect from sex and fertility
You shouldn’t have sex for one week after having a D & E. This will help prevent infection and allow you to heal.
Your doctor will let you know when you’re done healing and can have sex again. The procedure shouldn’t affect your ability to enjoy sex.
Your fertility won’t be affected, either. It’s possible to get pregnant right after your D & E, even if you haven’t had a period yet.
If you’re not sure what type of birth control is best for you, talk to your doctor about the pros and cons of each type. If you use a cervical cap or diaphragm, you must wait about six weeks for your cervix to return to its normal size. In the meantime, you’ll need a backup method.
As with any surgical procedure, there are some potential complications from D & E that may require additional treatment.
- allergic reaction to medications
- laceration or perforation of the uterus
- excessive bleeding
- blood clots larger than a lemon
- severe cramping and pain
- cervical incompetence in future pregnancies
Another risk of D & E is infection in the uterus or fallopian tubes. See your doctor right away if you’re experiencing:
- fever above 100.4°F (38°C)
- shaking and chills
- foul-smelling discharge
To help prevent infection, avoid these things for the first week:
- baths (shower instead)
- swimming pools, hot tubs
Whether you’ve made your final decision or not, it’s important to consult with a doctor you trust. They should allow plenty of time for questions so you completely understand the procedure and what to expect. It might be a good idea to have your questions and concerns written down in advance of your appointment, so you won’t forget anything.
Your doctor should be willing to provide you with information on all your options. If you’re not comfortable talking with your doctor, or don’t feel you’re getting all the information you need, don’t hesitate to see another physician.
Emotional reactions to pregnancy and having to end a pregnancy are different for everybody. Sadness, depression, sense of loss, or feelings of relief are some common initial reactions after ending a pregnancy. Some of this may be due to the hormonal fluctuations involved. If you have persistent sadness or depression, see your doctor as soon as possible.
If you’re considering a later-term abortion, or if you’re having difficulty dealing with one, help is available. You may find that a solid support system helps with recovery. Ask your gynecologist, general practitioner, clinic, or hospital to refer you to a mental health counselor or appropriate support group.