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How an abortion is performed

Abortion means the termination of pregnancy so that it does not result in a birth. The majority of abortions nowadays take place in the first ten weeks of pregnancy. Overall, the earlier in the pregnancy an abortion takes place, the less is the risk of complications during or after the procedure.

There are two ways by which an abortion can be induced. One type of abortion, called medical abortion, involves the use of medications that cause a miscarriage. The other method of abortion, called surgical abortion, takes place in a clinic and involves the use of instruments to physically remove the pregnancy from the uterus.

Medical abortion (also known as medication abortion or abortion with pills), has become the preferred method of abortion in most countries. This is because it can be performed by the women herself at home in the first 12 weeks of pregnancy. In many cases, this method of abortion does not require the woman to go to abortion clinics, and she can have the procedure in the privacy of her own home.

There are numerous medicines that can cause a miscarriage, but the most commonly used ones nowadays are Mifepristone and Misoprostol.

How an abortion with pills is done

Mifepristone & Misoprostol

Mifepristone (also known by its old name RU-486) is a medicine that causes the pregnancy hormone progesterone from working. It is usually the first abortion pill to be taken, and it prepares the body for an abortion. The usual dose of Mifepristone, when followed by Misoprostol, is 200mg. Mifepristone is taken as a tablet by mouth that is swallowed with water.

24 hours after Mifepristone, a dose of Misoprostol 800mcg is taken. Misoprostol is usually placed under the tongue for thirty minutes, where it dissolves and is absorbed. Misoprostol causes the uterus to contract and expel the pregnancy. The miscarriage usually starts from a few minutes to a few hours after using Misoprostol.

According to World Health Organisation guidelines, Mifepristone and Misoprostol can both be used by the woman at home in the first 12 weeks of pregnancy. If used beyond 12 weeks they will still cause an abortion, but the risk of complications is higher so they should only be used under medical supervision in a clinic or hospital.

A miscarriage that happens after the use of abortion pills is very similar to a natural miscarriage. It is normal for the woman to experience considerable cramping pain and vaginal bleeding with clots/tissue. In a minority of cases (around one in every twenty), the uterus does not expel all of the pregnancy, and a further minor procedure in a clinic or hospital will be required to remove the remains and prevent an infection in the uterus. This procedure can be done in any hospital that treats women having a miscarriage. It does not have to be an abortion clinic.

In very rare cases (around one in every fifty) the pregnancy continues despite the use of abortion pills. To check if the abortion has been successful, the woman can do a urine pregnancy test three weeks after using abortion pills, or arrange to have an abortion around ten days after using the pills. If the pregnancy has continued, the woman can take another course of abortion pills or opt for a surgical abortion.

How a surgical abortion is done

Empty gynecological chair in the clinic.

A surgical abortion takes place in clinics and hospitals that offer abortion services. Since abortion is completely illegal in Malta, women in Malta opting for a surgical abortion will have to travel abroad.

Despite being called a "surgical" abortion, this method does not actually involve cutting skin or stitches, because the pregnancy is removed through the vagina. The specific procedure used for a surgical abortion depends on how advanced the pregnancy is.

For pregnancies of less than 14 weeks, a surgical abortion is performed through a procedure called suction (or vacuum) aspiration. It involves the use of a small tube that is introduced into the uterus to suck out the pregnancy. This is a simple procedure that is usually complete in a few minutes. In most cases, a local anaesthetic around the cervix is all that is needed, but if the woman becomes uncomfortable a light sedative can be used.

For pregnancies beyond 14 weeks, surgical abortion is performed through a more extensive procedure called dilation and evacuation (D&E). As the name implies, this procedure involves the dilation (widening) of the cervix (the opening to the uterus) and evacuation (removal) of the pregnancy using forceps and gentle suction. This procedure requires the use of a general anaesthetic, so you can expect to be at the clinic for a whole day. You may also need to attend the clinic the day before the procedure for cervical preparation.

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After an abortion it is normal for the woman to experience vaginal bleeding for a number of days and up to a few weeks. Nonetheless, the vast majority of women recover quickly and can usually go about their usual routine in a day or two. In a minority of cases, products of conception remain in the uterus after an abortion and require an additional minor procedure to remove them.

Rare complications that may occur after an abortion include infections in the uterus, damage to the uterus or adjacent organs from instruments, and haemorrhage. 

Statistically, childbirth carries a higher risk of complications than an abortion, and the risk of death from the use of abortion pills is four times less than the risk of death from the use of Viagra. An abortion does not reduce the chances of a woman getting pregnant again in the future.