What to Expect After an Abortion
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There are many reasons why individuals have abortions. Some procedures are elective, for example, while others are medically necessary. They save the life of the pregnant person. But regardless of why, one thing is clear: Undergoing a procedure—or taking a medication—to end a pregnancy can be full of unknowns. It can also have long-lasting effects. The mental and emotional impact of abortion varies from person to person. Every procedure and situation is different. However, when it comes to your body healing from an abortion and the physical care one requires, there is lots of information and studies available to prepare you for what's to come.
Here's everything you need to know about the process, to how the procedure is handled to what happens to your body after an abortion.
What Is a First-Trimester Surgical Abortion?
A first-trimester abortion can be performed up to 13 weeks of pregnancy, and a surgery called suction curettage is the most common way in which it is performed. Many choose this method for a few reasons:
It allows for sedation, if desired
It's completed in a predictable period of time
High success rate (99%)
Bleeding is perceived as light
It doesn't require a follow-up in most cases
It's a single-step process
According to ACOG, your cervix usually is dilated (opened) so that a thin, plastic tube attached to a suction or vacuum pump can be inserted into the uterus in order to remove the pregnancy.
"The entire surgical abortion process took about three to four hours for me," says Libby Shabada, 25. "In addition to the usual pre-surgical tests, like blood pressure and heart rate, I also met with a counsellor who very thoroughly and kindly went through the entire procedure to ensure my comfort and consent. While I was confident with my decision, I did have the opportunity to get help processing my feelings during this stage. Afterwards, a vaginal ultrasound was completed to see how far along I was, which was roughly seven weeks. This was probably the most physically uncomfortable part, in my opinion."
After Abortion Care: After the procedure, you will rest in a recovery area. You may be able to go home as soon as an hour afterward.
"For me, the surgery itself was quick and relatively painless, other than some mild cramping and discomfort," says Shabada. "I was given fentanyl and atropine for the pain, which made me a little loopy. Honestly, I don't remember much else about the surgery because it was so quick, and I chatted to the nurse about local brunch spots the whole time. The doctor even inserted my IUD during the procedure, so there was also a silver lining to all of this."
Bleeding After Abortion: According to ACOG, individuals may experience severe cramping for one to two days afterward. Bleeding may last for up to two weeks.
"I was provided sanitary pads to wear for the light bleeding following. Then, was escorted into the recovery room, similar to one if you've ever donated blood," says Shabada. "I was given juice and cookies in a big, comfy chair and a heating pad to help with the light cramping. Thanks to my grandma's low blood pressure gene, I did briefly faint in the chair, but was totally fine and attended to by the nurse. Again, most patients came after and left before me in the recovery room. I was really the anomaly!"
Pregnancy Symptoms After Abortion: Your pregnancy symptoms do not last long after an abortion. They usually subside within a day or two.
"Immediately following the abortion, I felt immense relief," says Shabada. "I couldn't believe how positive the whole experience was. All of the clinic's staff were genuinely so kind and supportive to me and the other patients. I never felt ashamed or embarrassed; they simply made me feel human. Other than some extremely mild cramping and bleeding after, I also felt fine physically. I picked up some painkillers and a heating pad to be safe, but rarely needed it in the days following. The light bleeding lasted for a few days, as expected, but I was able to carry on with life normally by the next day."
What Is a First-Trimester Medical Abortion?
A first-trimester abortion can also be performed by taking medication. Many choose this method because it (usually) doesn't require surgery or anesthesia, notes the ACOG, but compared with surgical abortion, medical abortion requires multiple visits to your health care provider's office, takes longer to complete, and is associated with more severe bleeding and cramping.
There is only one FDA-approved regimen for medical abortion in the United States. This regimen includes mifepristone, 600 mg orally, followed approximately 48 hours later by a prostaglandin analogue, usually misoprostol 400 mg orally. The FDA-approved regimen includes this treatment with a follow-up visit approximately 14 days after mifepristone administration, according to ACOG.
After Abortion Care: Nausea, vomiting, fever, and chills may occur. You can take over-the-counter pain medication. Your health care provider may prescribe stronger pain medication if needed. It can take several days or weeks for the abortion to be complete. You doctor may also prescribe you antibiotics, and you will need to see your medical professional within two weeks to make sure the abortion is complete.
Bleeding After Abortion: The drugs used in a medical abortion will cause bleeding that is much heavier than a menstrual period. According to ACOG, an easy reference for too much bleeding is the soaking of two maxi pads per hour for two consecutive hours. If this occurs, you should call your medical professional immediately.
Pregnancy Symptoms After Abortion: According to ACOG, most contraceptive methods can be provided immediately after an uncomplicated first-trimester medical abortion. Oral contraceptives, patch, ring, depot medroxyprogesterone acetate, and subdermal implants all may be started on the day of misoprostol administration. However, this requires an additional visit to the clinic to start depot medroxyprogesterone acetate and implants. Optimal IUD insertion has been studied between one to six weeks afterwards.
According to the UCSF Women's Health Center, pregnancy symptoms of nausea, vomiting, and weariness usually cease within three days. Breast tenderness may take seven to 10 days to disappear. Your breasts may feel firm and tender and leak fluid after your procedure. Your breasts will return to normal after three to four days of swelling.
What Do You Need to Know About Second-Trimester Surgical Abortions?
A second-trimester abortion is one that takes place after 13 weeks of pregnancy, and the most common method used is a surgical procedure called dilation and evacuation (D&E). Women can receive a D&E later than medication abortion and vacuum aspiration—usually up to 24 weeks of pregnancy. Surgical second-trimester abortions are typically performed over a two-day period as an outpatient surgery, meaning that you can go home the same day, according to ACOG. To start the D&E procedure, doctors will dilate your cervix to reduce the risk of injury. One day later, the fetus and placenta will be removed with suction and instruments.
After Abortion Care: Administration of prophylactic antibiotics decreases the risk of infection after surgical abortion and, therefore, should be provided to all patients undergoing D&E. You'll also need to wait about six weeks after a second-trimester abortion to use a cervical cap or a diaphragm to give the cervix time to return to its normal size. You should see your care provider two weeks after the procedure for a follow-up examination.
Bleeding After Abortion: Soreness or cramping may occur for one or two days after the procedure. Bleeding may last for up to two weeks.
Pregnancy Symptoms After Abortion: According to the UCSF Women's Health Center, pregnancy symptoms of nausea, vomiting, and weariness usually cease within three days. Breast tenderness may take seven to 10 days to disappear. Your breasts may feel firm and tender and leak fluid after your procedure. Your breasts will return to normal after three to four days of swelling.
Are Second-Trimester Medical Abortions Possible?
According to ACOG, a second-trimester abortion can also be safely accomplished through medical induction or medical abortion. Mifepristone followed in 24 to 48 hours by misoprostol is the most effective regimen for second-trimester medical abortion. However, according to ACOG, compared with D&E, termination by induction with misoprostol is less cost-effective, is associated with a greater risk of complications, such as incomplete abortion, and may be prolonged.
Most of the time, individuals will undergo a medical second-trimester abortion if the fetus has a health condition, as was the case for Anna Sakawsky, 32. "Both my husband and I agreed that we would never want to be forced to live a life like our son would have if he survived, that we would never be able to forgive our parents for bringing us into this world knowing the pain and suffering we would face," says Sakawsky after she learned her son's lower spine was missing do to a spinal and nervous system defect. "We met with a geneticist and made the decision to terminate. Since I was already nearing 24 weeks, they made arrangements for me to come in for the procedure as soon as possible."
Second-trimester medical abortion usually is done in a hospital or clinic where you can be monitored throughout the procedure. The medications used to cause the abortion may be put in your vagina, taken by mouth, injected into your uterus, or given through an intravenous (IV) line. These drugs cause the uterus to contract and expel the fetus, and usually cause the abortion to begin within 12 hours.
"When we finally arrived at the hospital on the day of the procedure, I held it together. But at the last minute, as we were being ushered into the room, it all seemed to be happening too fast," says Sakawsky. "I watched as the nurse readied the needle. My mind raced as I wondered what it would feel like. Would I feel his soul leave my body? Somehow, I hoped so."
"'It's done,' the nurse said quietly, and then they packed up their instruments and left us alone together."
"We wept," she added. "I hadn't felt his soul leave my body when it happened. I honestly didn't know what to feel. I hadn't even delivered him yet but he was gone, and somehow I knew that for me, this was the hardest part. Labor and delivery couldn't compare to the pain I felt the moment we ended his life."
A second-trimester abortion is usually complete within 12 to 24 hours, although the timing can be unpredictable.
"We returned to the hospital the next morning and I was given another pill and told to wait a few hours until things started to happen. It took a long time, but finally, around 6 p.m., I started to feel some contractions," says Sakawsky. "I tried pushing for an hour as the doctor, the nurse, and my husband stood over me staring... finally, I gave one last push and he was out, and everything was silent. There were no cries. No chatter from the nurse or doctor. No happy congratulations. Just quiet."
After Abortion Care: The drugs used during a second-trimester medical abortion may cause side effects such as nausea, fever, vomiting, and diarrhea, and medications to manage these side effects can be given as needed. Since this procedure will likely take place in a healthcare facility, your doctor will monitor you to make sure you have not had any complications. The most common complication of a second-trimester medical abortion is a retained placenta, according to ACOG.
Bleeding After Abortion: The drugs used in a medical abortion will cause bleeding that is much heavier than a menstrual period. According to ACOG, an easy reference for too much bleeding is the soaking of two maxi pads per hour for 2 consecutive hours. If this occurs, you should call your medical professional immediately.
Pregnancy Symptoms After Abortion: According to the UCSF Women's Health Center, pregnancy symptoms of nausea, vomiting, and weariness usually cease within three days. Breast tenderness may take seven to 10 days to disappear. Your breasts may feel firm and tender and leak fluid after your procedure. Your breasts will return to normal after three to four days of swelling.
Do Abortions Affect Your Fertility?
While most patients worry about the procedure itself, fertility is also a concern. Many worry how having an abortion can and will affect their future health and fertility. But fear not: Terminating a pregnancy does not affect your ability to get pregnant or increase risk of future pregnancy complications. In fact, you can actually get pregnant soon after an abortion, even before your period returns, which is usually after 21 days, according to American College of Obstetrics and Gynecology (ACOG). Most birth control methods can even be started on the same day of an abortion.
