What to Expect When You’re Expecting an Abortion

If you’ve decided that you want to have an abortion, you’ll need to be careful when finding a clinic. Many anti-abortion pregnancy centers are set up near abortion clinics and a report by NARAL Pro-Choice America found that most use deceitful tactics and lies to misinform patients about abortion. The National Abortion Federation (NAF) and Planned Parenthood list reputable abortion clinics to ensure you receive quality care. Additionally, NAF, Planned Parenthood, and the National Network of Abortion Funds may be able help you with financial assistance if you are unable to afford your abortion. It’s possible that your state may require a mandatory delay between your first counseling session and your abortion appointment, resulting in two (or more) appointments. Since access to clinics is low in many areas, you might be delayed several days or weeks in scheduling an appointment, and wait several hours for your appointment. Be sure to plan your schedule accordingly and bring something to read.

“NAF, Planned Parenthood, and the National Network of Abortion Funds may be able help you with financial assistance if you are unable to afford your abortion.”

Once you arrive at the clinic, possibly past a group of protesters, you’ll enter the waiting room and sign in for your appointment. Dr. Chastine says you’ll begin your appointment with a few lab tests, such as a blood test to check your red blood cell level and urine sample for a pregnancy test and sexually transmitted infection screening (if you want one), as well as a counseling session. Some clinics will let you have a support person join you. “You’ll meet with a counselor who will make sure that you’re certain about your decision and that no one is coercing you into an abortion you don’t want,” she explains. “They’ll also talk to you about what the abortion process will be like and help you choose a method of pregnancy prevention for the future.” If you want to look into your options and come prepared with questions, check out Bedsider.org.

Dr. Chastine says it’s possible you may have an ultrasound to measure the size of your pregnancy, as deemed necessary by your provider or the state government if you live in one of these 25 states. In Louisiana, Wisconsin, and Texas, the ultrasound screen must be turned towards you and the ultrasonographer has to describe what they see; however, you are under no obligation to listen to them or look at the screen.

Your Procedure

When you are ready for your surgical abortion, a nurse will take you to your procedure room, which will look very similar to a gynecologist’s exam room. Your abortion provider will have you put your legs in the stirrups and talk you through the insertion of the speculum into your vagina so they can view your cervix and access your uterus. You might feel a little bit of pressure in your pelvis. If you’ve experienced any sort of sexual trauma, you may want to tell your provider ahead of time so they can take extra special care to walk you through what they’re doing.

“Your abortion provider will have you put your legs in the stirrups and talk you through the insertion of the speculum into your vagina so they can view your cervix and access your uterus.”

During your abortion, you have several pain relief options, depending on the clinic. Local anesthesia includes a medicine that numbs your cervix and allows you to be conscious during the abortion. “The provider will dilate your cervix slightly to allow removal of the pregnancy,” explains Dr. Chastine. “Then they’ll insert a small tube, like a straw, and use some gentle suction to empty your uterus. This part usually isn’t painful and takes a few seconds to minutes.” You’ll probably feel cramping and a bit of pressure during the procedure, as well as some heavier cramping afterwards while your uterus contracts back to the size it was before you became pregnant.

If you would like a heavier sedation, you have the option of IV sedation, often called “conscious sedation” or “twilight.” That’s what I had. I felt drowsy, but didn’t fall completely asleep. Like many patients, I don’t remember the procedure itself. Dr. Chastine says that in other clinics, especially hospitals, you might have the option of general anesthesia. She says you can expect to fall asleep on the procedure table and wake up in the recovery room after the abortion is complete.

If you’re over 14 weeks pregnant, the procedure is a little different because your cervix needs time to open up, thus Dr. Chastine says there’s more preparation involved to do it safely. “You may be given medication or have several sterile dilators around the size of matchsticks placed into your cervix. Either way, this takes time to work—several hours up to overnight.”

If you’re earlier in your pregnancy, between 7 and 10 weeks, you might be able to have a medication abortion, also known as a medical abortion or the abortion pill (again subject to the clinic’s policy and your state’s politicians.) Dr. Chastine says these medications don’t make the pregnancy disappear; basically they cause a miscarriage. “You’ll take one pill in the clinic that loosens the pregnancy in your uterus, and you’ll use a second medication at home that causes you to expel the pregnancy,” explains Dr. Chastine. “You can expect around 4 to 6 hours of strong cramping and heavy bleeding, including some large blood clots. You almost certainly won’t see anything recognizable as you pass your pregnancy tissue.” It’s possible that you’ll experience flu-like symptoms (fever, chills, nausea) as a side effect of the medication.

“You almost certainly won’t see anything recognizable as you pass your pregnancy tissue.”

Which abortion option should you choose, if you have access to both medical and surgical options? Dr. Chastine says patients report that the medication, which you can take in the privacy of your own home, can feel more natural and gives you a bit more control over the process, however it takes longer and there’s a tiny chance (1-3 percent) that it may not work and you’ll have to go back to the clinic 10 to 14 days later for a surgical abortion. The surgical abortion procedure itself will take a few minutes, usually under 10, and you know it’s complete before you leave. Dr. Chastine says patients report high satisfaction with either option.

After Your Abortion

After your abortion, you may feel a bit of cramping or light spotting. You can take your normal pain relievers and use a heating pad or hot water bottle to relieve any pain. Abortion is an extremely safe procedure, with a complication rate of less than 0.05 percent, however if you’re feeling sick, call your provider and they’ll diagnose your symptoms.

“Abortion is an extremely safe procedure, with a complication rate of less than 0.05 percent.”

I asked Dr. Chastine what she thought were the biggest misconceptions about abortion and she said that often people believe abortion is a risky procedure and can cause infertility later in life. “The truth is that modern abortion techniques are not associated with more trouble getting pregnant or staying pregnant,” she said. “I think this idea persists largely because it goes hand in hand with abortion stigma; people find it perversely satisfying to think that ending an unwanted pregnancy means “losing your chance” at a wanted pregnancy later.” She also said that abortion is a safe procedure and much safer than childbirth. “We tend to forget that childbirth comes with risks, including mental health problems, hemorrhage, injury to the uterus, retained pregnancy tissue, infection and even death. Every potential bad outcome with abortion is possible (and much more likely) with childbirth.” Research shows that the risk of death from childbirth is 14 times higher than abortion.

The other misconception she hears a lot is the idea that people who choose abortion choose it impulsively. “Most people come to these decisions with great care,” she says. “Most of my patients think about it in terms of whether they can or cannot be a good parent, based on their financial stability, work, family and childcare obligations, relationship to the person with whom they conceived, and health status.” A full three quarters of people choosing abortion cite inability to afford a child and desire to care for loved ones as top reasons for having an abortion. Two thirds of women having an abortion are already parenting a child, thus it’s largely a parenting and economic decision. “However they’re making their decisions, they know their own lives better than anyone else,” Dr. Chastine says. “We need to trust their judgment.”

Renee Bracey Sherman is an employee of the National Network of Abortion Funds and sits on the board of directors for NARAL Pro-Choice America.