What are vacuum aspiration and D&E — dilation and evacuation?
They are both abortion procedures that can be used to end pregnancy. Using the abortion pill is another way.
Vacuum aspiration is more common than D&E. It is used up to 14 weeks after a woman's last period. More than 90 percent of abortions in the United States happen during this time.
D&E is usually performed later than 14 weeks after a woman's last period. Fewer than 10 percent of abortions in the United States happen during this time. After 24 weeks of pregnancy, abortions are performed only for serious health reasons.
How are they done?
Vacuum aspiration empties the uterus with gentle suction of a manual syringe or with machine-operated suction.
Performed with a manual syringe, it is known as manual vacuum aspiration or MVA.
Performed with machine-operated suction and the use of a curette — a narrow metal loop used to remove the tissue that lines the uterus — it is sometimes called dilation and suction curettage or D&C.
D&E empties the uterus using a combination of suction and medical instruments.
How long does it take?
Vacuum aspiration takes about five to 10 minutes. D&E usually takes between 10 and 20 minutes. (Time is also needed for client education, a physical exam, forms to read and sign, and a recovery period of about one hour.)
What do I need to do to have a vacuum aspiration or D&E?
If you are a minor living in certain states, you will need to notify a parent to get approval — judicial bypass — from a judge. Check out your state laws on minors and abortion.
To have the abortion procedure, you will need to
discuss your options
be informed about the benefits and risks of the procedure
sign a consent form
give a medical history
have laboratory tests
have a physical exam — which may include an ultrasound
Special considerations may be necessary if you ...
are extremely uncomfortable about having the procedure
are extremely overweight
have certain kinds of sexually transmitted infections
have an infection in your uterus
have seizures more than once a week
are running a fever
have certain serious health problems
have problems with anesthesia
How does it feel?
Most women feel pain similar to menstrual cramps. For others, abortion is more uncomfortable.
Local numbing medications are usually used. Some clinics use a kind that allows you to be awake but deeply relaxed. Fewer offer general anesthesia so you can sleep through the procedure. This, however, increases the medical risks and how long you must remain at the clinic.
How is an aspiration abortion performed?
Your uterus will be examined.
You will be given medication for pain.
A speculum will be inserted into your vagina.
You may be offered sedation.
The clinician may inject a numbing medication into or near your cervix.
The opening of the cervix may be stretched with dilators — a series of increasingly thick rods. Or you may have special absorbent dilators inserted that will absorb fluid and slowly stretch open your cervix — sometimes absorbent dilators are inserted the night before and work as you sleep. Medication may also be used instead of — or along with — dilators to help open the cervix. You will be given antibiotics to prevent infection.
A tube is inserted through the cervix into the uterus.
Either a hand-held suction device (MVA) or a suction machine gently empties the uterus.
How is a D&C performed?
Your uterus will be examined.
You will be given medication for pain.
A speculum will be inserted into your vagina.
You may be offered sedation.
The clinician may inject a numbing medication into or near your cervix.
The opening of the cervix may be stretched with dilators — a series of increasingly thick rods. Or you may have special absorbent dilators inserted a day or a few hours before the procedure. They will absorb fluid and slowly stretch open your cervix — sometimes absorbent dilators are inserted the night before and work as you sleep. You will be given antibiotics to prevent infection.
A tube is inserted through the cervix into the uterus.
The tube is attached to a suction machine.
The suction machine is turned on and gently empties the uterus
A curette is used to remove any remaining tissue that lines the uterus. It may also be used to check that the uterus is empty.
How is a D&E performed?
Your uterus will be examined.
You will be given medication for pain.
A speculum will be inserted into your vagina.
Your cervix will be prepared for the procedure. You may be given medication or have absorbent dilators inserted a day or a few hours before the procedure. They will absorb fluid and slowly stretch open your cervix as you sleep. You will be given antibiotics to prevent infection.
In later second-trimester procedures you may also need an injection through your abdomen to ensure fetal demise before the procedure begins.
You may be offered sedation or IV medication to make you more comfortable.
A local numbing medication is injected into or near the cervix.
The uterus is emptied with medical instruments and machine-operated aspiration.
What are the health risks of abortion?
Aspiration, D&C, and D&E are very safe. But there are risks with any medical procedure. The risks increase the longer you are pregnant and if sedation or general anesthesia is used. Your overall health is another factor that affects your risk of complications. Possible risks include
incomplete abortion — Rarely, some tissue from the pregnancy is left inside the uterus. Repeated aspiration and other tests or treatment may be needed.
allergic reaction — Some women may be allergic to the local anesthetic or to other medicines used. Tell your clinician about any allergies you have, and what medications or recreational drugs you take.
infection — Rarely, an infection develops in the uterus. Usually antibiotics clear up the infection. In rare cases, repeated aspiration, hospitalization, or surgery is needed.
very heavy bleeding — Very rarely, excessive bleeding — hemorrhage — develops. Medication, repeated aspiration, blood transfusion, or surgery may be needed.
undetected ectopic pregnancy — A pregnancy that is outside the uterus wil not be ended by these methods of abortion. It must be removed with medication or with surgery. Ectopic pregnancies can cause death if untreated.
blood clots in the uterus — Very rarely, clots cause cramping and abdominal pain. Repeated aspiration may be needed.
injury to the cervix — Very rarely, the cervix is cut or torn. Medication, or rarely, surgical stitches, may be needed.
organ injury — Very rarely, an instrument goes through the wall of the uterus. Surgery, or very rarely, hysterectomy, may be needed.
death — Death from abortion is extremely rare. It is caused by very serious complication. The risk of death from childbirth is 11 times greater than the risk of death from an abortion in the first 20 weeks of pregnancy. After 20 weeks, the risk of death from childbirth and an abortion are about the same. In general, the risk of death from abortion increases the longer a woman has been pregnant.
After the abortion ...
You will rest in a recovery area.
If you have an Rh-negative blood type, you will receive an injection to protect future pregnancies.
You will receive written after-care instructions and a 24-hour emergency phone number. Call the emergency number if you have heavy bleeding, pain, fever, an unpleasant smelling vaginal discharge, or signs of a continuing pregnancy.
You can be given birth control. (You can ask when you schedule your procedure to have an IUD inserted right after it.)
You will make a follow-up appointment in two to four weeks.
How will I feel later?
You may have cramps. You may want to relax for the rest of the day. You may shower as soon as you wish. Do not take baths, douche, or use vaginal medications. Do not drive after the procedure if you've had sedation. You can usually return to work or other normal activities the next day. Recovery after D&E may take longer.
Most women ultimately feel relief. Some women feel anger, regret, guilt, or sadness for a little while. Sudden hormonal shifts may intensify these feelings.
Serious, long-term emotional problems after abortion are about as uncommon as they are after childbirth. If you want to talk with someone after an abortion, abortion providers can talk with you or refer you to a licensed counselor or to nonjudgmental support groups.
Will I bleed afterward?
Some vaginal bleeding is normal after an abortion. It is normal to pass a few clots the size of a quarter. It is also normal to have no bleeding, spotting that lasts up to six weeks, heavy bleeding for a few days, or bleeding that stops and starts again. You may use pads or tampons, but using pads makes it easier to keep track of your bleeding.
When will I get my period?
Abortion begins a new menstrual cycle. You should have a regular period in four to six weeks.
When can I have sex again?
Many clinicians recommend that you don't insert anything except a tampon into the vagina for a week. You can have sex again when you feel comfortable. You can get pregnant very soon after the abortion. Discuss birth control options with your clinician.
Where can I get an abortion?
Contact Planned Parenthood at 1-800-230-PLAN, other women's health centers, or your private clinician. Or call the National Abortion Federation at 1-800-772-9100.
How much do vacuum aspiration and D&E cost?
Fees depend on how long you've been pregnant and where you go. Nationwide, the cost at health centers ranges from about $350 to $700 for abortion in the first trimester. Hospitals generally cost more. Costs vary from community to community, based on regional and local expenses. Contact your nearest Planned Parenthood health center at 1-800-230-PLAN for information about costs in your area.
Sexuality and relationship info you can trust from Planned Parenthood® Federation of America
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