What kinds of abortion are there?
There are several kinds of abortion. They divide into two main categories: medical and surgical.
Medical abortion is where you take pills (or a shot and some pills) which cause you to miscarry. There are two forms of medical abortion: methotrexate abortion (a shot, then some pills later) and mifepristone abortion (also known as mifeprix or RU-486 - a pill and some more pills later). The difference between the two types of medical abortion is the medication used: one uses methotrexate and misoprostol, one uses mifepristone and misoprostol. They are basically the same in terms of how they feel, but the medications work differently.
When can I get a medical abortion? Medical abortion is available up to 8 or 9 weeks pregnant (depends on the clinic). Note: doctors count "pregnancy" from your last period, not from when you conceived. So if you had your period two weeks ago and conceived today, you'd be two weeks pregnant already.
What do the medications do?
The methotrexate/mifepristone stop the embryo from growing. At this point, the pregnancy is ended. But the tissue - the placenta and blood and the tiny embryo - is still in your uterus. The second medication, the misoprostol, will start giving you contractions, like labor. Your uterus will contract and push out all the tissue, which will be just like you are suddenly getting your period.
What is Medical abortion like? Generally, a clinic starts by giving you an internal ultrasound to make sure you're really pregnant, and not too far along. In the United states, the clinic will give you the methotrexate or mifepristone, then will send you home with some misoprostol pills. In other countries, the abortion provider may have you come back to go through the miscarriage in a hospital. A few days later, at home, you insert the misoprostol pills into your vagina. This will cause about 8 hours of contractions, first getting stronger and more painful, then ramping down again. These cramps may be extremely painful, or may just feel like period cramps. You will also very likely start your period at this time. Some women have a lot of bleeding during the contractions; soaking up to two heavy pads per hour is normal. You will keep having your period for about a week and a half to two weeks following the miscarriage.
A week or so after the miscarriage, you need to go back to the abortion provider for a check-up to make sure everything went ok. They will give you another internal ultrasound to see that the abortion worked and your uterus is clear.
Surgical abortion is a general category - it covers all forms of abortion where a doctor clears out your uterus in a clinic or hospital. They do this by dialating your cervix a little bit, then using a small straw and sometimes a small blunt surgical tool called a "curette."
"Manual Vaccum Aspiration" In this type of abortion, the woman's cervix is slowly opened by sliding in tapered rods. A cannula (straw-like tube), is inserted through the cervix into the uterus. The cannula is attached to a small hand-operated syringe (like a tiny pump - Picture here. The doctor uses the syringe to gently suction out all the pregnancy tissue and clear out the woman's uterus. This sort of abortion can only be used very early in pregnancy, to about 6-7 weeks. More info on manual vacuum aspiration.
"Machine Vacuum Aspiration": This is almost exactly the same as the Manual Vacuum Aspiration, only a small machine pump is used instead of a hand-held syringe. It's used for 6-12 week abortions.
Dilalation and Curettage ("D&C"): This is a method for abortions from 6-12 weeks. Like in MVA abortions, the woman's cervix is slowly opened by sliding in tapered rods. The cervix may be opened slightly more than in a MVA abortion. The doctor then slips a metal or plastic instrument called a "curette" into the woman's uterus. A curette is usually a slim metal handle with a small metal spoon or loop on the end .It looks like this. Here is a plastic, one-use version. When a woman is pregnant, a special temporary organ called a placenta forms in her uterus and sticks to the wall of the uterus. The doctor uses the curette to dislodge the placenta and other pregnancy tissue from the walls of the uterus where it is stuck. Sometimes a vacuum curette is used, which is like the suction straw at the dentist's office, but with a little spoon end. A D&C does not involve deliberately cutting up an embryo or fetus, because at this point in pregnancy the embryo or fetus is very small.
Which type of abortion should I get??
That's a totally personal decision... there's no right answer for everyone :) It depends on your preferences!
Here's a comparison chart of medical and surgical abortion.
And Here's another chart.
Later-term abortions.
90% of abortions are done in the first trimester. However, for the few done later in pregnancy, there are special forms of surgical abortion used to abort. These are known as Dialation & Extraction and Dialation & Evacuation. They involve more dialation of the cervix- it takes two days to dialate enough. Then the doctor goes in and either cuts up the fetus (D&E) and takes out the pieces or collapses its skull and pulls it out. Later-term abortions are rarely performed unless there is a fetal deformity or the mother's health is endangered. Here are some of the reasons for later-term abortions.
posted by openeyelid @ 7:13 PM
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