What Are the Types of Abortion Procedures?

Before the Procedure

When you schedule your appointment, your health care provider will probably give you some instructions over the phone. Because in-clinic abortions are considered surgeries, you may have to fast starting around midnight the night before your procedure.

When you arrive at the clinic, you’ll fill out some paperwork and answer questions about your medical history. You’ll then get a pre-abortion workup, which includes a physical examination, pregnancy test, blood test, screening for sexually transmitted infections, and possibly additional testing, if your case warrants it. Many providers will also use an ultrasound to confirm how far along you are in your pregnancy and check for uterine, fetal, or placental abnormalities.

All of this information, which your doctor will discuss with you during a short counseling session, will help them determine which procedure is right for you.

Some states require you to get this counseling in person instead of over the phone or a video call. And lots of states require you to wait a certain amount of time after the counseling session until you get your abortion, although there’s no medical reason for this. Depending on the state, this waiting period could be from 18 to 72 hours. If you’re having a medical emergency or your life or health is in danger, states waive the waiting period requirements.

Pain Management

Your doctor will also talk to you about different types of pain management available to you during the procedure.

For an in-clinic abortion, you’ll probably get local anesthesia, meaning that your cervix will be numbed but you’ll be awake. While 600 to 800 milligrams of ibuprofen usually provides enough pain relief, your doctor might also offer you an oral medication to calm you down or mildly sedate you, so you’re awake but relaxed. If you prefer heavy sedation, meaning you’re in a light sleep throughout the procedure, you can ask if a sedative medication can be given to you through an IV.

Vacuum Aspiration (Suction Abortion)

Most abortions done in the U.S. take place in the first 12 to 13 weeks of pregnancy. If you opt for an in-clinic abortion in your first trimester, you’ll have a vacuum aspiration, which you may also hear called a “suction abortion.”

In most cases, your cervix doesn’t need to be prepped or dilated for this procedure. But if you’re more than about 10 to 12 weeks pregnant, your health care provider may take steps to open your cervix a bit before getting started so that the medical tools can access your uterus. They’ll likely insert little sticks made of sterilized seaweed that absorb moisture and expand, called laminaria.

Second Trimester: Dilation and Evacuation

If you’re more than 12 weeks pregnant, your provider will use an ultrasound to date your pregnancy. The farther along you are, the more prep work you may have to undergo to prepare your body for the procedure.

While doctors can do vacuum aspirations until about 14 weeks, the most common type of second-trimester abortion is called dilation and evacuation, or D&E.

The first step a provider will take before this procedure is to prepare and dilate your cervix so that it’s not injured in the procedure. They will likely use laminaria sticks, which might be left in overnight. They might also give you a dose of a medication such as misoprostol, either by mouth or through your vagina, to soften your uterus. They may also use tools to help dilate your cervix.

Like a first-trimester abortion, you’ll lie on an exam table with your feet in stirrups, and your health care provider will swab your vagina and cervix with Betadine, inject anesthesia into your cervix, and then use a gripping tool to hold your cervix in place.

The main difference is that in addition to using a vacuum suction in your uterus, they’ll also use forceps and other medical tools, including one called a curette to scrape the inside of your uterus. Your doctor may use ultrasound to guide them, and will likely use a suction or vacuum to make sure everything is cleared out. Some providers may use a medication, which you would get as a shot into your abdomen, to stop the fetal heartbeat before the procedure. Afterward, your provider may give you a medication to contract your uterus and reduce bleeding.

This procedure takes 10 to 20 minutes. You’ll rest for 30 minutes to an hour while your health care providers make sure you’re well.

Late-Term Abortion: Dilation and Extraction

If you’re having an abortion further along in your pregnancy, you may have to find a specialized, experienced provider to do a dilation and extraction procedure, or D&X. This is a procedure that doctors usually reserve for when there is a serious problem with the fetus or medical complications related to the mother.

All the steps leading up to the procedure and steps taken after the procedure are the same as for a D&E, including the ultrasound to date your pregnancy and prep work to soften and dilate your cervix.

For sedation, you might be offered a general IV anesthesia, especially if the procedure is done in a hospital.

There are a few other options, like labor induction, hysterotomy and hysterectomy. But because they are riskier, doctors only do them if medically necessary.

How Much Does an Abortion Cost?

The amount may depend on how many weeks pregnant you are, if you get anesthesia or sedation for pain or discomfort, your financial situation, and where you get the procedure. Many clinics offer free or sliding-scale payment options based on how much money you make. To explore these options, look into your local Planned Parenthood or other women’s health clinics.

Generally, without other help, you can expect to pay anywhere from:

• $430 to $600 if you’re 4 to 12 weeks from your last menstrual period (LMP)
• $540 to $1,100 if you’re 13 to 16 weeks from your LMP
• $900 to $1,850 if you’re 17 to 21 weeks from your LMP

Suction termination (also called suction curettage or vacuum aspiration abortion) may range around $500 to $700. Dilation and evacuation abortions, which are usually for later-stage pregnancies, range from $800 to $2,500. But in some areas, these prices could be as little as $300. In other cases, they may be more expensive depending on your medical needs.

If you get conscious sedation as opposed to local anesthetic, your cost may be on the higher end.

If you’re 5-10 weeks pregnant, you can use the abortion pill to end a pregnancy. It usually costs about $500 to $1,500.

Paying for Abortions

In some states, you may only be able to get an abortion if you get pregnant because of rape, incest, or if the pregnancy threatens your life. In these situations, you may be able to receive financial help from the government. The facility that does your abortion will need to apply for government funds in these cases. Ask your provider to complete an application if you need financial help.

If you have Medicaid, you can get financial help for an abortion. Some states, including California, Colorado, Connecticut, Delaware, and New Jersey, also choose to use their funds to help people with abortion costs.

If you have insurance, abortions might be covered, depending on the rules of the state you’re insured in. Some states have stricter rules than others. If your insurance covers your abortion, it may be free. In some situations, you may have to pay a copay, just like with other medical procedures.

For example, Texas only allows abortion coverage if the pregnancy could severely threaten your health or life.

If you need a low-cost or free abortion, there are organizations that can help. You can find more information at:

• The National Abortion Federation: Visit prochoice.org or call 800-772-9100.
• Planned Parenthood: Visit plannedparenthood.org or call 800-230-7526.
• National Network of Abortion Funds: Visit abortionfunds.org to find local organizations that can offer financial help.

What Happens Next?

Once your procedure is done, you’ll rest at the clinic under supervision for about 30 minutes. You can then continue to relax in a recovery area until you’re ready to head home. If you’ve had any sedation, you’ll need someone to drive you. You’ll get a prescription for an antibiotic, too.

You’ll probably have some cramping for a few days and light bleeding for up to 2 weeks. Most pain and cramping is effectively treated with an over the counter or prescription painkiller like acetaminophen, ibuprofen, or codeine.

Plan to rest on the day of your procedure. You may need a few more days of rest if you had a D&E or D&X. You shouldn’t lift anything heavy for a few days. Ask your doctor when it would be OK to have sex or use a tampon again -- it may be up to a month before you can have anything in your vagina.

Does Abortion Affect Your Fertility?

If a trained health care provider safely gives you a surgical abortion, it shouldn’t cause you to have trouble getting pregnant in the future if you decide to have a baby. There’s an exception to this that’s linked to getting more than one surgical abortion in which the doctor uses an instrument called a curette. This could raise the chances for scarring of the inner lining of your womb, a condition called Asherman syndrome. That condition is tied to having a harder time getting pregnant later.

What Is a Spontaneous Abortion?

It’s a medical term for miscarriage. It’s not a procedure like a surgical or a medical abortion.

Doctors also use a term called “missed abortion” to mean that there is a fetus in the womb but it no longer has a heartbeat.

Why Do People Get Abortions?

You might want or need an abortion for any number of reasons. For example, you might:

• Get pregnant by accident and decide you don’t want to have a baby
• Not have enough money or time to raise a child
• Not have the support of a partner or relative and decide you don’t want to raise a child by yourself
• Have personal problems with your partner
• Learn the unborn baby has a serious health problem
• Have a health problem of your own that makes pregnancy unsafe