Pregnancy Termination

What is involved in an abortion?

Ultrasound scan

A woman will usually have an ultrasound scan first, to find out the exact length of the pregnancy. That is also necessary to see which method can be used for the termination, medical abortion with abortion pills, or vacuum aspiration. 

Too soon?

If a woman’s period is only a couple of days late, the ultrasound might not show anything. If the date of the last menstruation is certain, a medical abortion can be performed. However, if there was only light bleeding or any uncertainty about the menstrual cycle, she may need to wait another one or two weeks for the procedure. In such cases, two pregnancy tests are performed within a week to monitor the progression of pregnancy or the course of the abortion. 

Appointment

When a woman goes to a healthcare provider for an abortion, she will usually be asked numerous questions, like the following: 

• When did you last have your period?
• Is an abortion your own choice? 
• Are you unsure about your decision? 
• Would you like to talk to someone about it?
• Would you like to look at the ultrasound scan?
• Is there any chance of you having an STI?
• Have you thought about contraception after the abortion?

Methods of pregnancy termination

There are different ways to terminate a pregnancy. 

1. Less than 10 weeks pregnant 

Two methods of abortion can be used for pregnancies of 10 weeks and less

• Abortion pill: A medical abortion involves taking medications to end the pregnancy, with the guidance of a doctor.
• Vacuum aspiration: A vacuum or suction aspiration involves a thin plastic tube, which is inserted through the vagina to empty the uterus. During this surgical procedure, the contents of the uterus are gently sucked out.

2. Between 10 and 12 weeks

• Vacuum aspiration: A vacuum or suction aspiration involves a thin plastic tube which is inserted through the vagina to empty the uterus. During this surgical procedure, the contents of the uterus are gently sucked out.

3. More than 13 weeks pregnant – Dilatation and evacuation

If a woman is more than 13 weeks pregnant, an abortion is still possible in the Dutch context. This can be done up to 22 weeks. The uterus is then emptied using a tube and some special instruments. 

4. More than 22 weeks pregnant – Abortion not routinely possible

If a woman is more than 22 weeks pregnant, she can no longer have the pregnancy terminated. If there is a serious defect in the fetus, the woman can have the pregnancy terminated in a hospital. That is possible up to 24 weeks in the Dutch context.
 

Abortion pill

The ‘abortion pill’ is a combination of different tablets:

These pills should only be taken with the guidance of a doctor. Do not source these pills outside of the healthcare setting.

The first tablet is taken at the doctor’s practice. This tablet (mifepristone) blocks the pregnancy hormones from working, loosens the embryo from the uterus wall and opens the cervix (entrance to the uterus).

Four tablets (misoprostol) are taken at home between 24 and 48 hours later. Usually, the doctor advises to insert the 4 tablets into the vagina. But it is also possible to let the tablets melt in the mouth. This medication makes the uterus contract, and the pregnancy passes through the vagina, with some bleeding. It looks like a heavy period. 

You should only ever get these pills from the doctor or pharmacist. Never buy these pills on the street. Taking these pills without the guidance of a doctor can have serious implications on your health. 

How long does the bleeding last?

The bleeding usually lasts for about 1 week, sometimes it can last up to 4 weeks. How much a woman bleeds also varies per person. 

An abortion pill is not a morning-after pill

An abortion pill is different to a morning-after pill.  The morning-after pill is taken soon after having unprotected sex. A morning-after pill can prevent pregnancy. An abortion pill is taken when a woman is already pregnant. The abortion pill ends the pregnancy.

Vacuum aspiration

During a vacuum aspiration, the uterus is emptied through the vagina using a thin tube. Usually, medication is given beforehand to gently open the cervix (entrance to the uterus), and some pain relief. Then the doctor puts a special instrument into the vagina, which keeps it open. The cervix is given a local anesthetic, so the woman won’t feel anything. The doctor removes the pregnancy from the uterus through a thin tube. The procedure takes about 10 minutes.

Is it painful?

Women may feel a short, sharp pain as the local anesthetic is given. They may also feel some cramps during the procedure. These cramps are similar to bad period pains. 

After the abortion

After the procedure, women are advised to stay at the doctor’s office for a while to recover. Usually, the cramping goes away after the procedure, but stomach cramps may continue for a couple of days afterwards. Antibiotics are prescribed to prevent infection and advice about pain relief is given. There is usually some bleeding, something like a normal period.

How long does the bleeding last?

The bleeding often stops within 2 weeks. But it might last longer than that or stop soon after the procedure. 

What is more effective: an abortion pill or a vacuum aspiration?

Both an abortion pill and a vacuum aspiration are effective in terminating a pregnancy and they are both safe if carried out with medical supervision from a doctor. With either procedure, there is a slight chance that the pregnancy hasn’t ended. That’s why it’s important to do a pregnancy test after 3 to 4 weeks. 

Check-up

A check-up appointment is scheduled for 1 week after the procedure and if necessary, more check-ups will be scheduled. The doctor will check whether the termination went well. They will review any physical or emotional difficulties being experienced by the woman. They will also give advice about contraception. 

Having an IUD put in

Some women like to use a hormonal or copper IUD after an abortion. If they have a vacuum aspiration, the IUD can be placed immediately. If they decide to have the abortion pill, an IUD can be fitted 3 to 4 weeks later. A contraceptive implant can be placed in a woman’s arm straightaway. 

Do abortions affect fertility?

No, fertility doesn’t change after an abortion. Fertility does decrease as women get older. Usually from the age of 35.