Making the decision to have an abortion can be challenging, and choosing which type of abortion procedure is best for your circumstances can add to the confusion.
Both medical and surgical procedures are excellent, safe methods. This article seeks to identify and discuss the differences between surgical abortion and medical abortion in order to help you better understand the choices available to you.
Surgical abortion is a commonly performed and safe procedure, with countless women undergoing the procedure every year. It’s most commonly performed in the first trimester, up to 12 weeks’ gestation with a low complication rate at this point. The surgical procedure can be performed in the second trimester, reaching up to 20 weeks gestation. This does involve a more complex procedure.
A surgical abortion in the first trimester is often carried out under conscious sedation, with the option of a local anaesthetic being available. Once the anaesthetic has fully taken effect, the surgeon inserts a small tube into the uterus and removes the contents and lining of the uterus by applying gentle suction, earning the procedure the moniker ‘suction curette’.
From the time one arrives at the surgery, through the preparation and recovery from the anaesthetic, the surgical abortion can take 4 – 5 hours, the procedure itself takes around 10 minutes. After the anaesthetic has worn off and you have been taken through some aftercare advice, you will need to be driven home.
The risks of surgical abortion
Surgical abortion is one of the safest operations, however, all surgery carries some risks. Although complications can occur major complications are rare. Some of the risks are as follows:
- Incomplete abortion – Occurs when a small piece of the pregnancy or lining remains in the uterus. This may result in problematic bleeding or cramping and a repeat procedure may be required.
- Ongoing pregnancy is uncommon (1 in 500)2 but is more likely in procedures performed under 6 weeks.
- Infection – Although highly uncommon, less than 1% of women get an infection as you will usually be prescribed antibiotics with your procedure to reduce the risk.
- Cervix Damage – Is uncommon and rarely has longstanding effects if it does happen.
- Perforation of the uterus – where the surgical instruments make a hole in the wall, is potentially the most serious complication but fortunately is rare with an experienced surgeon.
Women who experience heavy bleeding, fever or severe pain or discomfort following a surgical abortion must consult a doctor as soon as possible.
Why choose surgical abortion?
Overall, surgical abortion is a very safe and highly successful option for termination of pregnancy in the first trimester. The advantages of choosing a surgical abortion are:
- Can be performed late into the pregnancy.
- Extremely short procedure, under 10 minutes.
- Usually involves a single visit to the clinic.
- Less bleeding and cramping than with a medical abortion.
- Medical staff are present throughout the procedure.
- It can be performed under conscious sedation, which reduces awareness and pain.
- Has a low complication rate and high success rate.
- You can continue to breastfeed, whereas you will need to cease breastfeeding during a medical abortion.
Medical abortion has been more widely available to most women up to 9 weeks of gestation. Choosing between a medical or surgical abortion dependend on your circumstances and personal preference.
For many women, the availability of medical abortion in South Africa has meant an increase in privacy when accessing termination options. The more recent introduction of medical abortion via Telemedicine has made early termination readily available to women living in remote areas or those without access to an abortion clinic.
The abortion is achieved using a combination of two medications which work together to terminate a pregnancy. The first medication is administered by your doctor, or taken by you at home. This medication is an anti-hormone, which acts by blocking the effects of progesterone – the hormone needed for a pregnancy to continue.
24 to 48 hours after taking the first medication, you take the second medication buccally. The second medication opens the cervix and assists the uterus to expel the pregnancy. This should occur between 30 minutes to 24 hours after taking the second medication, but most women can expect to experience some vaginal bleeding, cramps and to pass some pregnancy tissue within 4 hours.
Almost all women are suitable for a medical abortion, although there are a few medical conditions that may require you to check your eligibility.
The risks of medical abortion
Medical abortion is a safe and effective method of terminating a pregnancy up to 9 weeks’ gestation; however, like surgical abortion, medical abortion carries some risks:
- Incomplete abortion – The most common complication which occurs when the pregnancy is not completely expelled from the uterus. A surgical procedure may be required if bleeding or cramping persists.
- Ongoing pregnancy.
- Excessive bleeding
Vaginal bleeding and cramping is normal and usually starts within a few hours of taking the second medication (misoprostol). The amount of bleeding and cramping varies from patient to patient.
Why choose a medical abortion?
- It requires no anaesthetic.
- It’s a non-invasive procedure.
- There’s greater privacy than with a surgical abortion.
- No surgical risks associated with medical abortion.
- You are at home and can have the support of friends and/or family if you choose.
- It can feel ‘more natural’, as it is similar to having a heavy period or miscarriage.
How Marie Stopes Can Help You
If you have an unplanned pregnancy, Marie Stopes South Africa offers a safe abortion service should you choose to terminate the pregnancy. Book an appointment at one of our conveniently-located centres or call the TOLL FREE line (0800 11 77 85) for the Telemedicine service