Abortion

Manual vacuum aspiration

The only surgical abortion procedure available before 6 to 7 weeks of pregnancy, manual vacuum aspiration is a simple procedure done early in pregnancy. It must be performed early in pregnancy—as early as 3 weeks and no later than 7 to 8 weeks from the start of your last menstrual period. Manual vacuum aspiration uses the suction of a specially designed syringe to remove the pregnancy tissue from the uterus. Local anesthetic is used to numb the cervix, and you may also be offered painkillers and other medications to reduce anxiety.

Lasting between 5 and 15 minutes and performed in a doctor's office or clinic, manual vacuum aspiration involves the insertion of a thin tube through the cervical opening. The syringe is attached to the tube and is used to remove the contents of the uterus.

How is it done?

The doctor will place you on an exam table in the same position as for a pelvic exam: you will be lying on your back with your feet in stirrups. He or she may insert a speculum into your vagina. Once your vagina and cervix are cleaned with an antiseptic solution, a local anesthetic will be injected into your cervix. If necessary, a small instrument will then be inserted into your cervix to dilate (open) it. In most cases, however, dilation isn't needed.

A thin tube is then passed through the cervical opening and a handheld syringe is used to suction the tissue out of the uterus. As this uterine tissue is removed, your uterus will contract, causing cramping. The cramps will lessen once the tube is removed. You may also experience nausea and sweating, and/or you may feel faint. Generally, however, symptoms are less severe than with mechanical vacuum aspiration. (See Suction and curettage for more information.)

What can I expect afterward?

Once you return home following your abortion, rest quietly. Depending how you feel the following day, you should be able to resume normal activities. You may experience pain: medications such as Ibuprofen (Advil) or Acetominophen (Tylenol) can help relieve cramping pain.

You'll want to avoid sexual intercourse for the first week. You can begin birth control pills immediately following the procedure, but be sure to use a condom to prevent infection. Barrier methods of birth control (male condoms, for instance) or an intrauterine device (IUD) can be used as soon as you resume sexual relations.

Following surgery, you can expect to have irregular bleeding or spotting during the first 2 weeks. During the first week, avoid tampons and use only pads.

As the uterus shrinks back to its pre-pregnancy state, you'll experience cramps similar to menstrual cramps. They may be present for several hours or possibly a few days.

You can also expect emotional reactions for 2 to 3 weeks.

It's important after surgery to take all your prescribed antibiotics in order to prevent infection.

A follow-up exam is needed within three weeks to ensure the abortion was successful.

What are the advantages of manual vacuum aspiration?

• Because the procedure is not performed under general anesthesia, the risks often associated with anesthesia are not associated with manual vacuum aspiration.
• The procedure can be done early in pregnancy before any signs of pregnancy occur.
• Manual vacuum aspiration is over more quickly and is also more effective than a medical abortion.
• Manual vacuum aspiration is not available everywhere, but in some geographic areas, it may be more commonly available that machine aspiration. (See Suction and curettage for more information.)

What are the disadvantages?

• Because the procedure is not performed under general anesthesia, you are awake and conscious throughout.
• Because the procedure is performed so early in pregnancy, there is a 2 percent chance the abortion will not be successful and will need to be repeated.
• You may experience side effects such as pain, menstrual-like bleeding, and abdominal cramping.
• Although rare (occurring in fewer than 0.5 percent of cases), serious complications such as infection or damage to the uterus and/or cervix are possible.
• Because bacteria can enter the uterus during the procedure, infection is possible. This is more likely in the case of an untreated disease or sexually transmitted infection. Symptoms, which usually occur within 2 to 3 days of the procedure, include nausea, fever, pain, and abdominal tenderness. In order to reduce the risk of infection, be sure to finish all of your prescribed antibiotic medications.

What about my fertility?

An abortion rarely affects a woman's ability to become pregnant in the future. Because it is possible to become pregnant in the weeks right after an abortion, you should consider the various methods of birth control available to you and your partner to prevent another unplanned pregnancy. You should also avoid sexual intercourse until your body has fully recovered—usually at least 1 week. Use birth control in the first weeks following your abortion, and be sure to use condoms as well—to prevent infection.

How will I feel afterward?

Some women find it very emotionally difficulty to cope with having had an abortion. In fact, between 5 and 30 percent report feelings of anxiety, guilt or mild depression. It's normal to experience a broad range of emotions after an abortion—from relief and happiness to sadness, shame, regret, guilt, grief and loss. There are as many reactions as there are women and each woman is unique.

Most women, however, feel they have made the right decision; it's rare for them to become clinically depressed following an abortion. However, if your feelings are overwhelming and persistent, or if you have a previous history of depression, you should consult a professional therapist. (Refer to Finding and Evaluating a Therapist for more information.) Depression is a very serious illness.

Consider counseling even if you feel "OK"—abortion is a weighty issue and there is no "right" or "normal" way to feel about it: every woman is different.

Understanding your emotions and taking care of yourself are important: doing so can help you let go of pain and start to heal. Talk to your partner, friends, or family to let them know what you're feeling. You may also want to consider professional counseling. If you're not sure where to go for counseling, talk to your abortion provider: most providers can refer you to counseling services to assist you in dealing with your feelings.