About Second Trimester Abortion
Second trimester abortions are performed between 14.0 to 23.3 weeks of pregnancy and require 1 to 3 day visits. We use the dilation and evacuation procedure, also known as a D&E. After 15 weeks, in most cases, cervical dilators called Laminaria or Dilapan, are inserted into the cervix to gradually dilate it overnight before a doctor performs the procedure. Sometimes, early in the second trimester, we can use a medication to prepare the cervix instead of dilators.
The fee includes pregnancy testing, admitting, pre-operative history and physical, ultrasound, lab work, dilator insertion, most pre-operative medications, the D&E procedure, RhoGAM (if required), sedation, medications given on the day of procedure, most post-operative medications and your post-operative care as authorized by us.
Getting to the office and home safely
You may drive yourself to and from the office on the day(s) before your surgery. On the day of surgery you must be accompanied by a trusted person in your life such as a family member, friend, or partner. It is essential that you have a reliable ride home from the facility. You cannot drive yourself or leave by yourself after having a surgical procedure.
Increasingly, patients are travelling from Indiana, Wisconsin, Michigan, Ohio, Tennessee, Kentucky and Missouri to obtain abortion care with FPA. If you are travelling to Chicago from out of the area and you need to make overnight accommodations, we have obtained a discounted rate at a hotel just a block away from our office. Click on the icon below for more information and to check rates.
Preparation For the Procedure
When you arrive for your appointment you will be asked to complete personal demographic and health information and consent forms. An ultrasound will be performed to determine the length of gestation, if one has not been recently done at another FPA facility. You will meet with an admissions staff member to discuss the procedure, your medical history as well as pre-operative and post-operative instructions. The admissions staff member will assist you with any additional paperwork. The laboratory technician will draw a sample of blood to determine your iron level and Rh factor. After you have changed into a gown provided by the clinic your vital signs will be taken.
You will be escorted to the treatment room where the clinician, a Physician Assistant or Nurse Practitioner, will perform a history and physical and will insert the cervical dilators. This procedure takes approximately 5-15 minutes. Most patients experience cramping, pressure and discomfort during the insertion. We will provide you with pain medication. After the insertion, the vaginal canal will be packed with sterile gauze to keep cervical dilators in place and to prevent infection.
After your insertion, you will be escorted from the treatment room to the discharge area. The discharge medical staff will give you post-insertion instructions, medications, and an appointment time for your second insertion or surgery.
If a second day of preparation for the surgery is needed, you will return the following day and the clinician will remove the first set of dilators then insert a second set for additional dilation. Again, this procedure will take approximately 5-15 minutes and you will likely experience cramping and discomfort similar to the previous day. You can take the pain medication provided by our facility, with breakfast, before coming in for your visit to decrease your discomfort.
The Day of Procedure
Before You Arrive
- Do not eat or drink anything for eight full hours before your procedure, most often after midnight. Please do not have anything by mouth including medications, water, gum, candy, food or drink of any kind.
- If you have anything the morning of your visit your surgery will be delayed for your safety.
If You Take Medications
- In some rare instances you may be instructed by our medical staff to take your regular medications with a very small sip of water.
- If you take insulin for diabetes, DO NOT take insulin the morning of your surgery. Please bring your insulin with you along with a small snack.
- If you have an inhaler for asthma, please bring it with you, even if you rarely use it.
- Please bring any medications you are currently taking.
Preparing for Your Procedure
- Plan to spend 4 to 6 hours under our care at the office. Make sure that you have prearranged for a ride to and from the office.
- Do not wear any jewelry, including earrings, bracelets, rings, etc. All facial piercing jewelry must be removed, you may not have any piercings in the nose or mouth.
- Do not bring any valuables or a large amount of cash.
- Please do not bring children to the office.
When you arrive at the office, you will change into a gown that we provide and have your vital signs taken. A medical assistant will escort you to the procedure suite and start your IV.
In the procedure suite, a licensed CRNA will administer sedation and a licensed medical doctor who is board certified in OB/GYN will perform the abortion by removing the pregnancy and aspirating the uterus. The procedure generally lasts 10-20 minutes. Patients are sedated for this procedure, which means that they will not feel any pain or discomfort.
After the procedure, you will be taken to the recovery room where trained medical personnel, including nurses and medical assistants will care for you until you are ready to be discharged. Recovery time is approximately 1 to 3 hours for most patients, depending on the type of procedure performed as well as other factors.
After you leave the recovery room, our medical staff will offer you a light snack. Before you are discharged to your driver, you will receive post-operative care instructions and medications to take home.
You will also be given an instruction sheet with our 24-hour emergency number. Please call with any questions or to discuss concerns that might arise after your visit.
After your Visit
You should rest for the remainder of the day after your procedure. You are able to go to work or school next day, unless the doctor has told you otherwise.
What is the difference between local anesthesia and sedation?
Local anesthesia is a cervical block (injection of numbing medication) performed before your surgery. While your cervix will be numbed, you will be awake during the procedure and it is normal to feel some strong cramping and discomfort.
Sedation is administered intravenously through an IV placed in your hand or arm in most cases. If you are sedated for your procedure you will not feel or remember any pain or discomfort.
Will it hurt?
If you have chosen to have sedation, you will not feel or remember any pain during your procedure. After the procedure you may experience mild to moderate cramping, if needed we will give you pain medication.
If you have chosen to have local anesthesia with your procedure we will numb your cervix but you will feel some cramping, pain and pressure from the uterus. Some patients describe the pain as minimal while some patients find the pain to be more severe. You will be offered pain medication, and in some cases we can provide you a medication to help you feel more relaxed.
Once you are discharged, in most cases ibuprofen (Motrin/Advil), naproxen (Aleve) or acetaminophen (Tylenol/Midol) will help with the cramping. If the cramping is not helped by these over the counter medications, you should call us immediately.
How long will I be under sedation?
You will be unaware for about 5-10 minutes with a first trimester abortion, or about 10-20 minutes with a second trimester abortion. The medications used for sedation work very quickly and wear off very quickly as well. Most patients are alert and oriented within 5 minutes of their procedure.
I am afraid I won’t wake up after having sedation. Can that happen?
The sedation that we offer is safe, effective and short acting. You will be asleep for 5-20 minutes depending on the procedure. There is always some degree of risk with any surgery. Serious complications with sedation are very rare in our facilities. Complications may occur if a patient has ingested any food or liquid within 8 hours of surgery. Tell our staff if you have had prior complications with anesthesia or if you have had anything to eat or drink within 8 hours prior to your surgery, including gum and water.
How long will I bleed after an abortion procedure?
In most cases, the patient experiences bleeding for up to 2 to 3 weeks after the abortion procedure. However, some patients do not experience any bleeding and other patients have spotting or bleeding off and on. If you have any questions about what is normal after your procedure, you can always call the office. A 24-hour on-call service is available for after hours.
How is the in-office abortion procedure performed?
The first trimester abortion is a simple procedure performed by aspiration (suction). This procedure is referred to as a D&C (Dilation and Curettage). This procedure generally takes about 3 to 5 minutes.
If you are over 13 weeks pregnant, you will first have your cervix dilated with medication and/or sterile product made specifically for cervical dilation (laminaria dilators). This procedure is referred to as a D&E (Dilation and Extraction), and lasts 1 to 3 days. In some cases, a patient will require one or two consecutive days of dilation and will return for the procedure on the second or third day. The dilation procedure takes just a few minutes and you will be in the clinic for a few hours on the day or days that your cervix is being dilated. In some cases, we can administer a medication on the morning of your procedure that will soften and dilate the cervix without the need for insertion of dilators.
When can I return to work?
The majority of our patients return to work or school the following day. The admitting and medical staff will explain the DOs and DON’Ts after surgery.
Can I have someone with me during the procedure or in the recovery room?
Your support person will not be able to join you during the medical parts of the visit, including the exam rooms and recovery room. We must protect the privacy of all of our patients, and for that reason we cannot allow guest in these areas.
We encourage your support person to wait for you in our reception area. If this is not possible, they can return for you upon completion of your appointment.
After an abortion, when can I have sex?
When bleeding has been light for 24 hours, you may resume intercourse, provided you feel emotionally and physically ready to do so. You are the best judge of your feelings. You should use contraception when you decide to resume intercourse if you wish to avoid pregnancy. You are at risk for pregnancy right away after having an abortion.
Can I take a taxi or public transportation home?
Taking public transportation after surgery is not recommended. If no other method of transportation is available, we require that an adult must accompany you.
Can I use tampons after my procedure?
When bleeding has been light for 24 hours, you may use a tampon.
How effective is a surgical abortion?
In most cases, a surgical abortion is nearly 100% effective. In less than 0.3% of cases, a pregnancy is not terminated on the first attempt. Such a failure is most common in pregnancies of less than six weeks’ duration. A very small percentage of surgical cases will require a re-aspiration if unusual bleeding occurs or if there is retained pregnancy tissue.
How will I feel after my abortion procedure?
Most patients feel very ‘normal’ when they leave the office after having an abortion. You will probably be hungry and maybe a little more tired than normal. We recommend that you have a full meal and then take it easy for the rest of the day. It is normal to experience some mild to moderate cramping. If the cramping is not helped by over the counter medications such as Tylenol, Advil or Aleve we ask that you call our 24-hour emergency number. The bleeding is usually comparable to a normal period and some patients do not have any bleeding at all. If at any point you soak one full maxi-pad in an hour or less you should call us immediately.
If you have had pregnancy symptoms such as nausea, fatigue or breast tenderness, these symptoms will start to go away within a few days of the procedure. If you still ‘feel pregnant’ after a few days, you should call us right away.
You may take a shower or tub bath after your procedure. Do not douche, use tampons, have intercourse, or place anything in the vagina for two weeks after having a surgical abortion. Avoid any products that contain aspirin or alcohol as they can promote heavier bleeding.
Why can’t I eat before having the abortion procedure?
When sedation is provided, gag reflexes are temporarily suppressed. If food or liquid remain in the stomach vomiting can occur, resulting in asphyxiation (choking). This can cause serious complications and in very rare cases death. Please inform our staff if you have had anything at all to eat or drink on the day of your procedure.
Is it a doctor who performs the procedure?
Yes. All of our doctors are licensed by the State of Illinois, are board certified in obstetrics and gynecology and specialize in pregnancy termination.
What happens to the pregnancy tissue removed during the abortion?
The pregnancy tissue that is removed during the procedure is sent to a pathology laboratory where it is weighed and examined, most often microscopically. A report detailing this examination is sent to our office within a week of the procedure. The tissue then disposed of in accordance with the mandates of state law–most often this means it will be cremated (incinerated).
How will I know that the abortion was successful?
Our physicians at FPA are very thorough and take multiple steps to ensure that the abortion procedure is complete. First, the physician will examine the pregnancy tissue after the surgery. Second, a post-operative ultrasound can be performed at the request of the physician. Third, the pregnancy tissue that is removed during the procedure is sent to a pathology laboratory where it is weighed and examined, most often microscopically. A report, detailing this examination, is sent to our office within a week of the procedure. After reviewing the pathology reports the physician decides whether a follow up visit is needed. We will contact you if the physician requests that you come in for an evaluation. We want to ensure that your pregnancy hormones are falling at the appropriate rate and that you are recovering well. Lastly, in some cases if you are very early in the pregnancy at the time of your surgery, the doctor may request that you return to the clinic 2-3 days after your abortion for a blood test to ensure that the procedure was successful.
Can I exercise after an abortion procedure?
Most often you can go back to your regular activities the day after your procedure. Strenuous exercise can sometimes increase the amount of bleeding and cramping that you experience. If you notice an increase in your bleeding or cramping after exercising you may want to decrease your activity for a few days. Please do not hesitate to contact us if you have any questions or concerns. If at any point you fully soak a maxi-pad in one hour or less, after your procedure, you should call us right away.