Do Abortions Hurt? Know How to Manage the Pain

Abortion is a highly personal decision. It is important to speak with a healthcare provider to determine your abortion eligibility. There are a few abortion procedure options depending on your gestational age- the number of weeks since your last menstrual period.

Key takeaways:
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    Abortion, whether medical or surgical, can be a discomforting or painful process.
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    Medical abortion involves medication only in early gestation pregnancies.
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    Surgical abortion is an in-clinic or hospital experience for later gestation pregnancies.
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    Pain relief tips following medical and surgical abortion procedures are very similar.
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    The research regarding infant pain is ongoing and may be a moral consideration for some.
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    It is important to monitor your physical and mental health following either procedure.

Medical abortions, which involve taking medication only, are suitable for pregnancies up to 10 weeks. Surgical abortions, a more invasive procedure, are necessary for pregnancies beyond 10 weeks.

Are abortions painful?

Abortions are associated with pain and discomfort. These are expected side effects. Whether it is a medical or surgical abortion, the uterus needs to contract or squeeze out the fetal and placental tissue. Surgical abortion is a more invasive procedure that involves tools and equipment used to remove fetal and placenta tissue. However, there are several ways to diminish the pain and make the experience tolerable.

Medical abortion

Medical abortion is a method used for pregnancies that are 10 weeks or less in gestation. The success rate is high but decreases as the gestational age increases.

Two different medications are often given to achieve termination of pregnancy. The first medication is Mifepristone which blocks progesterone and destroys the ability of the embryo to maintain implantation on the uterine wall. The second medication is misoprostol which causes the uterus to contract and empty the fetal and placental tissue from the body.

Bleeding and cramping are the most common and expected side effects of medical abortion. Bleeding is the result of the shedding of the uterine lining- much like during a period. Bleeding can last for a few days to a few weeks.

Cramping is the result of the uterus contracting to empty the fetal and placental tissue. It is a necessary discomfort. Cramps may feel the same or worse than period cramps depending on the individual. Cramps generally last for a few days after the abortion is complete.

How to control the pain

Here are some helpful tips to make the pain or discomfort associated with medical abortion tolerable.

  • Over-the-counter NSAID medications such as Ibuprofen.
  • A heating pad or hot water bottle on the lower belly.
  • Take a bath or shower.
  • Drink warm fluids such as tea.
  • Reduce activity.
  • Rest and sleep.

Do not hesitate to speak with your healthcare provider if you require additional pain relief.

Surgical abortion

Vacuum Aspiration Abortion and Dilation & Curettage

Vacuum aspiration-suction abortion and Dilation and Curettage (D&C) can be performed at 14 weeks gestation and under. The procedure takes place in a doctor’s office and often takes a couple of hours from start to finish. Counseling, physical assessment, and ultrasound are performed before the procedure.

Misoprostol, or similar medications, are given before the abortion to soften the cervix. Misoprostol can take 2-3 hours to work. Oral pain medications are given ahead of time to limit pain during and after the procedure. Anesthetic sedation may be utilized depending on your situation, healthcare provider, and abortion location.

A speculum is inserted into the vagina and the area is cleaned with soapy gauze. A local numbing anesthetic is injected into your cervix. The cervix is dilated or opened up with thin rods. A skinny, curved suction tube is then inserted through your cervix into the uterus. Gentle suction is applied to remove the fetal and placental tissue.

A D&C procedure is the same as a suction abortion except that after the cervix is dilated, and suction applied, a curette is used to scrape any remaining contents out of the uterus. A curette is a long metal or plastic tool that has a smooth or serrated surface on the tear-drop-shaped end. D&Cs can be done on non-pregnant women without suction, such as when there is abnormal uterine bleeding in menopause. In these cases, the uterine lining is sampled to rule out cancer. There is the potential for minimal to moderate pain during the procedure because of the local anesthetic, oral pain medications, and anxiety-reducing medications given beforehand. There may be some discomfort with the speculum insertion.

Cramping and bleeding are expected and necessary following the procedure. Cramping is often period-like and is the result of your uterus shrinking back to its normal size. This may last for a few days. Bleeding can often continue for a few days to a month. Bleeding may increase and decrease with activity level.

Dilation and Evacuation (D&E)

Dilation and Evacuation (D&E) is the procedure most commonly used for the termination of pregnancy between 13 and 24 weeks gestation.

Counseling, confirmation of gestational age, physical exam, and cervical preparation medications such as misoprostol or laminaria occur before the D&E procedure.

Sometimes, induced fetal demise with medication before the procedure is appropriate though this is not available everywhere.

Due to the higher gestation age, cervical preparation medications may need to be administered over a couple of days. As with other types of abortion, cervical preparation medications can cause cramping and bleeding.

Mechanical dilators are needed to open the cervix enough to perform the procedure. Discomfort, pain, and cramping are all side effects of mechanical dilators. Most D&Es are performed under general anesthesia because the degree of cervical dilation is significant.

Just before the procedure, you will be given a combination of oral and intravenous (IV) pain medication and anti-anxiety medications. This procedure can also be completed under sedation or general anesthesia.

A speculum is inserted, and dilation of the cervix is performed. Once dilation is adequate, a suction tube is inserted to remove the amniotic fluid-fluid that surrounds the fetus. Forceps- a large curved pincer tool- are then inserted and used to remove the fetal and placental tissues.

Pain control is a priority during a D&E surgical abortion. The longer procedure involves a larger cervical opening and greater uterine manipulation. D&E can involve heavier anesthetic sedation to minimize pain and anxiety during the procedure.

As with any abortion, bleeding and cramping are expected and necessary side effects that may inflict pain.

How to control the pain?

Pain-relieving tips for post-surgical abortion are the same as post-medical abortion.

  • Over-the-counter NSAID medications such as Ibuprofen.
  • Prescription pain medications.
  • A heating pad or hot water bottle on the lower belly.
  • Take a bath or shower.
  • Drink warm fluids such as tea.
  • Reduce activity.
  • Rest and sleep.

Narcotic analgesics may be necessary to control post-abortion pain, especially following a D&E procedure. Every individual is different. Do not hesitate to speak with your provider If you are feeling the need for additional pain relief.

Does the baby feel pain?

The question of whether the developing fetus feels pain is a controversial and highly sensitive subject.

Until recently, the scientific consensus was that a fetus does not feel pain until after 24 weeks of gestation because of its immature neurological system. By adult standards, pain is a reaction to a stimulus and a mental awareness or ability to self-reflect on the pain. Pain is subjective. Scientists proposed that a fetus under 24 weeks cannot feel pain because they are not neurologically developed to experience pain with these two components.

New neuroscience research is reevaluating the definition of pain and how it is experienced. While the research is ongoing, it has concluded that fetuses younger than 24 weeks can experience pain. What remains unknown is how the fetal brain translates to pain. Also, premature babies born younger than 24 weeks have shown a pain response following stimuli.

Fetal pain and abortion morality may be a personal consideration for some, especially in later gestation pregnancies.

Is abortion pain similar to labor pain?

While abortion and labor are both painful, it is difficult to compare the two. Pain is subjective and guided by experience. Abortion pain is limited to strong period-like cramps. Labor contractions are much more intense and therefore painful because of the work they do to guide a fuller-term fetus out of the uterus.

Research has found that many women who have experienced childbirth pain previous to an abortion describe decreased pain with abortion in comparison to childbirth.

Possible side effects of abortion

It is no secret that any form of abortion can place a physical and mental toll on you. The physical side effects pass relatively quickly if there are no complications. The mental side effects may range from minimal to severe depending on the individual and the circumstances surrounding the abortion. Do not hesitate to contact a mental health professional if you need help.

After taking the abortion pill

Physical side effects of the abortion pill include bleeding and cramping. Other possible side effects may include nausea, vomiting, diarrhea, headache, dizziness, and chills. These side effects generally last a few days following medication. Bleeding may last a few weeks.

Longer-lasting side effects may be mental. Abortion can be a time of relief, happiness, guilt, sadness, anger, or depression. It is important to know that all of these feelings are normal. Recognizing and acknowledging these feelings is an important step in overcoming them.

It is important to recognize that your partner, if applicable, may experience similar feelings during this time. Communication is key.

After surgical abortion

Physical side effects of surgical abortion include bleeding and cramping. Other side effects may present depending on the cervical ripening agent that was used.

Emotions such as relief, happiness, guilt, sadness, anger, or depression are all common. It is important to recognize that all of these feelings are normal to feel in any combination.

Abortions later in pregnancy are often performed after the discovery of severe physical defects or significant congenital anomalies of the fetus that would not support life outside of the womb. This circumstance may or may not contribute to significant feelings of guilt, sadness, anger, and depression that may persist well beyond termination.

As with a medical abortion, it is important to communicate with your partner, if applicable, as they may be experiencing similar feelings during this time.

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