Women’s and clinicians’ experiences with later abortions

woman talking with her doctor

What happens during a later abortion?

This information is a general overview of what a woman can expect when having a later abortion. Most clinics that offer the procedure have detailed information on their websites about the specific protocols at that clinic.

Later abortions are done by a process called “Dilation and Evacuation” (D & E) or “Dilation and Extraction” (D & X).

At the first appointment, the woman is given an ultrasound, counseling and a medical examination. Cervical dilation is begun with the use of osmotic dilators. Osmotic dilators that are used most commonly may be either sterile sticks of compressed seaweed (called laminaria) and/or a synthetic get (Dilapan) that upon insertion will gradually swell in size. This process gently opens (dilates) the cervix. The number of osmotic dilators used and the time required for dilatation will depend upon the duration of the pregnancy and the individual woman’s body. Usually it takes 24-48 hours for the cervix to sufficiently open. During this time, some clinics offer counseling and/or support groups.

For the procedure itself, medicines are used for pain control and sedation. Most commonly, anesthesia medicines are administered intravenously in the arm, and local anesthesia is done by an injection into the cervix. The physician then removes the pregnancy through the cervix with a combination of suction aspiration and grasping instruments. The abortion itself generally takes about 10-30 minutes.

In other cases, clinics or hospitals may offer labor induction as the way to end a pregnancy. In most cases, after an ultrasound, counseling and a medical assessment, an injection is used to stop the fetal heart. After that, the woman receives medicines to get her to go into labor and deliver a dead fetus vaginally. This process may take anywhere from less than a day to several days. Sometimes, the labor process is made more rapid by taking mifepristone (the “abortion” pill) and then waiting a couple of days to get the body more ready to go into labor.

For labor induction terminations, the woman may be offered any type of pain control that would be used for a vaginal delivery. This may include intravenous or intramuscular pain and anti-anxiety medicines, or epidural anesthesia.

Compared to carrying a pregnancy to term and having a delivery, most later abortions present fewer risks of complications.

Women’s stories

Why doctors provide later abortions

A note on terminology and “late-term abortion”:

The terminology used to discuss abortions after the first trimester varies enormously. There is no agreement in the law or in the medical community about what constitutes the limit of the second trimester, for example. In scholarly journals, these abortions are variously referred to as “mid-trimester abortion,” “second-trimester abortion” (which is used to describe abortions up to 24 weeks or up to 27 weeks, depending on the writer or the state law) and late abortion. Within the mainstream media, the phrase “late-term abortion” is often used in articles about abortion policy and advocacy. These competing terms do not provide accurate clinical descriptions or contribute to public knowledge about abortion care and the differences at various stages of gestation. It is for this reason that we do not use the phrase “late-term abortion” here, and recommend against its use. Instead, we use and recommend the phrase “later abortion” to identify any pregnancy termination after 17 weeks of gestational age.