Guide to a safe abortion

In this page, we will give information on the two safe methods of abortion within the first trimester or the early second trimester of a pregnancy: the abortion with pills (medical abortion) and the vacuum aspiration abortion (in-clinic abortion).

It is up to the women to decide which abortion method is best for them according to their budget, availability, geographical location, gestational age, and personal choice.

A medical abortion is commonly known as abortion with pills. Some people also refer to this method as self-induced abortion, self-managed abortion or do-it-yourself (DIY) abortion. [1]

If you use abortion pills you will experience bleeding and cramping. The symptoms are very similar to your menstrual period or as if you were having a miscarriage (natural abortion).

There are two methods to have an abortion with pills: using a combination of two different types of tablets or using only one type of pill. Discover more here.

Abortion Pill Instructions (MA)

Safety of abortion pills

Medical abortions are safe for the majority of women. There are only a few medical conditions that are contraindications for using the abortion pills. [2]

Contraindications

If you have an IUD (intra-uterine device), it is not a contraindication to using the abortion pills, but it does require some precaution. A pregnancy that occurs with an IUD in place increases the risk that it is an ectopic pregnancy (pregnancy not inside the uterus). Whenever possible, the safest recommendation is to have the IUD removed prior to using the abortion pills.

If you are not sure if abortion pills are safe for you, contact us! We can help you determine if this method is for you.

Remember safe2choose is only trained to support women who will use abortion pills in the first 11 weeks of pregnancy. If your pregnancy is more advanced, we will do our best to refer you to a better-prepared local organization to support you. [2]

What to expect during an abortion with pills

As previously mentioned, after using the abortion pills you will have symptoms similar to a menstrual period or a miscarriage.

Other temporary side effects are: fever, chills, diarrhea, nausea, vomiting, and headaches. If you do not experience any of these it is perfectly normal. If you do, these will disappear in the next 48 hours or less. Contact us to know how to manage these side effects.

Abortion Pill Instructions (MA)

How to know if the pills worked

If you used the medications according to the recommended instructions, and you had a bleeding as abundant as your menstrual period (or more) for several hours, it is very likely the abortion was successful. Your pregnancy symptoms (breast tenderness, nausea, fatigue), should gradually improve and then disappear around 5 days after using abortion pills, and this is another good indication that the pills were successful. [2]

While it is not necessary, if you desire additional confirmation you may choose to do one of the following:

Urine test (urine hcg): This is the simplest test that can be done for confirmation, as it can be done in the privacy of your own home. It is recommended to wait at least ~4 weeks after using the abortion pills. If the process was successful, the test should be negative after ~ 4 weeks.

Blood test (quantitative hcg): This test requires a medical visit, and is most useful when this same blood test was done prior to using the abortion pills for comparison of the hormone levels. This test is not routinely performed, and thus if you desire confirmation the urine test as described above is more often recommended. If you do choose to do this test, the pregnancy hormone should be absent approximately 4 weeks after medication use if the process was successful.

Ultrasound: This requires a medical visit, and can be used to detect an ongoing pregnancy. Keep in mind that if the abortion pills worked, there may still be some blood and tissue visible on ultrasound for at least 2 weeks. Even if the pregnancy is gone, sometimes the ultrasound is performed too early and women are diagnosed with an “incomplete abortion” which could lead to unnecessary surgical procedures. If you choose to have an ultrasound, it is recommended to wait at least 2 weeks, unless you have symptoms of complications and need an ultrasound sooner.

If 48 hours have passed after you used the last pills and you have not bled or your bleeding is much less amount than your period, it is likely that the abortion was not successful. In most cases, it is possible to try again with abortion pills. Contact us if this is your case so we can support you.

Medical care after the abortion pills

If your symptoms are as expected and you do not have any warning signs, you do not need to get medical care. It is not necessary to get a pregnancy test or an ultrasound afterward, nor having any surgical intervention such as a D&C.

Fertility and menses after an abortion

After an abortion (medical or in-clinic) your cycle will restart, as if you have had your menstrual period. You will ovulate again approximately 10 days afterward. This means that you can get pregnant again if you have sex.

Your next period can come back in approximately 4 to 6 weeks after using abortion pills.

Vaccum Aspiration Information : Manual (MVA) or Electric (EVA)

What is an in-clinic abortion?

1/ Definition of an in-clinic abortion

In-clinic abortion is a safe and 99% effective method for elective abortion, or management of miscarriage, and it is performed in a clinic or hospital, by a trained healthcare provider. [1]

During the procedure the clinician uses instruments to gradually open (dilate) the cervix, and then uses a method of aspiration to remove the pregnancy from the uterus. The woman is likely to experience cramping during the procedure, and there may be some bleeding on and off for several days or weeks afterward. [2]

2/ The different methods of in-clinic abortion

There are several safe methods of in-clinic abortion that you can choose from, and it mostly depends on the gestational age of your pregnancy. Because there is some overlap in the gestational ages for different methods of abortion, the decision may also be based on geographic location, availability of equipment, and provider and personal preference. [1], [2]

  • Manual Vacuum Aspiration (MVA) is a form of uterine aspiration, and is typically used up to 14 weeks gestation
  • Electric Vacuum Aspiration (EVA) is a form of uterine aspiration, and is often used up to 15 weeks gestation
  • Dilation and evacuation (D&E) methods are commonly used beyond 14 weeks gestation
  • Induction abortion, when used, is typically done for pregnancies beyond 16 weeks gestation
  • Dilation and Curettage (D&C) is an outdated method of abortion and has largely been replaced by methods of uterine vacuum aspiration and dilation and evacuation (D&E).

safe2choose endorses Manual Vacuum Aspiration (MVA) abortion or Electric Vacuum Aspiration (EVA) abortion for pregnancies in the first trimester or early second trimester, and provides detailed information regarding these methods here.

What is a Manual Vacuum Aspiration (MVA) abortion ?

Manual vacuum aspiration (MVA) is a very safe method of abortion for pregnancies in the first trimester, and/or early second trimester all the way up to 14 weeks of gestation [1]. The gestational age limit for MVA often depends on the clinic, as well as the healthcare provider performing the procedure.

MVA is performed by a trained provider in a clinic.

During the procedure the clinician uses instruments, including a silent suction device, to remove the pregnancy from the uterus [2]. Most commonly this procedure is performed using local anesthesia while the woman is awake, and it takes typically between 5 and 10 minutes. The woman is likely to experience cramping during the procedure, and there may be some bleeding on and off for several days or weeks afterward.

MVA is Manual Vacuum Aspiration but it might also be known as in-clinic abortion, aspiration abortion, suction abortion, vacuum aspiration, procedure abortion. [1]

What is an Electric Vacuum Aspiration (EVA) abortion ?

Electric Vacuum Aspiration (EVA) is a safe and very similar method to MVA. EVA can be used for pregnancies in the first trimester, and/or early second trimester. EVA is performed by a trained provider in a clinic.

During the procedure the clinician uses instruments, including an electric vacuum suction to remove the pregnancy from the uterus.

The primary difference between EVA and MVA is that electricity is used to create suction to remove the pregnancy. Because the EVA requires electricity, it may not be available in low-resource settings. Where available, clinicians may use this method of EVA as the gestational age increases after 10-12 weeks because it allows the clinician to perform the procedure more quickly than the MVA, and thus decreases the procedure duration for the woman. Another significant difference is that there is noise associated with the EVA machine, because it uses electricity. [2]

What happens during a manual vacuum aspiration abortion procedure?

1/ Medication before a vacuum aspiration abortion

The World Health Organization (WHO) recommends administering antibiotics prior to manual vacuum aspiration and electric vacuum aspiration. This helps to reduce the risk of infection. [1]

However, if antibiotics are unavailable, a vacuum aspiration abortion can still safely be performed. Clinics may also choose to give an oral medication to help with the cramping pain, such as Ibuprofen. [2]

2/ In preparation on the manual vacuum aspiration Abortion

During a clinic visit for a manual vacuum aspiration abortion (MVA) or an electric vacuum aspiration abortion (EVA), there are often steps taken in preparation for the procedure including (but not limited to) [2]:

  1. Urine pregnancy testing
  2. Determination of Rh blood type
  3. Manual pelvic exam and/or ultrasound to estimate the gestational age
  4. Blood pressure measurement

Some additional tests may be performed based on requirements/laws specific to each geographic location.

3/ During the manual vacuum aspiration abortion

Step 1. The manual vacuum aspiration abortion (MVA) or the electric vacuum aspiration abortion (EVA) procedures will begin with a pelvic or speculum exam.

Step 2. A local anesthesia is most commonly injected next to the cervix.

Step 3. The clinician will then begin to dilate the cervix with instruments called cervical dilators. These dilators gradually increase in size, and this step is guided by the number of weeks of gestation of the pregnancy.

Step 4. Once the desired dilation is achieved, the clinician will either use a silent, handheld suction device called an Ipas for an MVA, or an electric device for an EVA to perform the aspiration and remove the pregnancy.

Step 5. After removal of the pregnancy, the provider may choose to do an ultrasound, and then the woman is allowed to rest. [2]

4/ After the manual vacuum aspiration abortion

The manual vacuum aspiration abortion (MVA) or the electric vacuum aspiration abortion (EVA) recovery time is relatively short in the clinic.

  • For women who have the procedure with only local anesthetic, the recovery time is typically less than 30 minutes.
  • For women who were given a sedation medicine for the procedure, the recovery time may be a bit longer (30-60 minutes) while the sedation effect diminishes.

Once the in clinic abortion recovery is completed, the woman is sent home. Some clinics may request that she have an escort or someone with her to get home, but this depends on the clinic. [2]

5/ Post-abortion care after the manual vacuum aspiration abortion

After a safe in-clinic abortion, women are often offered a follow-up visit, and while this is not required, each woman should listen to the recommendation of her healthcare provider.

There is no medically proven amount of time that a woman has to wait to do specific activities including shower/bathing, exercise, sex, or using tampons. Generally, it is advised that at least until the bleeding lightens after the procedure, the woman should avoid introducing objects into the vagina including tampons and menstrual cups, and avoid intense physical activity. Each woman can return to her normal activities as tolerated, and each woman will be different.

Prior to leaving the clinic, women should be offered information about methods of contraception. Most forms of contraception can be started immediately, however, a discussion should take place regarding each woman and her choice of method. Clinics should provide women with contact information, in case they have questions or concerns after the abortion. [2]

To find the appropriate contraceptive methods of your choice, visit www.findmymethod.org

The manual vacuum aspiration (MVA) equipment used during the procedure

Manual vacuum aspiration (MVA) involves the use of a convenient, handheld device called an Ipas. The Ipas is a silent, suction device that is used to aspirate the pregnancy. [2] More information about the Ipas device can be found here.

The electric vacuum aspiration (EVA) equipment used during the procedure

Electric vacuum aspiration (EVA) uses a machine that creates suction, which is connected to a tube that the clinician inserts through the cervix to aspirate the pregnancy. The EVA device often creates a humming/buzzing noise during aspiration.

Most commons side effects of the vacuum aspiration abortions

The most common pain associated with vacuum aspiration abortions is strong cramps experienced by the woman during the procedure. Often this cramping will improve quickly afterward, but some women may experience cramping on and off for a few days or weeks. This side effect is best managed with NSAID medications such as ibuprofen.

Local anesthesia is often used during vacuum aspiration abortions, and this helps to numb the area around the cervix to ease some of the pain during the procedure. [1]

Most women will experience bleeding and cramping during and after vacuum aspiration abortions, these symptoms will gradually improve in the following days after the procedure.

It is also common to experience many different emotions after a surgical or a suction abortion, all of which are valid, and if the woman feels like she needs additional help, she should seek counseling care. [1]

Risks of complications of the vacuum aspiration abortions

While vacuum aspiration abortions are very safe, there are still some risks to the procedure which include: heavy bleeding, infection, injury to the uterus and surrounding structures, incomplete abortion, and death.

These risks are very small when the procedure is performed by a trained clinician, but they are important to know when consenting to a procedure.

A routine vacuum aspiration abortion procedure without complications does not lead to future infertility. [1]

After an vacuum aspiration abortion, there are a few signs that women should pay attention to and seek clinical attention in case of [2]:

  • Heavy bleeding (completely soaking 2 pads per hour for 2 hours in a row or more)
  • Fevers (more than 38C or 100.4F) more than 24 hours after the procedure
  • Severe, worsening pelvic pain
  • Continued signs of pregnancy (increasing nausea, breast tenderness, etc.)

For more information

Get in touch with our counselors to get more information on the manual or the electric vacuum aspiration procedure and receive support on the most appropriate abortion methods depending on your situation. You can also learn more about the other method, an abortion with pills if you are under 11 weeks pregnant.

Authors:

by the safe2choose team and supporting experts at carafem, based on the 2019 recommendations by Ipas, and the 2012 recommendations by the WHO..

carafem provides convenient and professional abortion care and family planning so people can control the number and spacing of their children.

Ipas is the only international organization solely focused on expanding access to safe abortion and contraceptive care.

WHO is a specialized agency of the United Nations responsible for international public health.

[1] World Health Organization (WHO). Safe abortion: technical and policy guidance for health systems, second edition. 2012. Retrieved from: https://apps.who.int/iris/bitstream/handle/10665/70914/9789241548434_eng.pdf;jsessionid=F77B761669FC579124C1E9CA2CC3CFDB?sequence=1

[2] Ipas. Clinical Updates in Reproductive Health. 2019. Retrieved from: https://ipas.azureedge.net/files/CURHE19-april-ClinicalUpdatesInReproductiveHealth.pdf

Updated on 28/05/2021