Legal abortion, carried out by trained medical practitioners, is one of the most common and safest surgical procedures. About 600,000 million Americans have induced abortions each year. Fewer than a quarter of a percent of all abortion patients experience a major complication associated with the procedure.
In an abortion, the contents of the uterus (uterine lining and implanted fertilized egg) are extracted, which ends the pregnancy. In Rhode Island, surgical abortion procedures are performed in medical clinics rather than in a physician's office. Each clinic is inspected and regulated by the Rhode Island Department of Health in the same manner as hospitals and individual medical providers. In other states, abortion procedures may be performed in clinics or by an individual physician in their office.
In early pregnancy, the procedure used most commonly in the US is vacuum aspiration (suction). The procedure itself takes about 10 minutes and is usually done with a local anesthetic, although sedation or general anesthetic may be requested. The cervix (opening to the uterus) has to be opened (dilated) enough for a small tube to fit in. The plastic tube is attached to a machine that creates a mild suction. With this suction, the doctor removes the endometrial lining of the uterus, the embryo, and the placenta. Vacuum aspiration abortions may be done from 5 to 16 weeks after the last menstrual period. (Abortion is not performed before 5 weeks because the embryo is too small to ensure that all fetal material has been removed. Lab examination of the removed uterine contents helps to prevent incomplete abortions.)
For pregnancies beyond 16 weeks, which represent about 1/10 of the total abortions performed, other methods are used. Surgical abortions in Rhode Island can go up to 18 weeks 6 days at Planned Parenthood of Southern New England and sometimes above 18 weeks 6 days at other locations, such as hospitals. Surgical abortions can go up to 20 weeks 6 days at Planned Parenthood League of Massachusetts, while some clinics in Massachusetts may perform abortions up to 24 weeks. Oftentimes, if a clinic cannot perform an abortion based on your gestational age, they will help you find another location.
Second trimester pregnancies often require a two-day process of laminaria insertion (on day 1) and then an in-clinic surgical abortion (on day 2). Laminaria are small seaweed sticks that are inserted by a clinician into the cervix for dilation. The laminaria are left in place overnight and then removed the next day before the procedure. The laminaria expand, similar to a tampon, to prepare and dilate the cervix to make the procedure quicker and more comfortable. The clinician will numb the area before insertion of the laminaria and often prescribe pain medication to help with any associated cramping while the dilation process occurs. (Once the laminaria are placed, it is essential that they be removed the next day since leaving them inserted can cause serious health issues, such as sepsis. It is also important to note that once laminaria is inserted, there is an increased risk of miscarriage if a person did not have the abortion procedure and continued the pregnancy.)
After any surgical abortion procedure, patients remain at the clinic for at least 30 minutes so that their vaginal bleeding and health status can be monitored. Antibiotics are often given to guard against infection. Also routine is a discussion about contraceptive methods and giving the patient contraceptive supplies before the end of the visit. This can include the placement of an IUD or implant while in the procedure room if one is desired. The involvement of a friend, partner or family member throughout the abortion process, from the diagnosis of pregnancy through follow up after the procedure, is often very helpful and is usually encouraged by clinics.
