South Avenue Women’s Services provides surgical and medical abortion procedures from our clinic in Rochester, NY. Deciding which of these elective procedures is right for you is a difficult decision, and our professionals are here to help by providing all of the necessary information and advice in detail.
The process of surgical pregnancy termination is determined by gestation age.
For Pregnancies Up to 15 Weeks Gestation
With pregnancy up to 15 weeks gestation, the procedure will be performed by suction aspiration or vacuum aspiration. This elective procedure is considered to be one of the safest procedures in common medical practices, and complications are very rare.
For Pregnancies Beyond 15 Weeks Gestation
For pregnancy beyond 15 weeks gestation, other techniques must be used due to the requirement of cervical dilation. Dilation and evacuation involve opening the cervix of the uterus and clearing it through surgical and suction methods. This process does require more healing time since dilation is induced, but the procedure itself is relatively brief. For information on recovery and healing instructions, please refer below.
Discussion, question-and-answer, and signing a consent form precede the elective procedure itself. The patient then lies on the exam table with her feet in stirrups, and her hips at the end of the table. The doctor performs a bimanual exam, or feels the uterus with two fingers of one hand in the vagina, and the other hand on the abdomen. The speculum is then placed in the vagina to expose the cervix. Many women dislike the speculum. In fact, it is a well-designed instrument, which fits a woman’s anatomy perfectly, and should not hurt when it is carefully placed in the vagina. The cervix is then swabbed with a cleansing solution.
A small amount of local anesthetic is injected into the cervix, and the cervix is then grasped with an instrument. Then the paracervical nerve block is placed. Many women are concerned about needles. The fact is, that needle sticks are not well felt by the cervix, and most women feel either nothing or just a sense of pressure while the block is being administered. In any event, putting in the block takes only a few seconds. The nerve block does not take away all the pain, but it does modify sensations to the extent that the vast majority of women can tolerate the procedure with a fair amount of grace.
The cervix is then dilated or opened, with tapered plastic rods called dilators, each a little bigger than the last. The doctor will dilate only as far as necessary, which is determined by the gestational age of the pregnancy and the size of the uterus. Women usually feel cramping during the dilating phase of the procedure, which typically lasts a minute or less. In some circumstances, such as a very early pregnancy, dilating the cervix is not necessary. In other circumstances a medication called misoprostol can be given before the procedure, which tends to dilate the cervix by causing cramping and softening of the cervix.
The doctor then inserts a plastic tube called a suction catheter or suction curette into the uterus. Different sizes are available, and are used to correspond with different gestational ages of the pregnancy. The suction catheter is then attached to the suction machine, which is turned on. The machine makes a low hum suggestive of a vacuum cleaner. The doctor rotates the suction catheter in the uterus a few times, and then withdraws it. This process may be repeated a couple of times until the uterus is empty. During the suction phase of the procedure, most women feel cramping. This may become more intense just as the procedure is ending, indicating that the uterus is empty. In some cases the doctor may check the uterus with a metal curette to make sure it is empty. This phase of the abortion usually takes a minute or two.
The procedure is then essentially over. A sponge may be used to clean up in the vagina, and then all instruments are removed. The patient may rest until she feels ready to get up and dress. In some cases, an antibiotic pill is given by mouth at the time of the procedure, and for one dose afterwards. A plan for contraception is usually discussed before the patient leaves. A follow-up appointment is recommended within the next two weeks.
Advantages of Surgical Abortion
First of all, it is quick. In most cases, it can be accomplished right at the first visit, and once it is over, it is over. Even when the patient is further along in the pregnancy and requires laminaria (see below) the whole thing is over in 24 hours. The second big advantage is that surgical abortion is almost always successful. With a skilled operator, the chance of not being able to complete the procedure is very small. The third advantage is that it is very safe. Surgical abortion has been developed and refined over thirty years or more, and now is one of the safest elective procedures that a woman can have. Minor complications are uncommon and major complications are very rare. Women can have great confidence that the procedure will almost always go well. They can leave knowing that they will be able to recover over the next few hours and days and get on with their lives. They may still have children in the future if they wish.
Disadvantages of surgical abortion are fairly minimal. The procedure may cause some pain, for example. If IV sedation is selected, the patient will be drowsy or “woozy” for a time afterwards, and will require a ride home. There is a small risk of complications.
No procedure in medicine is completely free of potential complications. Anesthetic complications include allergy to the drug used (which is very rare) and a reaction to high levels of the local anesthetic drug in the bloodstream (which is fairly common) including a sense of dizziness, ringing in the ears, and a taste in the mouth, all of which disappear in a couple of minutes and are no threat to health or safety. Some women feel nauseated during or after the procedure.
The most serious complication of the procedure itself is perforation, or poking a hole in the uterus with one of the instruments. Should perforation occur, patients may be hospitalized, or may even have to undergo additional surgery. Fortunately, perforation is very rare. Excessive bleeding is another complication, which may occur during the procedure or afterwards. Various medications are usually effective in controlling excessive bleeding. Another complication is the failure to remove all the tissue from the uterus. The doctor may suspect this at the time of the procedure, and perform an ultrasound to monitor the completeness of the procedure. If tissue is retained, the procedure must be repeated. Another complication is infection. Infection can be diagnosed if in the days after the procedure the patient develops a fever, or has pain in the lower abdomen and pelvis. Antibiotics usually treat infection successfully. Rarely, the doctor is unable to perform the procedure, either because the cervix is too tight, or tumors prevent access to the uterus, or for some other reason. There are various strategies to deal with this situation.
Another complication is the discovery of a tubal or ectopic pregnancy. While this is not, strictly speaking, a complication of the abortion procedure itself, it is a serious problem requiring prompt action to preserve the safety of the patient. About one in a hundred pregnancies may be a tubal pregnancy. Tubal pregnancies may be treated with medicines or surgery. The patient may be sent back to her regular gynecologist, referred to a suitable gynecologist clinic, or treated by the doctors in our practice.
Psychological complications can occur. Some women may feel depressed or guilty after an abortion. Counseling before and after an abortion will help prevent such feelings, and help women deal with them if they occur.
Late complications, or problems that arise later in life, are rare. Studies have examined the occurrence of infertility, premature labor, and other pregnancy problems. None of these are proven to happen as a result of a previous abortion. Recently the news media reported a higher incidence of breast cancer in women who have had an abortion. This announcement was made by a staunch anti-abortionist, whose scientific method is highly suspect. In general, women who have had an abortion have been able to have all the children that they wish at the proper time.
Overall, although the thought of complications is scary, they occur at a very low frequency. Minor complications occur less than one percent of the time, and major complications—those severe enough to require hospitalization—occur much less than once in a thousand cases. Death from abortion is exceedingly rare, occurring in less than one in one hundred thousand cases nationwide, and most of these deaths are associated with either general anesthesia or late (second trimester) abortion. South Avenue Women’s Services has never experienced this terrible but rare event.