Abortion Procedures

There are two basic ways abortions are performed:

  1. One is called “medical” or “medication abortion,” meaning that you take medicine to end the pregnancy.
  2. The other is called “aspiration” or “surgical” abortion, meaning that a doctor does a procedure to remove the pregnancy.

MEDICAL ABORTION

A medical abortion uses two medicines to end a pregnancy. 

  1. The first medication, mifepristone, weakens the attachment of the pregnancy to the uterus. 
  2. A second medication, misoprostol, placed in your cheek or into your vagina 1 to 2 days later, makes the uterus cramp and causes bleeding to expel the pregnancy.
  • If you are 7 weeks (49 days) pregnant or less, this is effective 95.5% to 98% of the time. 
  • Between 7 weeks and 9 weeks (63 days ), the effectiveness is 94.2% – 98%. 
  • Between 9 weeks (63 days) and 10 weeks (70 days) the effectiveness drops to 90% – 95.9%.

With a medical abortion, women often have stronger cramping and heavier bleeding than with a period.  Bleeding and spotting usually lasts about 9 – 16 days.  A return visit is needed to make sure that the abortion is complete and that you are no longer pregnant. Continuing a pregnancy after taking misoprostol is not safe due to the risk of birth defects from the misoprostol.  If early medication abortion does not work in ending your pregnancy, you will need to have an aspiration abortion.

Complications are rare but can include infection and heavy bleeding. An aspiration abortion may be necessary to stop the bleeding.

Your clinic visit is covered by your BC Medical Service Plan. The cost of the medicine for the medical abortion is $332.75. If you have private insurance, it may pay for the medication.

ASPIRATION ABORTION

At the Elizabeth Bagshaw Women’s Clinic, we perform aspiration abortion for women up to the 17th week of pregnancy. If your pregnancy is more than 17 weeks, we will refer you to BC Women’s Hospital. 

With aspiration abortion, sometimes called surgical abortion or vacuum aspiration abortion, the cervix is opened enough to pass a small tube into the uterus. Then gentle suction is used to remove the pregnancy.

  • The procedure is successful 99% of the time. 
  • Aspiration abortion takes about 5 to 10 minutes. 

During the procedure you will be supported by your nurse and offered “conscious sedation”, a combination of 2 intravenous medications that relieve pain and anxiety. After the procedure, spotting or bleeding like a period may last for a few days or weeks.

Complications are rare, but include infection, heavy bleeding, a tear in the cervix or uterus, incomplete abortion or a continuing pregnancy. 

The visit and aspiration procedure are completely covered by your BC Medical Service Plan (Care Card ).  If you do not have BC MSP, you will be asked to pay $500.

MEDICATION OR ASPIRATION ABOARTION, HOW TO CHOOSE

Medical Abortion

  • Success rate 95 – 98% ( varies with weeks)
  • No aspiration procedure in most cases
  • Requires at least 2 visits
  • Abortion occurs within 24 hours of second medication for most women, but might take longer
  • Finger stick blood test, but no IV
  • The process happens at home
  • Heavy bleeding and cramping at home
  • Medication costs $332.75

Aspiration Abortion

  • High success rate ( 99%)
  • Instruments inserted in the uterus
  • Can be done in one visit
  • Procedure is completed in 5 to 10 minutes
  • IV pain medication
  • Supportive nurse during procedure
  • Procedure done in our clinic
  • Procedure covered by MSP
  • You will be asked to not eat for 4 hours before your appointment
  • Best to have a ride or someone to accompany you home.

WHAT TO EXPECT WHEN YOU COME TO THE CLINIC

With both medication and surgical abortion, you can expect the following steps:

You will see a counsellor to discuss your decision to have an abortion.

Most women will already know if they prefer a medical or surgical abortion.  The risks and benefits of the abortion will be reviewed and the procedure described. This is an important step; if you have any questions or concerns, this is the best time to ask. We will help you feel certain that you are making the best decision.  The counsellor will also offer to discuss your options for contraception (“birth control”).  After medication or aspiration abortion, you can become pregnant again quickly, even before your next menstrual period. You can start using most methods (pill, patch, vaginal ring, injection, intrauterine device [IUD]) on the day of an aspiration abortion. With medication abortion, you can start some kinds of birth control on the same day you take the medicines. If you choose an IUD, it can be inserted soon after the pregnancy has ended, usually within a few days after you take the medicine.

You will see a nurse to review your medical history

The nurse will test your blood to determine your “Rh” blood type. If your blood is Rh negative, you will be offered an injection of a medication called Rh immune globulin (Rhogam or WinRho). This helps to prevent complications in future pregnancies.  You will be offered blood testing for HIV and Syphilis.

You will see a doctor who will do a physical exam including tests for gonorrhea and chlamydia. You will have an ultrasound exam to determine the exact age of the pregnancy.

IF YOU HAVE CHOSEN TO HAVE A MEDICATION ABORTION: 

You will be given a prescription for Mifegymiso®: The Mifegymiso® package contains two boxes:  one box contains 1 tablet of mifepristone 200mg, the second box contains 4 tablets of 200 mcg misoprostol. You will also be given pain medication pills.

You will buy the Mifegymiso from the pharmacy next door to our clinic: You take the mifepristone on the day that you see the doctor. 24 to 48 hours later, you will place the other medication (misoprostol) in your cheek or vagina.

  • Expected side effects — Abdominal pain, cramps, and vaginal bleeding are expected side effects with early medication abortion. Some women also have fever, nausea, vomiting, or diarrhea.
  • Pain and cramps — Most women will have abdominal pain and cramps after taking the second medication (misoprostol).
  • Vaginal bleeding — It is normal to experience vaginal bleeding with an early medication abortion. The bleeding may be heavy, especially in the first few hours after you take the misoprostol. The bleeding usually decreases after you pass the pregnancy tissue out of your uterus, and then continues for several weeks. It should be lighter than a menstrual period after the first few days.
  • Fever, nausea, vomiting, diarrhea — Some women experience a mild fever, nausea, vomiting, or diarrhea after taking the second medication (misoprostol). This usually goes away quickly on its own without treatment.

Follow-up Care

One to two weeks following your procedure, YOU MUST return to the clinic or have blood tests to be certain that you are no longer pregnant.

IF YOU CHOOSE TO HAVE AN ASPIRATION ABORTION: 

The nurse will start an IV and do your blood type test and STI tests with blood from the IV line.

You will be offered intravenous medications for pain and anxiety.  This combination is called “moderate sedation” or “conscious sedation.  General anesthesia (that makes you completely unconscious) is not available in our clinic.  If you require general anesthesia, we will refer you to BC Women’s Hospital.  The doctor will perform a pelvic exam and ultrasound.  A speculum is then placed in your vagina and swabs for Gonorrhea and Chlamydia taken. Next, the cervix is cleansed and a local numbing medication administered.  The cervix is then gently opened.  A thin suction tube is placed in the uterus and the pregnancy removed with suction.  The procedure takes between 5 and 20 minutes.  Following the procedure, you will be monitored in a recovery area for about 30 minutes.  You are not allowed to drive after the IV medicines.  We ask that you have someone to give you a ride or to accompany you home on public transit.  If you can’t have someone with you, we require that you take a taxi cab.

  • Expected side effects — Vaginal bleeding, abdominal pain, and cramping are expected side effects after an aspiration abortion.
  • Pain and Cramps— Most women have some abdominal pain and cramping after an aspiration abortion. You can take 600 to 800 mg ibuprofen (Advil, Motrin) every 6 to 8 hours for pain, if needed. 
  • Vaginal bleeding — It is normal to have some vaginal bleeding after an aspiration abortion. Usually the bleeding is less than with a menstrual period. The bleeding usually lasts a few days to two weeks, and should become light after the first few days.

Follow-up Care

Most women need no further care after their procedure.  If you are having a problem you can come back to the clinic at any time for a check-up. If you still feel pregnant 2 weeks later or if you do not have a period within 6 weeks come back to the clinic.  If you have an IUD placed at the time of your procedure, we suggest you have a check-up 4 to 6 weeks after the IUD is placed.