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What to expect during an in-clinic vs. at-home abortion and how late you can wait

Rebecca Strong,Sara Twogood   

What to expect during an in-clinic vs. at-home abortion and how late you can wait
  • There are two main types of abortion procedures: in-clinic and at-home.
  • In-clinic abortions are more invasive and the only option if you're more than 9 weeks pregnant.

Whether you've decided to get an abortion because you can't afford a baby right now, you're not ready to be a mother, or for a different reason entirely, you should know that you have multiple options for ending your pregnancy.

The main types are surgical and medical abortions, and which type you get will often depend on how far you are into the pregnancy.

Your doctor will also take certain medical conditions into account, like bleeding disorders, a history of seizures, and liver or kidney diseases.

The most important thing to remember is that your doctor is available to help guide your decision, but the choice is ultimately yours, says Dr. Monica Grover, an OB-GYN and Chief Medical Officer at VSPOT.

In 2019, nearly 630,000 legal abortions were performed in the US. If you're considering an abortion, the following information will better prepare you for what to expect before, during, and after the procedure.

Medical vs. surgical abortions

There are two types of abortions:

1. Medical abortion, aka the abortion pill, or medication abortion

2. Surgical abortion, aka an in-clinic abortion

Here's what to know about both types.

Medical abortion
The majority of abortions, over 50%, are medical abortions. However, it's important to note that you can only get a medical abortion up to nine weeks of pregnancy, or 11 weeks after that first day of your last period. Therefore you'll first need an evaluation and exam so your doctor can confirm you're eligible.

Important: It may be difficult to know you're pregnant early on, but if you've missed a period or experienced symptoms like increased vaginal discharge, morning nausea or sickness, or tender breasts, then you might be pregnant.

Moreover, medical abortions are not generally considered a safe option for people who have:

Medical abortions are very safe and serious complications, like injuries and infections, are rare. If you follow through with one, it will consist of a series of medications that your doctor will prescribe to you:

  • According to Masterson, a medical abortion usually entails first taking a dose of mifepristone at the doctor's office, which blocks progesterone and causes the uterine lining to thin.
  • You'll then take a dose of misoprostol prescribed by your doctor, which causes uterine contractions that then force out the embryo. Typically, the second medication, misoprostol, is taken within 24-48 hours of the first, but your healthcare provider will give specific instructions about when and how to take them.

For most people, a medical abortion feels like intense period cramps, Masterson says, and may also cause heavy bleeding with clots. This is because, like your period, a medical abortion causes contractions in the uterus to help expel its lining.

Heavy cramps usually start within one to four hours of taking the second medication and last a few hours. However, you may continue to experience on and off mild to moderate cramps for up to a week after taking the second medication.

What's the cost? Dr. Lisa Masterson, an OB-GYN in private practice, says the cost can vary but usually starts at around $200 and can be as high as $800. Not all health insurance plans cover abortion services, so it's best to check with your provider ahead of time.

Masterson says it's important to schedule a follow-up with your healthcare provider within two to three weeks of having a medical abortion to make sure the procedure was successful and there were no complications. During this appointment, they'll perform a pelvic exam and ultrasound of your uterus as well as look for any signs of infection.

Surgical abortion

Once you're more than 9 weeks pregnant, you're no longer eligible for a medical abortion and will need to consider one of two types of surgical abortions:

  • Vacuum aspiration abortion: Also known as a suction abortion, this is typically used before 14 weeks of pregnancy. During a vacuum aspiration abortion, your doctor will place a speculum into your vagina, numb the cervix using local anesthesia, and then widen the cervix before inserting a tube into the uterus. From there, the vacuum will apply suction to empty the uterus. According to Grover, the procedure itself takes about 5-10 minutes.
  • Dilation and Evacuation (D&E) abortion: This type of abortion is usually used starting at 14 weeks of pregnancy.. The difference with a D&E abortion is that different surgical tools may be used to help empty the uterus. Due to this extra step, to ensure the uterus is totally empty, a D&E typically takes closer to 10-20 minutes.

When you get a surgical abortion, your doctor will inject a local anesthetic to numb the area around your cervix, so you shouldn't feel much pain during the procedure.

Note: You can also choose to be fully sedated for the procedure, just make sure to arrange a driver for after since you may still be drowsy from the anesthesia, Masterson says.

Your doctor may also give you dilation medication to take ahead of time and instruct you not to eat or take other medications for a specified amount of time before the procedure.

What's the cost? As with medical abortions, the cost can vary depending on where it's performed and whether your health insurance covers it. According to Grover, it usually ranges from $600 to $1,000 for the procedure itself, and some insurance plans will cover the full cost or at least part of it.

Your doctor may prescribe an antibiotic to take either before or after a surgical abortion. They may also prescribe a medication to help your uterus contract, which can reduce bleeding.

Surgical abortions are considered very safe. Complications are rare — but may include:

  • Infection
  • Incomplete abortion
  • Heavy bleeding lasting longer than 12 hours or bleeding lasting longer than 21 days
  • Injury/damage to the womb

What is a late-term abortion?

Late-term abortion is among the list of phrases to avoid when discussing abortions, according to the American College Of Obstetricians and Gynecologists (ACOG).

Rather, ACOG recommends describing these procedures as "abortion later in pregnancy" or specify the weeks of pregnancy, such as "abortion at 23 weeks".

These procedures typically happen as a result of fetal anomalies or medical concerns that pose a risk to the pregnant person or the pregnancy.

The procedure may be done in one of two ways:

One of the biggest and most problematic misconceptions around abortion is that these procedures can happen moments before childbirth or even after birth, when in fact that's illegal in the US.

"Partial-birth" abortion is not a recognized medical term, either, but typically refers to certain procedures used in second-trimester abortions. These abortions have been banned by law, except when the pregnant person's life is in danger.

Recovery

Recovery time can vary from a couple of days to several weeks, depending on how far along the pregnancy was.

The most common side effects of an abortion are vaginal bleeding and cramping. The bleeding may range from spotting to a fairly heavy flow, and Grover notes that small blood clots are normal.

Take over-the-counter pain relievers or apply a heating pad to your lower abdomen to relieve discomfort from cramps, Grover says.

Some remedies used to relieve period cramps — like getting plenty of rest, trying pain-relieving herbs, or massaging the lower abdomen area — may also help. However, for the first few days after your procedure, stick to gentle movement and don't do any strenuous exercise.

With a medical abortion, side effects tend to start soon after taking the second pill. Cramping and bleeding will usually last a few days.

According to Grover, you may also experience the following symptoms, which should only last for several hours to a day:

With a surgical abortion, the cramping may last anywhere from a few days to two weeks, and bleeding or spotting may last for up to four weeks.

While complications are rare, it's important to keep a lookout for any warning signs that something is wrong. Dr. Kim Langdon, an OB-GYN with the digital health platform Medzino, recommends contacting your doctor as soon as you notice any of the following symptoms after an abortion:

  • Excessive bleeding (soaking two pads or more per hour)
  • Prolonged abdominal pain or cramps that medication won't relieve
  • Foul-smelling vaginal discharge
  • A fever over 100 °F that lasts more than a day

Those symptoms could be a sign of infection or incomplete abortion.

You should also contact your healthcare provider if your period doesn't return within two months of getting an abortion. This could mean you're pregnant again, your hormone levels are out of whack, or something else — but your doctor will be able to rule out any possible complications.

Risks

Even though abortions are generally safe, they can sometimes lead to complications. Complications are rare, and generally out of your control as the patient. However, there are some steps you can take to minimize certain risks.

According to Grover, the main risk with both medical and surgical abortions is incomplete evacuation, meaning that some pregnancy tissue remains in the womb. This happens in about 7% of medical abortions, and 3.5% of surgical abortions.

An incomplete evacuation doesn't mean you're still pregnant, and it's not generally dangerous — however, it's important to get any remaining pregnancy tissue out of the womb to avoid an infection and bleeding.

Grover recommends scheduling a follow-up appointment with your doctor two weeks after taking the second pill. They can conduct an ultrasound to determine whether or not the abortion was complete.

Other risks include:

  • Infection: An infection, which only happens after 1% of abortions.
  • Perforated uterus: In very rare cases, an abortion can damage the uterus or cervix. When the uterine wall is perforated by a surgical instrument, it usually heals on its own — however, it can sometimes lead to an infection or additional complications.
  • Torn cervix: If the cervix is torn during a surgical abortion, you may experience extra bleeding. Your doctor may place medication or stitches on the cervix to reduce that bleeding.
  • Asherman's syndrome: While extremely rare, a D&C abortion can cause a condition called Asherman's syndrome that's characterized by scar tissue inside the uterus. This syndrome may cause absent, irregular, or painful periods as well as infertility — but it can usually be treated with surgery.

To reduce your risk of rare complications, the first, and most important, thing you can do is to only pursue an abortion by a licensed physician and in an environment that meets the medical standards for this procedure.

Grover recommends searching the online directories at The National Abortion Federation or Planned Parenthood to find a registered provider. Grover also notes that hospital clinics and some gynecology offices often offer abortions.

To reduce the risk of infection, avoid the following for two weeks after your abortion:

In some cases, Masterson says your doctor may prescribe an antibiotic following a surgical abortion that, when taken as directed, can minimize your chances of getting an infection.

Insider's takeaway

The type of abortion that's right for you largely depends on how far into the pregnancy you are and how many weeks it has been since the first day of your last period.

Medical abortions are done, earlier up to nine weeks of pregnancy. Surgical abortions are for both early and later in pregnancy.

Both medical and surgical abortions are safe, although complications like incomplete procedures, infections, and injuries do happen in rare cases.

The most common side effects are heavy cramping and bleeding — which tend to only last a brief amount of time.

Remember: Getting an abortion is a highly personal decision, and only you can decide what's best for your body. That said, your doctor can guide you every step of the way — from deciding which procedure makes sense to recommending pre- and post-abortion care steps.

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