Understanding Abortion : Procedures, Effects, and Aftercare

Abortion is nothing but termination of pregnancy where the pregnancy has ended due to natural causes or medically.⁽¹⁾

Each woman experiences abortion differently and it also depends on when the pregnancy was aborted and the cause for it.  Abortion can be similar to menstrual cramps in some women or can be more than just discomfort for others. The pain experienced during abortion depends on:

• The patient’s general health.
• The pain threshold of the patient.
• The duration and stage of the pregnancy.
• Underlying health problems.
• The patient’s stress and emotion levels.
• The type of abortion the patient is having.

Termination of pregnancy using an abortion pill in the first trimester of pregnancy is known as medicated abortion. The medications used for this are: misoprostol and mifepristone.⁽²⁾ Misoprostol is commonly taken orally; however, it can be taken vaginally, sublingually or buccally.

These medicines stop the pregnancy hormones and initiate the uterine contractions, which in turn cause expulsion of the embryo. The time taken for this whole process can be around 4 to 5 hours.

Medicated abortion causes heavier vaginal bleeding than usual and can also be painful, more so for women having a history of heavy and painful menstrual cycles.⁽³⁾ The patient can also pass some large clots, which will subside after some days, however, bleeding or spotting can continue for a couple of weeks.

Medicated abortion can also cause: breast tenderness, headache, mild to severe cramping, nausea, stomach upset, vomiting, chills, low grade fever, diarrhea, fatigue and dizziness.^{(4, 5)} These side effects of medicated abortion can take 1 to 2 days to clear.

According to the ACOG or American College of Obstetricians and Gynecologists, the most acute pain from medicated abortion can occur around 2.5 hours to 4 hours after taking the medicine misoprostol and the pain can remain for around 1 hour.

Always consult your doctor before taking any type of OTC medication, like ibuprofen. Doing so can help in reducing the risk of cramping and pain. Aspirin should not be taken, as it can increase bleeding.⁽⁶⁾

In case of tendency for nausea, anti-nausea medication can be prescribed, which should be taken beforehand or when nausea is experienced. In case of acute pain, the doctor can also prescribe stronger pain medication.

Other things which can help in dealing with the side effects of medicated abortion are:

• Always schedule the process of abortion when you are able to stay at home.
• Try to wear loose fitting clothing the initial couple of days.
• Use a hot water bottle or heating pad on the abdominal region to help in relieving pain and cramping.
• Deep breathing exercises help in relaxing.
• Make yourself comfortable by using pillows to prop yourself up.
• Long and warm shower help in soothing pain.
• Massaging the back helps in relieving pain.

In surgical abortion, a pelvic exam is done after which the vagina and cervix are inspected with the help of speculum. Next, a numbing medication is applied and the process of dilating the cervix is started. A small, flexible tube is then inserted into the uterus and this tube is attached to a gentle suction device that removes the contents of the uterus.⁽⁷⁾

The inside of the uterus is also gently scraped using a loop-shaped small tool known as curettage and this process is commonly known as D&C; or dilation and curettage. Doing this step helps in ensuring that all the pregnancy components are completely removed from the uterus.

In case of the pregnancy being more than 15 weeks, the use of a combination of suction, curettage and extraction using forceps is done.

After this procedure, the patient starts having uterine contractions and bleeding immediately which can persist for many weeks.

Some of the potential side effects of surgical abortion are: fever, chills, nausea, and dizziness, vomiting and heavy bleeding.

A local anesthesia is commonly given before surgical abortion is done. The patient may also be advised to take a pain medication. The patient can be sedated if she wants, in case of which a very minimum dose of general anesthesia, also referred to as “twilight sedation,” is given or an oral sedative can be given to reduce anxiety and pain.

The patient can be conscious during the procedure; however, won’t be able to remember what occurs. The patient can feel groggy or unaware till the anesthesia wears off. The patient is advised to bring someone to drive her home afterwards.

Patient can take OTC medications, such as ibuprofen which will help in relieving symptoms of pain, fever etc. Aspirin should be avoided as it can cause heavier post-abortion bleeding.

Application of hot water bottle and heating pad to the abdomen helps in easing the pain and cramping. Loose clothing should be worn for the initial days so there is no unnecessary pressure or friction to the abdomen.

In order to feel pain, there should be transmission of signals to the brain from the peripheral sensory nerves. To process these signals, certain brain structures are also needed.  According to the American College of Obstetricians and Gynecologists, meticulous studies done found that these connections which are needed for processing the pain signals are not developed till a minimum of 24th week of pregnancy.⁽⁸⁾

However, other studies tell that these neural pathways, which are responsible for experiencing pain can activate earlier, however, the conclusion is not clear on this.⁽⁹⁾

The current laws do not permit to have abortions in pregnancy that has exceeded 24 weeks, after this time period, the pregnancy is termed as viable.

Any kind of medical procedure carries risk and with abortion the risks are: severe or prolonged bleeding, infection, incomplete medicated abortion which needs further intervention and having to deal with an unplanned pregnancy if the medical abortion is not effective or successful.

However, abortions done in a correct manner by medical professionals is often a safe procedure. The mortality rate of legally induced abortion is only 0.7 in 100,000 procedures.⁽¹⁰⁾

An uncomplicated abortion does not affect the patient’s ability to get pregnant in the future.

Every patient experiences different kind of emotions when undergoing an abortion. A lot of this depends on the cause for having the abortion and if the patient is having any kind of stressors and if the patient has a good support system or not.

Some patients can feel relieved and ready to move on. Some feel guilt, sadness and a sense of loss, which is completely normal. There can be a combination of emotions felt by the patient.  All kinds of emotions felt by the patient are often normal and nothing to worry about.

In case of having extreme negative emotions which hinder the patient’s daily life, then consulting a mental health care professional helps the patient in dealing better with their emotions.

Deciding to get an abortion and the type of abortion is a big decision. So, the patient should educate herself before undergoing it. It is important to tell your doctor if you are suffering from any health conditions, discuss about your options regarding the type of abortion and their pros and con. The preparation, recovery time and potential side effects of the abortion should also be discussed with the doctor.

The patient should also ask her doctor on how to deal with the aftermath of the abortion and what symptoms warrant medical care post abortion and about birth control after getting an abortion. The abortion laws differ from state to state. Consult the Center for Reproductive Rights to know the law on abortion present in your state.⁽¹¹⁾

References:

Also Read:

• Kinds Of Abortions & The Pros And Cons Of Legalizing Abortion
• How to Take Care of Yourself After Abortion?
• Risks of Home Remedies for Abortion
• 4 Different Types of Abortion
• What are the After Effects of Surgical Abortion? | What To Eat and What To Avoid After Surgical Abortion?
• How to Care for Yourself Post Abortion?
• Signs of Womb Damage After an Abortion : Risks and Treatment