Surgical abortion

Many women want to have someone they know with them before and after the procedure. You’re allowed to take someone along to support you after the procedure but they can’t stay in the room with you while it’s being done.

Period-like bleeding and pain may occur afterwards, and you might feel a little shaky due to the anesthetic. So it’s a good idea to arrange for someone to pick you up and take you home. You won’t be able to drive or ride a bike on the day that you have the anesthetic.

The practice, clinic or hospital where you’re having the abortion will want to see you before the procedure. There they will work out how many weeks pregnant you are and whether you have a higher risk of complications – due to an existing illness, for example.

Pre-abortion health checks may also include

• a talk with the doctor where they ask about things like your last period, previous pregnancies, illnesses and any current health problems,
• a gynecological examination,
• an ultrasound scan,
• a chlamydia test, and
• a test to determine your Rhesus factor (after your 9^th week of pregnancy).

The doctor who performs the abortion has to tell you all about the different abortion methods, what they involve, and any potential complications. They also have to ask whether you want to talk about your reasons for having an abortion. But you don’t have to.

This is a good time to talk about contraception after the abortion, too, because you could become pregnant again quite soon after.

You may be given an antibiotic (one dose) before the abortion to reduce the risk of an infection in the genital area.

Usually, you’ll be given medication to soften your cervix (the opening between the vagina and womb) before the procedure. This makes it easier to insert the instruments. There are two possible medications for this:

• Misoprostol: This hormone pill starts to have an effect after around 2 to 3 hours. Using it for this purpose hasn't been approved by the authorities in Germany, so it's considered to be " off-label use." Doctors have to tell you what that means. Misoprostol can have various side effects, including belly ache and diarrhea.
• Mifepristone: This hormone pill starts to have an effect after 24 hours. Sometimes it can trigger an abortion on its own but this is rare. Doctors more commonly use the other medication (misoprostol) when preparing for an abortion.

At your pre-abortion appointment, the doctor explains how the medication works and then they usually give it to you to take at home.

If the doctor agrees, you can take painkillers before the procedure to keep any pain to a minimum during and after it. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or diclofenac are recommended for this purpose.

Surgical abortions are usually done under a short-acting general anesthetic, which is given through a needle in your arm.

The use of a local anesthetic is less common. When it is used, it’s injected directly into the cervix. You can also have a sedative to put you to sleep for a short time.

If you have a local anesthetic, you’ll be more aware of what's happening. You're more likely to feel pain than with a short-acting general anesthetic.

Most places only do surgical abortions using a short-acting general anesthetic. You can ask about the options at your pre-abortion appointment.

First, the doctor inserts thin metal rods into the opening of your cervix to gradually make it wider. Then, they use one of the following two methods:

• In the suction (vacuum aspiration) method, they insert a thin plastic or metal tube into your womb. The tube is connected to a suction device, which is then used to remove the lining of the womb and the embryo. This procedure takes about 5 to 10 minutes.
• Dilation and curettage (D&C): Here the doctor inserts a scoop-like instrument called a curette into your womb to scrape out the lining and the embryo. This procedure takes about 10 minutes. Current German medical guidelines don’t recommend D&C because it’s considered to be higher-risk than the suction method.

If you’re Rhesus-negative, you’ll be given an anti-D immunoglobin injection after the abortion. This is to prevent antibodies forming that would be dangerous for any children you might have later.

You can get a sick note to give to your employer for the day of the abortion and the days following it. It tells the employer you’re unfit for work but not why.

Most women have period-like pain and light bleeding for one to two weeks after the procedure. It is common to have severe pain and heavy bleeding for several hours about four to six days after the procedure. The blood may contain clots. You can take non-steroidal anti-inflammatory drugs (NSAIDs) for the pain.

Possible complications include:

• heavy bleeding (in 2 out of 1,000 women)
• damage to the womb or cervix (in 1 to 6 out of 1,000 women) that usually heals completely
• an infection in the genital area (in around 20 out of 1,000 women who took antibiotics before the procedure and around 60 out of 1,000 women who didn’t)

In roughly 20 out of 1,000 surgical abortions, some of the womb lining or the embryo is left in the womb. Signs of this complication include vaginal bleeding, fever, and pain in the lower belly area. The remaining tissue may come out when you have your next period. Sometimes it’s removed surgically. Alternatively, you can take misoprostol to expel it.

In very rare cases, scar tissue can develop inside the womb, causing irregular periods and period pain. The medical name for this is Asherman Syndrome. It happens in around 2 out of 10,000 surgical abortions. Experts believe that it mainly happens when a dilation and curettage (D&C) procedure is carried out because the abortion didn’t remove all of the pregnancy tissue.

The risk of side effects and complications is higher for women who have blood-clotting disorders, anemia, or abnormalities in their womb (like uterine fibroids). Complications are also more common if you’ve had a Cesarean section (C-section) in the past.

The doctor checks the tissue that was removed in order to see whether the pregnancy has been stopped. When the procedure is over, they can also do an ultrasound scan to check whether there is any tissue left in the womb. If there is, they’ll remove it straight away.

The abortion only fails to work in 2 out of 1,000 women. Then they’re still pregnant. If this happens, the surgical procedure can be repeated.

Your next menstrual cycle will usually begin straight after the abortion. Then your next period will start roughly four to six weeks later.

Doctors often offer a check-up one to two weeks after the abortion but this is not strictly necessary. You can decide whether you would like to have one. It might be a good idea to have a check-up if, for instance, you had an IUD (coil) inserted straight after the procedure.

But it's always important to see a doctor if you have symptoms like heavy bleeding and a fever, or if you’re in pain for more than seven days. That might mean that the abortion didn’t remove all of the pregnancy tissue.

It is also advisable to see a doctor if there are signs that you’re still pregnant (like nausea) after you’ve had the abortion.