Abortion Procedure (16-27 weeks 6 days)

This procedure is called a Dilation & Evacuation procedure, or a D&E. Dilation begins on day one with evacuation (the removal of the pregnancy) taking place at your final visit.

A licensed health care provider will complete a pelvic exam prior to your procedure to visualize your cervix. The provider will then clean your cervix with an antiseptic solution and insert dilators into your cervix. Dilators are small rods about 2-2.5 inches in length that work to dilate your cervix by absorbing moisture from your cervix, causing them to expand, dilating your cervix. Dilators only take a couple of minutes to insert, during which time you can experience cramping that ranges from mild to severe. Insertion of dilators can feel like some intense menstrual cramps. We will send you home with pain medication to help manage any cramping caused by the dilators overnight. You should not be in intense pain all night, the pain medication should provide relief. After insertion, dilators take several hours to work. Because of this we will send you home and have you come back the next day to check and see how far your cervix has dilated.

You will have overnight instructions given to you in written format at the time of your appointment.

If your cervix is adequately dilated to safely complete the abortion, the procedure will be completed on day two. If you require additional cervical dilation, your health care provider will remove the dilators and insert new dilators, and repeat the process.

On the day of your procedure, we will give you moderate, intravenous sedation to help reduce pain and cramping during the procedure. The removal of the pregnancy (or evacuation of the uterus) takes place after receiving moderate sedation. Your provider will do a pelvic exam to visualize your cervix, remove the dilators, manually dilate your cervix more if needed, and then remove the pregnancy tissue through the use of various techniques, including vacuum aspiration. Procedures typically last anywhere from 15-30 minutes, but can occasionally take more or less time. During the procedure, you can feel pain and cramping ranging from mild to severe. You may also feel a pulling or a tugging sensation during the procedure.

After your procedure, we will keep you at the clinic to monitor your recovery for at least 1 hour prior to discharge. During this time, we will check your vital signs, bleeding, give you a snack, heating pad, and go over aftercare information with you in detail.

Pain and cramping varies from person to person and can range from mild to severe. In order to reduce your discomfort, we offer pain medications including oral NSAIDs, cervical numbing, and moderate sedation. Deep breathing is something many of our patients find helpful in addition to the medications.

Moderate IV sedation is offered to all patients to help reduce pain and cramping during the procedure. This medication works to reduce anxiety and pain. You may feel a little sleepy, relaxed, dizzy, experience nausea, and you may not remember some or all of the procedure (amnesia) after you receive this medication. It is important that you do NOT drive for 24 hours after your procedure after receiving this medication.

At this point in time, general anesthesia (being put completely under for the procedure) is unavailable at Hope Clinic.

You will need to be at the clinic for 2-3 appointments, depending on your length of pregnancy and how your body responds to cervical dilation. These appointments must be on consecutive days (example: Tuesday, Wednesday, Thursday).

Your abortion appointment consists of the following:

• Ultrasound (if indicated)
• Lab work
• Individual Patient Education
• Preventative Antibiotics
• Pain Medication
• Other medications as indicated
• Dilation procedure(s)
• Abortion Procedure
• Recovery Period (typically 1 hour)

A staff member will review detailed information for what to expect after an abortion at the time of your visit, including what is normal and what is not normal after an abortion.

With an in-clinic abortion procedure, most people are able to return to regular activities within 1-2 days. Vaginal bleeding and cramping are expected after a procedure. See Multi-Day Aftercare Instructions for more information.

If you are more than 13 weeks pregnant and have previously had a C-section, you may need a diagnostic ultrasound to determine the positioning of the placenta and assess for the risk of a condition called "placenta previa". Call us for detailed instructions.

Research has proven over and over that abortion procedures are safe. An uncomplicated abortion carries no long-term risk of infertility, ectopic pregnancy, or birth defects. There is no association between abortion and breast cancer. When facing an unplanned pregnancy, there are no greater mental health issues in those who choose abortion than in those who carry the pregnancy to term.

Risks associated with abortion procedures are similar to the risks associated with pregnancy and childbirth, though complications occur much less frequently with abortion than they do with a full-term pregnancy and birth.  

These risks include:

• Hemorrhage (too much bleeding)
• Infection
• Failed or incomplete abortion
• Perforation or laceration

Risk of hemorrhage, infection, incomplete or failed abortion, and perforation/laceration occur in less than 2% of our patients (over 14 weeks) with risks for serious infection occurring even less frequently.  Risks associated with abortion are possible, but they are not probable or likely to occur.

Perforation/laceration, a tear or puncture in the uterus or cervix, occurs most frequently with sudden movement during the procedure. It is crucial you remain still during the procedure for this reason. Moderate sedation works to keep you as comfortable and safe as possible.

Serious infection, hemorrhage, and perforation/laceration can have serious negative health impacts if left untreated. For this reason, Hope Clinic provides all of our patients with access to a 24-hour emergency line for concerns, as well as detailed guidelines for reasons to call us or seek immediate medical attention.

Many of our patients having a procedure between 16-27 weeks 6 days in pregnancy are experiencing a fetal anomaly, a severe problem with the pregnancy. We understand how difficult of a decision it can be to terminate a pregnancy, especially when it is very much wanted. We want to help support you through this difficult time.

If you have been diagnosed with a fetal anomaly, please contact our office and have your provider or genetic counselor fax or email copies of your medical records to Hope Clinic prior to your appointment. Our fax number is 618-451-9092.

• Sexually Transmitted Infection (STI) Testing
• Birth Control
• Emergency Contraception
• Counseling Services