Abortion Procedures
There are many ways to terminate a pregnancy. The cost and type of an abortion procedure is often determined by how many weeks a woman is into the pregnancy. Each one has risks and possible complications. The following information is made available by the Pennsylvania Department of Health and the U.S. Food & Drug Administration.

Medical Abortions (1st trimester only)

What is MIFEPREX (mifepristone) and how does it work?
Mifepristone is a drug that blocks a hormone called progesterone that is needed for pregnancy to continue. Mifepristone, when used together with another medicine called misoprostol, is used to end an early pregnancy by inducing an abortion.

In Pennsylvania, the administration of mifepristone for the purpose of inducing an abortion is regulated under the Abortion Control Act.

About 5-8 out of 100 women taking mifepristone will need a surgical procedure to complete the abortion or to stop too much bleeding.

Symptoms to expect. This treatment causes cramping and bleeding. Usually, these symptoms mean that the treatment is working to induce an abortion. But sometimes women can get cramping and bleeding and still be pregnant. This is why a woman who chooses an abortion by this method must return to her provider on Day 3 and about Day 14.

If a woman is not already bleeding after taking Mifeprex, she probably will begin to bleed once she takes misoprostol. Bleeding or spotting can be expected for an average of 9-16 days and may last for up to 30 days. The bleeding may be similar to, or greater than, a normal heavy period. The woman may see blood clots and tissue that come from her uterus. This is an expected part of ending the pregnancy. Misoprostol may cause cramps, nausea, diarrhea, and other symptoms. Other side effects of this method include vomiting, headache, dizziness, back pain and tiredness.

Heavy bleeding and the need for surgery. In about 1 out of 100 women, bleeding can be so heavy that it requires a surgical procedure (curettage) to stop it.

Before a woman receives mifepristone, she must be given a Medication Guide and sign a statement (Patient Agreement) certifying that she has decided to end her pregnancy this way. Not all women should take mifepristone, including those taking certain other medications, those more than 49 days (7 weeks) past their last menstrual period, and those who cannot easily get emergency medical help in the 2 weeks after taking it.

For more information about medical abortions, visit www.fda.gov/cder/drug/infopage/mifepristone/mifepristone-qa.htm

Surgical Abortions

The First Trimester
Doctors use a vacuum aspiration method during the first trimester (the first three months of pregnancy). The doctor must first check the size of your uterus. Your doctor will ask you to lie on your back and bend your knees. He or she will place one hand in your vagina and the other on your abdomen (belly). The doctor will look at the opening of your uterus (the cervix) using a speculum (a special instrument). Next, the doctor will spray or inject medicine on your cervix. This prevents you from feeling any pain. Then the doctor will put a catheter (a soft, clear tube similar to a long straw) into your cervix. The catheter is connected to a machine that acts like a vacuum cleaner. The fetus is sucked out of the womb through the catheter.

If more than six weeks have passed since your last normal period, the doctor must first gently open (dilate) the cervix. He or she will use a larger, firmer plastic tube (a curette) to remove (evacuate) the fetus.

Please click here for photos of the unborn child at 7 weeks, 8 weeks, 11 weeks, 12 weeks, and 14 weeks. Use your browser's back button to return to this page after viewing the photos.

The Second Trimester
Usually during a second trimester (the fourth, fifth, and sixth months of pregnancy), to perform an abortion, the doctor opens (dilates) the cervix and empties (evacuates) the uterus. This method is known as dilation and evacuation (D & E).

When this abortion method is used in the second trimester, the doctor may insert a sponge-like material into the cervix. As the sponge gets wet it becomes larger, opening the mouth of the cervix. The doctor will remove the sponge two to sixteen hours later. The doctor uses forceps to remove the fetus or fetal parts; the doctor may also suction the fetus or fetal parts by vacuum aspiration using a larger catheter than described for the first trimester. The afterbirth is most commonly removed by vacuum aspiration.

Before the doctor will perform this procedure, he or she needs to feel the size of the uterus to determine the gestational age of the fetus. If the age is determined to be late in the second trimester, the doctor may elect to perform the abortion by labor induction.

During labor induction, labor can be started (induced) by injecting medicines or salt water into the fetal bag of waters (amniotic sac). The medicine can be injected into the bag of waters by cleaning the belly (abdomen) to kill germs on the skin; putting numbing medicine (anesthetic) into the skin; and pushing a needle through the skin into the bag of waters. Medicine may also be injected into the woman's bloodstream through her vein to induce labor. Labor will usually begin in two to four hours.

Generally, labor induction requires a longer stay and is not performed in a clinic setting. If the afterbirth is not removed with the fetus during labor induction, the doctor must open the cervix and suction the uterus as described in the vacuum aspiration method.

When an abortion is performed by the D & E method, there is virtually no chance that the fetus will live through the procedure. When an abortion is performed late in the second trimester, the doctor may elect to inject medicine into the fetus to terminate it before doing the vacuum aspiration. If the labor induction method is used, there is minimal chance that a baby could live for a short period of time. The chance of living outside the uterus increases as gestational age increases. In the event the baby removed is alive, a physician or other medical personnel attending the baby is required by law to provide the type and degree of care and treatment which in the good faith judgment of the physician is commonly provided to any other person under similar conditions and circumstances.

Please click here for photos of the unborn child at 16 weeks and 20 weeks. You can return to this page by using your browser's back button.

The Third Trimester
Your physician may advise you to end your pregnancy early between 24 and 38 weeks gestation (weeks menstrual). Should this advice call for the use of any means to end your pregnancy with knowledge that the termination by those means will, with reasonable likelihood, cause the death of the unborn child, then the termination of pregnancy using such means is an abortion. An abortion at this stage of your pregnancy may only be done if your physician reasonably believes that it is necessary to prevent either your death or a substantial and irreversible impairment of one of your major bodily functions.

When a pregnancy is ended at this stage, one of two procedures is performed: labor induction or cesarean section.

If pregnancy is ended by labor induction during the third trimester it is quite different from the description above. In the third trimester, labor can be started by injecting medicine directly into the bloodstream (vein) of the pregnant woman. Labor and delivery of the fetus during the third trimester are similar to childbirth. The duration of labor depends on the size of the baby and the "readiness" of the womb.

As with childbirth, the complications of labor induction during the third trimester include: infection, heavy bleeding, stroke, and high blood pressure. When medicines are used to start labor, there is a greater risk of rupture of the womb than during normal childbirth.

If labor cannot be started by injecting medicine into the pregnant woman, or if the pregnant woman is too sick to undergo labor, a cesarean section may be done. A cesarean section is surgery to remove the baby from the womb. Generally, the woman is made numb and sleepy and/or by a combination of medicines injected into the vein or spine and/or medicine inhaled into the lungs. Then the belly is prepared by washing with a soapy solution (antiseptic) to kill germs. The belly and womb are then surgically cut open and the baby removed.

The likelihood that your baby will live after it is delivered during this stage of your pregnancy depends on the baby's gestational age and health at the time of delivery. When an abortion is performed during the third trimester the following steps must be taken:

1. The physician who terminated the pregnancy must certify in writing that based upon the physician's medical examination and medical judgment, the abortion is necessary to prevent either your death or substantial and irreversible impairment to one of your major bodily functions.
2. A second physician must also examine you and certify in writing that based upon that physician's medical examination and medical judgment, the abortion is necessary to prevent either your death or substantial and irreversible impairment of one of your major bodily functions.
3. The abortion must take place in a hospital.
4. The physician must select a procedure that is most likely to allow the unborn baby to live.
5. A second physician must also be present in the room in which the abortion is performed. That physician will take charge of medical care for the baby immediately after it is delivered and must take all reasonable steps necessary to preserve the baby's life and health.

The physician is not required to use the abortion method that would provide the best opportunity for the baby to live if the physician determines in his or her good faith medical judgment that use of that method poses a significantly greater risk to your life or to the substantial and irreversible impairment of one of your major bodily functions than would another method.

In the case of a medical emergency, a physician is also not required to comply with any condition listed above which, in the physician's medical judgment, he or she is prevented from satisfying because of the medical emergency.