Guide to a safe abortion
In this page, we will give information on one of the safe abortion methods within the first trimester or the early second trimester of a pregnancy: the vacuum aspiration abortion (in-clinic abortion).
Vacuum Aspiration Abortion Instructions
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 afterwards. [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- Dilation and Curettage (D&C) is an outdated method of abortion and has largely been replaced by methods of uterine vacuum aspiration and dilation and evacuation (D&E).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]
Vacuum Aspiration Abortion Instructions
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]:
- Urine pregnancy testing
- Determination of Rh blood type
- Manual pelvic exam and/or ultrasound to estimate the gestational age
- 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 showering/bathing, exercising, 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 https://findmymethod.org/
Vacuum Aspiration Abortion Instructions
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 a 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.)
Vacuum Aspiration Abortion Instructions
Manual Vacuum Aspiration for Miscarriage Management
Aside from its use for abortions, Manual or Electric Vacuum Aspiration can also be used for miscarriage management. Spontaneous abortions, also known as miscarriages can sometimes fail to fully dispel all products of conception. In these cases, the vacuum aspirator can be used to ensure all products of conception are removed. The procedure remains the same with the aspirator being used to suction what remains after a miscarriage. A follow-up visit is often not required, but in some cases, your practitioner may request a follow-up with you.
When to seek miscarriage management
The decision on whether to seek in-clinic treatment is often up to your discretion. Many women will choose the wait and see method in which they allow their bodies to dispel all products of conception. Some women feel more comfortable seeking in-clinic care during the process. However, there are some symptoms that can occur during a miscarriage which indicate a need for in-clinic treatment, such as:
- increased bleeding, for instance soaking two pads per hour and/or passing golf ball sized clots
- severe abdominal pain or shoulder pain
- fever or chill
- dizziness or fainting
- foul smelling vaginal discharge
- diarrhoea or discomfort when emptying your bowels [3]
After a Miscarriage
After a miscarriage, 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]
Vacuum Aspiration Abortion Instructions
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.
[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