Abortions are generally divided into two main categories and are then classified according to the trimester in which they can be safely and effectively performed.
Medical abortions are achieved through chemical and pharmaceutical methods, while surgical abortions are performed in a clinic or hospital setting by a physician. In both cases, the procedure should be monitored by a medical professional in order to minimize risks to the woman and ensure a healthy outcome.
Available to women during the first trimester, medical abortions are most effective in the very early stages of pregnancy. The RU-486 abortion pill is the most widely used method of medical abortion. Medical abortion methods are up to 95% effective in terminating pregnancy during the first seven weeks. The morning-after pill is not a form of abortion, as it is only effective in preventing implantation and cannot terminate a pregnancy once implantation into the uterine wall has already occurred. Additionally, medical abortion methods can often take weeks to work, creating added stress and worry for women.
A combination of mifepristone and misoprostol, the RU-486 abortion pill is designed to change the chemical environment within the woman’s body and especially within the uterus. Licensed in both France and China in 1988, RU-486 was not approved for use in the United States until September 2000. RU-486 works by blocking progesterone, a necessary hormonal element in sustaining pregnancy. Without sufficient progesterone, the lining of the uterus begins to break down and the implanted embryo is flushed from the system along with the lining. Women may experience cramping in some cases, and the flow produced by this method of medical abortion may be extremely heavy due to the added tissue and material that is expelled from the body.
Methotrexate And Misoprostol
Another hormonal formulation with the same general effects as RU-486, methotrexate and misoprostol can be injected or ingested. This pharmaceutical abortion method is generally not as effective after the first seven weeks of pregnancy and therefore is not as commonly used as RU-486.
During the second and third trimesters, medical abortions are not an effective way to terminate pregnancy. Surgical abortions are generally performed in a clinic or hospital setting. A number of different methods are used depending on the stage of the pregnancy; typically, these methods involve surgically removing the fetus from the uterus via the birth canal, a process that can be prolonged and painful and may require local anesthetics to ensure the comfort of the woman.
This method of abortion requires that the cervix be manually dilated so that a suction device can be used to remove materials from inside the uterus. This terminates the pregnancy, but may cause light bleeding afterwards due to materials adhering to the uterine wall or minor tissue damage from the vacuum aspiration of those materials. This method is only performed during the first trimester and the early stages of the second.
More commonly referred to as a D&C procedure, the dilation and curettage procedure is performed up until about the fifteenth week of pregnancy and involves manual dilation of the cervix so that a long, curved loop can be used to carefully scrape away material from the uterus. Suction aspiration is usually combined with this method in order to ensure that all materials are removed. Dilation and evacuation is a similar procedure used slightly later in pregnancy that usually requires a more complex dilation method; usually a synthetic dilator is inserted twenty-four hours prior to the procedure in order to achieve a wider opening through which to withdraw the uterine material. After the twentieth week of pregnancy, dilation and extraction can be performed; this is a higher-risk procedure and can cause serious complications, the risks mounting higher as the pregnancy progresses.
Generally only performed in cases of medical necessity, induction abortions take place during the third trimester and require the delivery of the fetus, typically after a saline solution has been injected into the uterus. This procedure is painful and usually requires anesthesia; in most cases, dilation and extraction is a safer and more comfortable procedure for medically necessary abortions.
In nearly all cases, abortions performed early in pregnancy are significantly safer and less disruptive than those done in the second or third trimester. Many medical providers lack the facilities or the expertise to safely perform third trimester abortions, so these are usually done in a hospital or clinic setting, usually by physicians who specialize in these procedures. Most women experience no long-term ill effects from abortion and can usually conceive afterwards normally. Some bleeding and discomfort are normal after an abortion; however, if bleeding is exceptionally heavy or persists for a prolonged period of time, women should consult a physician to determine if further medical attention is required in order to protect their health.