Procedure for a Vacuum Aspiration Abortion

When the patient goes into the clinic operating room for her abortion she will be on the operating table with her feet in stirrups, during the operation she must lie with her legs apart.
  • The operating doctor first does an internal examination to check how far advanced the pregnancy is.
  • The cervical canal is then slowly stretched open with dilators. The woman may feel cramps.
  • The doctor inserts a plastic catheter through the cervix which is attached by a long plastic tube to a suction machine.
  • The foetus is sucked through the plastic tube and into a container.
  • The amount of discomfort varies. Some women feel virtually nothing, others feel discomfort from mild cramps, to more severe ones.
In the first trimester, usually 6 to 13 weeks, vacuum aspiration (suction) is the abortion procedure most commonly used.

A first trimester abortion involves three main steps: (1) an injection to numb the cervix, (2) insertion of a tube through the cervix into the uterus, (3) suction created by an aspirating machine to remove the foetal parts. It takes around five minutes to complete.

A FRONTLINE documentary (filmed at a USA abortion clinic in 1983) shows a first trimester suction abortion taking place. View here.

The Epsom Day Unit (EDU), at National Women's Hospital in Auckland, New Zealand, provides first trimester abortion services (up to 12 weeks and 6 days on the day of referral) for the greater Auckland area. EDU performs the majority of all abortions in New Zealand.

The following is Patient Information provided by Epsom Day Unit for a vacuum aspiration abortion.

Patient Information
A woman coming for an abortion to EDU will have a woman counsellor who will go into the operating theatre with her and will stay with her during the operation if she wishes. She is there to give support and explain what is happening. The patient has a choice whether she wants a counsellor or not.

When she goes into the clinic operating room for the abortion she will be on the operating table with her feet in stirrups, or her legs supported by knee pads. During the operation she must lie with her legs apart.

In the operating room there will usually be two nurses, a doctor and the counsellor. Before the operation the patient will probably be given a tranquillising injection to help her to relax. This may make her feel a little light headed.

The operating doctor first does a bimanual (internal) examination to check how far advanced the pregnancy is, and the position of the uterus. The woman will probably already have had a bimanual examination done by her doctor, if so she will know what it is like.
In a bimanual examination, the abortionist will insert two (or one,  teenagers who have never given birth) finger(s) of the right hand are brought into the vagina, while the other hand supports the fundus (upper part of the uterus) by pushing gently into the abdominal wall, preferably standing on the right side of the patient. The internal finger(s) explore the cervix. The size of the uterus is estimated by mentally measuring the distance of both hands and subtracting the thickness of the layer of abdominal fat.

The doctor then washes the vaginal area with antiseptic liquid. Next he/she places into the vagina a speculum, which is an instrument which holds the vagina walls open so that the doctor can see the cervix. This does not hurt, but it can feel heavy (similar to having a Pap Smear).

The cervix is then numbed with a local anaesthetic. As there are few nerve endings in the cervix it is quite likely the patient will barely feel this, although occasionally some women will feel a sharp pinch.

Next, the doctor takes hold of the cervix with an instrument which holds the cervix still during the operation. The patient will probably not feel this because of the local anaesthetic.

The cervical canal (the passage through the cervix into the interior of the uterus) is then slowly stretched open with dilators. These are curved smooth instruments with no sharp edges which vary in size from ones as thick as a match stick to those as big as a piece of chalk.

By inserting a small dilator first and then taking it out, then a larger one and taking it out, the cervical canal is opened wide enough to allow a plastic catheter to be passed through it into the interior of the uterus. There is no cutting or stitching involved.
This stretching can be difficult because the cervix is hard or "green" and not ready to open.

During the dilation of the cervix the woman may experience what feels like heavy menstrual cramps. Dilation takes up to two minutes.

Once the dilation is completed the doctor inserts a plastic catheter through the cervix. This catheter is like a plastic straw attached by a long plastic tube to the vacuum aspiration machine. It makes a sound because of the air in the tube.
The suction is approximately 29 times more powerful than a home vacuum cleaner and removes the placenta from the wall of the uterus, sucking blood, amniotic fluid, placental tissue and foetal parts into a collection bottle.

The'pregnancy' is removed by gently moving the catheter around inside the uterus and is drawn through the plastic tube and into a container. As the uterus is emptied, it contracts and the woman will feel this like menstrual cramps. This part of the operation takes two to five minutes.

Finally the doctor will check the inside of the uterus to make certain it is completely empty with a curette, a long thin instrument with a curved round end.

The amount of discomfort women feel during the abortion varies from woman to woman. Some women feel virtually nothing, others feel discomfort from mild cramps, to more severe ones.

It helps to be able to relax so that the muscles in the body are soft and relaxed, not tight.

The woman should try to relax her stomach muscles, breathe slowly and evenly, and not hold her breath. A nurse or counsellor can help her with her breathing.

A sanitary pad is held in place by the woman's underpants and she is returned to the recovery room to lie down for an hour and a half. She may experience cramps afterwards for ten to thirty minutes.

There are some problems that can arise during or after an abortion.
The following are complications which can occur:

A Frontline documentary shows the (mms://video.pbs.org/general/windows/media4/frontline/112/windows/112ch6_hi.wmv) abortion procedure being performed.

INFECTION: Signs are feeling unwell, a temperature of over 37.5C and cramping. You will be given written information on caring for yourself after the operation and preventing infection.

INCOMPLETE ABORTION: This is when not all of the pregnancy material is removed by the operation. The operation may have to be completed in a hospital by the procedure of dilation and curettage. Signs are continued heavy bleeding, probably losing clots. If left untreated you may experience signs of infection.

HAEMORRHAGE: A heavy flow of blood. If this occurs during the operation the doctor can give drugs to stop the bleeding.

PERFORATION: Very rarely one of the surgical instruments goes through the uterine wall, making a small hole or perforation. These generally heal themselves. If a large perforation occurs the doctor will know from the amount of bleeding at the time of the operation. Then hospital treatment may be necessary.

Further Possible Complications include:
  • urinary tract infections (UTI)
  • cervical trauma
  • peritonitis
  • endometritis
  • salpingitis
  • renal trauma
  • pelvic inflammation
  • embolism
  • sterility
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