Medical and surgical abortion methods are available, yet they differ at each stage of pregnancy. Typically, once a pregnancy is past 7 weeks, only surgical abortion methods can be used. Second-trimester abortions tend to carry higher risks than first-trimester ones.
Medical Abortions:
These abortions use medication to end the pregnancy. This can be accomplished with a variety of medications given either as a single pill or a series of pills. It is commonly known as the Abortion Pill -- RU486 (brand name Mifeprex). It causes an early abortion through the combination of the two medications, mifepristone and misoprostol. This method is FDA approved for use up to 49 days after one's last menstrual period or if a woman is 7 weeks pregnant (which equals 5 weeks since conception) and is 92% to 98% effective, allowing a woman to completely pass the pregnancy without the use of surgery. Please be aware that a medical abortion is not FDA approved if it has been more than 49 days since your last menstrual period; some healthcare providers will still use this method after this point, but it is off label (meaning, no longer FDA approved).Vacuum Aspiration and Dilation and Curettage:
This abortion procedure, also known as D&A or suction aspiration, uses gentle suction to remove all of the pregnancy tissue. There are two methods of vacuum aspiration: When this procedure is performed with a handheld suction device, it is referred to as a manual vacuum aspiration. Vacuum aspiration is also performed with a machine-operated suction device. Additionally, dilation and curettage or D&C, may be necessary after a vacuum aspiration. In this procedure, a separate curette (a spoon-shaped instrument) may be used to help remove any remaining tissue that may be lining the uterus. A vacuum aspiration abortion procedure (by itself or followed by a dilation and curettage) can be performed in one visit and is an option for women until 14 weeks have passed since their last menstrual period. It is nearly 100% effective.Dilation and Evacuation (D&E):
This method uses the same procedures as D&C procedure while also using additional surgical instruments (such as forceps). A D&E abortion is usually performed during the second trimester of a pregnancy (roughly 13 to 24 weeks since conception). This method is nearly 100% effective as the healthcare provider will examine the removed uterine tissue to ensure that all of it was removed and the abortion is complete. Some healthcare providers will also use an ultrasound during the procedure to confirm that all of the tissue has been removed and the pregnancy has ended.Induction Abortion:
This procedure is used to end a second or third trimester pregnancy through the use of medications that trigger the start of contractions. This, in turn, expels the fetus from the uterus. Induction abortions must be done in a hospital, so that the woman can be monitored during the entire procedure. During this procedure, a woman will undergo all the steps of delivery and childbirth. Induction abortions are usually only performed if there is a medical problem or illness present in the fetus or the pregnant woman. This method minimizes risk to the woman's health, and may allow doctors to perform a more accurate autopsy on the fetus to determine exactly what was wrong. Induction abortions represent less than 1% of all abortions obtained in the United State.Intact Dilation and Extraction:
Perhaps the most controversial of all the abortion procedures, this method is performed after 21 weeks of pregnancy and is also referred to as D&X, Intact D&X, Intrauterine Cranial Decompression and Partial Birth Abortion. This abortion procedure takes about 2 to 3 days and results in the extraction of an intact fetus. An Intact D&X is performed for the safety of the woman. The Partial Birth Abortion Ban Act makes certain circumstances of the intact dilation and extraction method illegal in the United States. This was signed into law on November 5, 2003 by President George W. Bush. In 2006, the law's constitutionality was upheld by the U.S. Supreme Court in the case of Gonzales v. Carhart.Sources:
Finer, L.B. et al. (2005). Reasons U.S. women have abortions: quantitative and qualitative perspectives. Perspectives on Sexual and Reproductive Health, 37(3), 110–118.
Guttmacher Institute. (2007). In brief: Facts on induced abortion in the United States. Accessed 9/23/07.
Jones, R. K., Darroch, J.E., & Henshaw S.K. (2002). Contraceptive use among U.S. women having abortions in 2000–2001. Perspectives on Sexual and Reproductive Health, 34(6), 294–303.
Paul, M. (1999). A clinician's guide to medical and surgical abortion. New York: Churchill Livingstone.
Pichler, S. (2007). How Abortion Is Provided. Accessed 9/23/07, from Planned Parenthood.
