Indiana University Bloomington Pregnancy and Parenting Portal
What is an abortion?
The intentional termination of pregnancy after conception, resulting in the death of an embryo or fetus
What are the different types of abortion procedures?
Medicine-Induced Abortion
This is a procedure completed within the first 9 weeks of pregnancy and usually involves two types of medication: Mifepristone and Misoprostol. The Mifepristone depletes the womb of progesterone, a hormone necessary for the body to carry a pregnancy to term and causes the uterine lining to become thinner. The changes in the uterus prevent the embryo or fetus from staying implanted and the Misoprostol (second medication) then induces contractions to remove the embryo or fetus from the womb.
Procedure Methods:
Oral Mifepristone and Oral Misoprostol - Both medications are ingested by mouth in a scheduled regimine.
Oral Mifepristone and Vaginal, Buccal or Sublingual Misoprostol - First medication is ingested by mouth, while the other comes in a slow dissolving tablet form to be inserted either through the vagina, between teeth and cheek (buccal), or underneath the tongue (sublingual).
Methotrexate and Vaginal Misoprostol - The first medication is inserted into the vagina or by a vaccination, while the second is taken at home. This abortion method is less common and mostly used in the event of an ectopic pregnancy. It can take up to one month to complete an abortion using this method.
Vaginal Misoprostol Alone - Only the second medication is used and is inserted through the vagina. This method tends to be less effective than other medicine-induced methods the further a pregnancy progresses.
Risks and Possible Side Effects:
Vaginal Bleeding
Nausea
Vomiting
Fever
Chills
Diarrhea
Headaches
Incomplete Abortion that Requires a Surgical Abortion
Infection
Severe Abdominal or Back Discomfort
Foul-Smelling Vaginal Discharge
Procedure can pose severe risk if you:
are beyond 9 weeks of pregnancy
have an IUD
have an ectopic pregnancy
have certain medical conditions such as bleeding disorders, certain heart or blood vessel diseases, severe liver, kidney or lung disease, or an uncontrolled seizure disorder
are on blood thinners or certain steroid medications
unable to make follow-up appointments with a doctor or lack access to emergency care
have an allergy to any of the medications used during the procedure
Abortion Pill Reversal
After starting medically-induced abortion, patients may experience and/or report feelings of remorse, anger, internal conflict, and other strong emotions. Patients experiencing these emotions may attempt to stop the abortion through a process called abortion pill reversal.
To attempt this, the patient refrains from taking the second pill used for medical abortion (Misoprostol) and instead increases their progesterone levels in hopes of carrying their pregnancy to term.
Abortion pill reversal requires further medical research and remains a highly-debated topic in the community. It is advised that you seek counsel from a medical professional as you make a decision.
Suction Dialation and Curettage (Suction D&C)
Procedure occurs within the first 14 weeks of pregnancy and is most common for abortion services. Suction D&C entails the dialation (widening) of the cervix and then the insertion of tubing into the patient's uterus. The tubing connects to an electric pump that sucks the embryo or fetus out of the womb. The patient will usually receive anesthesia via their cervix during the dialation process and/or intravenous medication for anxiety and pain relief.
Risks and Possible Side Effects:
Perforation of the Uterus
Cervix Damage
Scar Tissue on the Uterine Wall
Abnormal, Absent, or Painful Menstrual Cycles
Future Miscarriages and Infertility
Infection
Headaches
Infection
Increased Pain
Foul-Smelling Vaginal Discharge
Fever
Vaginal Bleeding
Abdominal Cramps
Dialation and Curettage (D&C)
A variation of the above Suction D&C, this procedure involves the use of a curette to scrape fetal parts from the uterus in addition to suction methods.
Risks and Possible Side Effects:
Perforation of the Uterus
Cervix Damage
Scar Tissue on the Uterine Wall
Abnormal, Absent, or Painful Menstrual Cycles
Future Miscarriages and Infertility
Infection
Headaches
Infection
Increased Pain
Foul-Smelling Vaginal Discharge
Fever
Vaginal Bleeding
Abdominal Cramps
Dialation and Evacuation (D&E)
D&E is typically performed between 16 weeks and 24 weeks gestation. In the 24 hours leading up to a D&E procedure, the doctor will insert laminaria or another form of dilation device into the cervix. The day of the procedure, the doctor will use other tools to keep the cervix and uterus in place during the surgery. Cone-shaped rods that gradually increase in size are utilized to continue widening the cervix, as the fetus is larger at this stage and will not pass through a suction tube. To remove the fetus, the doctor uses tools such as a cannula, a currette, and forceps, then suction tube to eliminate any remaining tissue. To reduce the risk of infection and other complications, fetal remains are examined to ensure all parts were removed from the uterus and the patient is given an antibiotic.
Risks and Possible Side Effects:
Nausea
Bleeding
Cramping
Cervix and/or Uterine Lining Damage
Perforated Uterus
Blood Clots
Infection
Dilation and Extraction (D&X)
This procedure is chosen for abortions after 21 weeks gestation and is also called Intact D&X, Intrauterine Cranial Decompression, and Partial-Birth Abortion. Laminaria is used 48 hours before the procedure to widen the cervix, leading the patient's water to eventually break. The doctor will then rotate the fetus and use forceps to pull parts through the birth canal. The base of the skull is given a small incision in order to insert a suction catheter, which removes cerebral matter until the skull collapses and the fetus can be fully removed from the birth canal.
Risks and Possible Side Effects:
Nausea
Bleeding
Cramping
Cervix and/or Uterine Lining Damage
Perforated Uterus
Blood Clots
Infection
Increased Risk of Emotional Trauma
Indiana State Laws Regarding Abortion (As of Feb. 2020)
Must be performed by a licensed physician.
Must be performed at a hospital if you're 20+ weeks pregnant.
A second physician must participate if you're 20+ weeks pregnant.
Prohibited once at 20 weeks of pregnancy unless there is a case of life or physical health endangerment.
Partial-birth abortion is banned in the state of Indiana.
Public funding of abortion is limited to life endangerment, rape, and incest.
Private insurance coverage for abortion is available, but limited.
An individual provider may refuse to perform or participate in abortion services.
Private health institutions may refuse to perform or participate in abortion services.
Patients seeking abortion must receive mandated counseling which includes information provided on fetal pain.
After receiving counseling, a patient seeking abortion must wait 18 hours before having the procedure.
If a patient is a minor, the provider must receive parental consent from the patient's parent and/or legal guardian before performing an abortion.
Seeking Post-Abortive Recovery
After having an abortion or after the abortion of a partner, friend, or family member, one may or may not experience emotional and psychological impacts commonly described as Post Abortion Stress Syndrom (PASS). Symptoms and reactions vary and can occur at different stages of life for each individual. Listed below are resources which address post-abortion healing:
Abortion Recovery InterNational (ARIN) - A resource website and online support community for those who have experienced abortion or know someone with an abortion experience. Organization offers additional centers, programs, and contacts based on zip code.
Rachel's Vineyard - A ministry of Priests for Life that offers weekend retreats across the United States and Canada for people seeking healing after abortion. Programs are open to all who experience psychological or emotional impact related to abortion including individuals who have had one, partners, ex-partners, grandparents, and siblings of post-abortive individuals, and those with previous volunteer or occupational experiences involving abortion.
Project Rachel - A national network for post abortion healing which includes trained clergy (priests, nuns, etc.), lay people (non-clergy members, staff, and volunteers of a church community), mental health professionals, medical staff, etc. These various roles are likely to collaborate with each other in order to address the needs of both adults and adolescents who have had experiences involving abortion.
Exhale - A free, national hotline, textline, and resource website for those who have had an abortion and their partners, friends, allies, and family. Exhale serves individuals of all backgrounds, religious affiliation, political identity, sexual orientation, gender identity, etc.
AfterAbortion.com - A politically and spiritually neutral peer support website for those who have had an abortion; provides private discussion forums and resource sharing opportunities for those seeking information, social support, and healing following an abortion experience.
All-Options Talk Line - A free, confidential hotline available in the United States and Canada to those who would like to discuss a current or past experience related to pregnancy, parenting, abortion, infertility, and miscarriage. All-Options takes a secular approach to counseling and peer support is available to all backgrounds, affiliations, orientations, and identities.
Faith Aloud - A free, confidential counseling and support service for people of all spiritual and non-spiritual traditions seeking resources during pregnancy, parenting, abortion, and adoption experiences. Trained counselors are clergy members from Roman Catholic, Jewish, Unitarian Universalist, Protestant Christian, and Buddhist faith traditions.
Connect & Breathe - A free, confidential hotline for individuals seeking a space to discuss abortion experiences. Organization is unaffiliated with any particular faith tradition.
References
An Overview of Abortion Laws, Guttmacher Institute, https://www.guttmacher.org/state-policy/explore/overview-abortion-laws
Medical Abortion, Mayo Clinic, https://www.mayoclinic.org/tests-procedures/medical-abortion/about/pac-20394687
Abortion Pill Reversal, American Pregnancy Association, https://americanpregnancy.org/abortion-pill/abortion-pill-reversal/
Abortion (Termination of Pregnancy), Harvard Health Publishing - Harvard Medical School, https://www.health.harvard.edu/medical-tests-and-procedures/abortion-termination-of-pregnancy-a-to-z
Dilation and Curettage (D&C), Mayo Clinic, https://www.mayoclinic.org/tests-procedures/dilation-and-curettage/about/pac-20384910
Surgical Abortion Procedures, American Pregnancy Association, https://americanpregnancy.org/unplanned-pregnancy/surgical-abortions/