Abortion after the first trimester?

Dear Curious, 

As a whole, abortion is a low-risk procedure and research demonstrates that it’s safer than childbirth. That being said, the earlier in pregnancy an abortion is performed, the safer and less complicated the procedure is likely to be. The second trimester typically occurs between weeks 14 and 26 and the third trimester is between 27 and 40 weeks, or until the end of pregnancy. The vast majority of abortions in the United States (US) are performed during the first trimester, which is within 12 to 13 weeks of the pregnant person’s last menstrual period. When performed by a licensed medical provider, abortions done in the second and third trimesters don't affect future fertility or health of the pregnant person. There are some risks associated with it, and they are similar to childbirth and other surgical procedures. All of this said, in many places in the US, abortion is illegal after the first trimester, and in some regions, at any point during the pregnancy. If you or someone you know is located in the US and is looking to get an abortion in the second or third trimester, checking into the laws in your state will be a good first step. 

Though some countries support abortion at any time before the birth, abortions later in pregnancy (which are abortions that occur anytime in the third trimester) are extremely rare in the US. In 2019, nearly 80 percent of the procedures reported to the Centers for Disease Control and Prevention (CDC) were performed before the 10th week of pregnancy, and almost 93 percent were performed before the 13th week. Only one percent of abortions occur after 21 weeks of pregnancy. 

Most states prohibit abortion after a certain point in pregnancy, often considered to be the point at which a fetus could survive outside of the pregnant person. However, these abortions later in pregnancy may still occur for a number of reasons including previously undiagnosed pregnancy, medical complications, or severe fetal abnormality, as well as the inability to obtain an earlier abortion due to financial limitations, difficulty finding a provider, or delays caused by parental consent or waiting requirements. 

While it’s true that the earlier the abortion is done, the safer the procedure is, second and third trimester abortions can be done safely and correctly when performed by a licensed medical provider. However, with the overturn of Roe v. Wade, many states have restricted access to and the administration of these types of procedures, with some prohibiting them altogether. These laws are constantly changing, so for up-to-date information on state abortion laws, the Guttmacher Institute has created an interactive map that provides guidance on the laws in each state. 

Different abortion methods are used at different points during pregnancy. During the second trimester, it's more common for a patient to receive an in-clinic surgical abortion. Early in the second trimester, a method called suction abortion may be used, while later in the trimester a method called dilation and evacuation (D and E) is used. Suction abortion can be used until about 14 to 16 weeks, while dilation and evacuation can be used from 16 to 24 weeks. The main difference between a suction abortion and a D and E is the amount of dilation that is needed and the instruments that are used to remove the fetal tissue. However, the processes are incredibly similar. 

During both procedures, a health care provider uses the following medications and techniques: 

• Pain medication or sedation to make the pregnant person comfortable 
• Antibiotics to prevent infection 
• Medication to slowly stretch open and numb the cervix (often similar medications are used when inserting an intrauterine device (IUD)) 
• Some abortions late in the second trimester require a shot given through the abdomen 
• Medical instruments and a suction machine to empty the uterus 

List adapted from Planned Parenthood 

Though less common, medical abortions can also be done during the second trimester through a method called induction. While D and E is typically lower risk, quicker, and more effective than induction and therefore more common, there are a number of reasons that an induction abortion may instead be performed during the second semester. Someone may choose to receive an induction abortion if their fetus has several medical problems or abnormalities, or induction may be necessary to achieve a successful abortion if the pregnant person wasn't aware of their pregnancy until recently or they didn't previously have access to abortion until now. 

During induction, medication is given to the patient to induce labor by causing the uterus to contract and expel the fetus and placenta. This medication can be inserted directly into the vagina, taken orally by either swallowing the medication or letting it dissolve in the mouth, or injected intravenously. Misoprostol is typically used for vaginal administration, whereas a combination of misoprostol and mifepristone is used for oral administration, and high-dose oxytocin is used for intravenous administration. Because an induction abortion does involve going through the stages of labor and delivery, pain medication is often provided during the procedure. The process can take between 12 to 24 hours and is usually performed in a medical setting such as a hospital or clinic. 

Abortions that occur in the third trimester often vary by circumstance and usually involve a combination of surgical and medicine-based abortion procedures. They also may take several days to complete. Most abortions, even later in pregnancy, are very safe. Folks generally have no long-term health effects, and safe abortion doesn't interfere with fertility or future pregnancies, unless a rare or serious complication occurs and is left untreated. For more information on abortion and fertility, see What are the effects of having multiple abortions? in the Go Ask Alice! archive.

However, like all medical procedures, there are some risks involved, and the later in pregnancy an abortion is performed, the higher the complication risk. Anesthesia and sedation also increase the potential for problems. In extremely rare cases, these complications can be fatal, and abortion after 20 weeks has the same risk of death as childbirth. 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 or a friend are seeking an abortion, it's a good idea to speak with a medical professional as soon as possible. Abortion early in pregnancy is a low-risk procedure, and the earlier you seek an abortion, the fewer risks and complications you're likely to encounter. Furthermore, due to restrictions imposed on abortion across the country as a result of the overturn of Roe v. Wade, some states prohibit abortion of any form or for any reason after a certain point in pregnancy. Organizations such as Planned Parenthood, the National Abortion Federation, and the National Network of Abortion Funds can help get you connected with health care providers that perform abortions as well as funding to help finance the procedure.