Vacuum Aspiration is the commonest method of abortion used in New Zealand. It's also known as also known as Suction Curettage, or Dilatation and Curettage (D&C).
It can be performed from five to six weeks after the last normal mentrual period.
Firstly the operating doctor will examine you internally by placing a finger in your vagina. They will then put in a speculum (small device to open the vagina) and then numb the cervix (the opening to the womb), with a local anaesthetic. Some women notice a pinching feeling which does not last for long as the local anaesthetic starts to work straight way.
The cervix is then gently dilated (stretched). The woman may feel cramping similar to menstrual period pains. Slow, even breathing helps to lessen the discomfort of the dilatation. Pre-operative medication softens the cervix and makes the dilatation much easier to do. An experienced nurse or midwife will support you throughout the process.
The doctor will insert a small plastic tube (cannula) through the cervical opening into the uterus. The tube is attached to a mild suction pump or syringe (manual vacuum aspirator or MVA), and is used to carefully remove the contents of the uterus (fetus, placenta, and lining of the uterus).
The suction part of the procedure usually lasts one to three minutes. For larger pregnancies tissue forceps may be used as well to lift out the pregnancy tissue. This will take a little longer.
Most women feel pain similar to menstrual cramps. For others, abortion is more uncomfortable. Slow, even breathing again helps to ease the cramping.
Taking the products of the pregnancy home is an option which can be discussed with your counsellor, doctor, or nurse.
This is the term often used for pregnancies over 14 weeks. The procedure is similar to the Vacuum Aspiration except that, as well as aspiration, removal of the tissue with forceps is usually routine. The cervix may require more dilatation.
Most commonly in New Zealand a drug called misoprostol or Cytotec® is given one to three hours before surgery to soften the cervix (either taken by mouth or inserted into the vagina). It can cause some cramping or bleeding, but makes the abortion procedure quicker and more comfortable.
Medicines are generally registered in New Zealand for specific purposes, and misoprostol is not registered for use in abortion. However, it has a long-established safety record when taken by mouth. Research has showed it is a sufficiently safe and effective medicine which can be used prior to a termination procedure.
Also known as the "abortion pill" or Mifegyne®. This is used for medical abortion but is also registered for use prior to surgical abortions. It is more effective than misoprostol but takes longer and is much more expensive.
With later pregnancies sometimes in a two-stage procedure the cervix is treated with laminaria which absorb fluid and swell over 12 to 24 hours to slowly dilate the cervix. Other hydrophilic (water absorbing) material can also be used. These are more commonly used with later pregnancies and have been to some extent been replaced by prostaglandin and/or mifepristone use.
Most early abortions in New Zealand are performed with local anaesthetic which is injected in and around the cervix (neck of the womb).
For some patients this is not felt, but others feel it as a short-lasting unpleasant sensation, like local anaesthetic used by dentists.
Analgesia and "conscious sedation"
Many clinics use some form of pre-operative pain relief or sedation. This may be a mixture of tablets given in the hour before the operation or drugs given intravenously (into a vein) just before the procedure.
When drugs are used which alter consciousness by making the woman significantly drowsy this is called "conscious sedation". This is usually enough to make the patient feel more relaxed and experience minimal pain from the procedure. The use of "conscious sedation" requires closer monitoring of the patient during the time that consciousness is altered.
A number of different drugs are used and the details can be obtained from the individual clinic. Some drugs which may be used are:
- Non-steroidal anti-inflammatory drugs (NSAIDs) like Nurofen, Synflex, Voltaren
- Benzodiazepines such as Midazolam or Diazepam
- A mild narcotic such as codeine
- Short-acting stronger narcotics like Fentanyl
Some hospitals perform the whole procedure under a general anaesthetic with the patient fully asleep.
After the abortion in the clinic
- After early abortion you will rest in a recovery room for up to an hour. For later abortions, or if there are any difficulties, you may be required to stay longer.
- 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 instruction for how to access care if you experience any complications.
- If you have had any sedative medications, you will not be safe to drive a car for 12 to 24 hours following the operation.
- It is common for women have mixed emotions immediately after an abortion. Sometimes it is helpful to talk about these feelings to a counsellor, or the clinic will arrange an appointment for post-abortion counselling if this is required.
- All clinics will assist you with Contraception including the insertion of intra-uterine devices (IUDs & IUSs) or contraceptive implants (Jadelle)
What to expect after going home
- You can expect to bleed off and on for up to two weeks.
- You may continue to experience cramps and can pass a few large blood clots for up to 10 days.
- Sanitary pads should be used - not tampons.
- You should relax for the rest of the day of the abortion but they can usually return to work or other normal activities the next day. Recovery after late abortions may take longer.
- The use of baths, douches or vaginal medications is not recommended until the bleeding has completely stopped (usually one to two weeks).
- You should not have vaginal intercourse or insert anything into the vagina until the bleeding stops.
- You can get pregnant very soon after the abortion. Contraception options should be discussed with the clinician before discharge.
- A doctor should be consulted if there is heavy bleeding, pain or fever.
- A routine follow-up appointment is advised in one to two weeks.
- Abortion begins a new menstrual cycle. A regular period should resume in four to eight weeks.