Abortion after the first trimester?

Dear Curious,

The earlier in pregnancy an abortion is performed, the safer and less complicated the procedure is. Abortions in the third trimester are extremely rare in the United States, but the procedure can be done safely when necessary.

Most, but not all, states in the United States prohibit abortion after a certain point in pregnancy. In these cases, a woman may only obtain an abortion if a physician determines her life or health is threatened. For up-to-date information on state abortion laws, visit the Guttmacher Institute. In some other countries, laws support abortion at any time before the birth.

The vast majority (88 percent) of abortions in the United States are performed within 12 to 13 weeks of a woman's last menstrual period. Less than two percent of abortions occur after 20 weeks, and abortion is extremely rare after the 26th week of pregnancy (in the third trimester). Abortion may happen after 20 weeks for a variety of reasons including undiagnosed pregnancy, medical complications, or severe fetal abnormality. Some women may not have been able to obtain an earlier abortion due to a lack of money, difficulty finding a provider, or delays caused by parental consent or waiting requirements.

Different abortion methods are used at different points during pregnancy. A procedure called "dilation and evacuation" (D&E) is usually performed from weeks 16 to 24 or for most second trimester abortions. During a D&E, a health care provider uses the following medications and techniques:

• Pain medication or sedation to make the woman comfortable
• Antibiotics to prevent infection
• Medication to slowly stretch open and numb the cervix
• Some abortions late in the second trimester require a shot given through the abdomen
• Medical instruments and a suction machine empty the uterus

List adapted from Planned Parenthood.

Most abortions, even later in pregnancy, are very safe. Women generally have no long-term health effects, and safe abortion does not interfere with future pregnancies. For more information on abortion and fertility, see Effects of multiple abortions in the Go Ask Alice! archive for Sexual and Reproductive Health.

The later in pregnancy an abortion is performed, the higher the complication rate. Anesthesia and sedation also increase the potential for problems. In extremely rare cases, these complications can be fatal. Childbirth and abortion after 20 weeks have the same risk of death. Other risks of abortion include:

• Allergic reaction
• Blood clots in the uterus
• Infection
• Injury to the cervix or other organs
• Very heavy bleeding (a small amount of bleeding or spotting for a few weeks is normal)
  List adapted from Planned Parenthood.

If you are more than just "curious," and you or a friend are seeking an abortion, it's a good idea to speak with a medical provider as soon as possible.

Online, you can find more information about abortion from the following organizations:

• Our Bodies, Ourselves Health Resource Center — The section on abortion provides information about the history of abortion, Medicaid coverage, and personal stories.
• National Abortion Fund (NAF) — The NAF provides information about state laws, suggestions for finding an abortion provider, and guidance for financial assistance.

Early abortion is one of the safest surgical procedures. However, as time passes in pregnancy, the risks do increase. For women seeking abortion, the sooner the better.