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Abortion during the second (week 13 to 27) or third trimester (week 28 onwards) of pregnancy is sometimes called a “later-term abortion.”
Although some people refer to abortions that occur later in pregnancy as “late-term,” this phrase is medically inaccurate.
A “late-term” pregnancy is past 41 weeks gestation — and pregnancies only last 40 weeks overall. In other words, childbirth has already occurred, making “late-term abortion” impossible.
On June 24, 2022, the Supreme Court of the United States overturned Roe v. Wade, the landmark 1973 ruling that secured a person’s constitutional right to an abortion.
This means that individual states are now able to decide their own abortion laws. Many states will ban or severely restrict abortion access, and more states may follow suit.
The information in this article was accurate and up to date at the time of publication, but it’s possible the information has changed since. To learn more about your legal rights, you can message the Repro Legal Helpline via a secure online form or call 844-868-2812.
Most people ending a pregnancy in the second or third trimester undergo a surgical abortion. This procedure is 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 clinician will use a speculum to widen your vaginal opening. This allows them to clean your cervix and apply a local anesthetic.
Afterward, your clinician will insert a dilating stick called a laminaria stick into your cervical canal. This stick absorbs moisture and opens the cervix, as it swells. Alternatively, your clinician can use another type of dilating stick called Dilapan, which can be inserted on the same day as the surgery.
Your clinician may also choose to give you a drug called misoprostol (Cytotec), 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 clinician 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 abortions in the second or third trimester are permitted vary from state to state.
After the overturning of Roe v. Wade, several states’ abortion laws changed, with more scheduled to change in the coming weeks as a result of the likes of trigger laws or the lifting of temporary blocks on such trigger laws.
Currently, 44 states ban some abortions after a certain point in a pregnancy. Of the 19 states that ban abortion at or after a specific week of gestational age, 10 ban ending a pregnancy at approximately 20 weeks post-fertilization.
Trying to make sense of the limitations in your state? Our state-by-state guide to abortion restrictions can help.
According to Planned Parenthood, a D&E can cost as much as $750 in the first trimester, with second-trimester abortions tending 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, but many do not. The clinician’s office can contact your insurer on your behalf.
If you don’t have insurance or are underinsured — meaning, your insurance doesn’t cover much — you have other options for financial assistance.
Many organizations across the country can work with you to help fund the procedure. To learn more, check out the National Network of Abortion Funds.
Before scheduling the procedure, you’ll have an in-depth meeting with a doctor or other healthcare professional to discuss:
- your overall health, including any preexisting conditions
- any medications you take and whether you’ll need to skip them before the procedure
- the specifics of the procedure
In some cases, you’ll need to see your clinician the day before the surgery to begin having your cervix dilated.
Your clinician’s office will provide instructions before and after the surgery for you to follow. You may also be advised to avoid eating for about 8 hours before the procedure.
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 to help prevent infection and will be advised exactly how to take it.
For pain, ask your clinician if you can take acetaminophen (Tylenol) or ibuprofen (Advil) and how to take it. Avoid taking aspirin (Bayer) or other medications containing aspirin, because it can cause you to bleed more.
Recovery time can vary significantly from person to person, so listen to your body and follow your clinician’s recommendations for resuming everyday activities.
You might feel just fine the next day or you may need a day off before returning to work, school, or other activities. It’s best to avoid heavy exercise for a week, as it can increase bleeding or cramping.
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 2 days
- tender breast or chest tissue
- light to heavy bleeding for 2 to 4 weeks — tell a healthcare professional if you soak through more than two maxi-pads an hour for 2 or more hours in a row
- clots that can be as large as a lemon — notify a healthcare professional if they’re larger than that
- low grade fever — call a healthcare professional if it rises above 100.4°F (38°C)
Menstruation and ovulation
Your body will begin preparing for ovulation immediately. You can expect your first menstrual period within 4 to 8 weeks of the procedure.
Your usual cycle may return right away, but it may take several months before periods return to the way they were. For some people, periods are irregular and lighter or heavier than they were before.
Because of the risk of infection, you’ll be advised not to use tampons for at least a week following the procedure.
Sex and fertility
It’s best to avoid having penetrative vaginal sex — including fingers, a fist, sex toys, or a penis — for at least a week after having a D&E. This will help prevent infection and allow your body to heal.
Your clinician will let you know when you’re done healing and can have penetrative vaginal sex again. The procedure shouldn’t affect your ability to enjoy sexual activity.
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 with a healthcare professional about the pros and cons of each type. If you use a cervical cap or diaphragm, you’ll need to wait about 6 weeks for your cervix to return to its usual 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
- excessive bleeding
- blood clots larger than a lemon
- severe cramping and pain
- laceration or perforation of the uterus
- cervical incompetence in future pregnancies
Another risk of D&E is an infection in the uterus or fallopian tubes. Seek medical attention as soon as possible if you’re experiencing:
- fever above 100.4°F (38°C)
- shaking and chills
- severe pelvic or abdominal pain
- strong-smelling discharge
To help prevent infection, avoid the following for the first week:
- penetrative vaginal sex
- baths (shower instead)
- swimming pools, hot tubs, and other bodies of water
Whether you’ve made your final decision or not, it’s important to consult with a healthcare professional 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 don’t forget anything.
Your clinician should be willing to provide you with information on all your options. If you’re not comfortable talking with them or don’t feel you’re getting all the information you need, don’t hesitate to see another physician if possible.
Emotional reactions to ending a pregnancy are different for everybody. You may experience sadness, depression, a sense of loss, or feelings of relief. Some of this may be due to the hormonal fluctuations involved.
If you experience persistent sadness or depression, you might find it helpful to talk with a healthcare professional about how you feel.
If you’re considering ending a pregnancy in the second or third trimester or if you’re having difficulty navigating your options, help is available. A gynecologist, general practitioner, clinic worker, or hospital advocate can refer you to a mental health counselor or appropriate support group.