Surgical vs Medical Abortion: Pros and Cons

News of the U.S. Supreme Court’s overturning of Roe vs. Wade has caused abortion to become a hot political topic. Yet, for many women, it is practical. One in which they desperately need support, information, and assistance. In this article, the two common methods of abortion, instrumental evacuation, and medical abortion will be evaluated in an unbiased and informative way.

Key takeaways:
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    Surgical abortion, the aspiration of an embryo and other tissue, requires in-clinic oversite.
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    If implemented early enough, medical abortion can be administered at home.
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    Individualized, compassionate counseling is highly recommended pre- and post-procedure.
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    Risk factors for surgical and medical abortion are similar; however, surgical complications tend to be more severe.
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    Statistics concerning quantitative blood loss, breastfeeding, infertility, and safety concerns related to abortions are inconclusive for many reasons.
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    Support is available.

Surgical abortion

Surgical abortion, also known as instrumental evacuation or suction aspiration abortion, is the removal of an embryo, placenta, and amniotic fluid. Though this procedure is effective at terminating a pregnancy, it is more invasive than medical abortion.

However, surgical abortion can be legally performed anytime before 24 weeks gestation. Though the longer a woman waits, the greater the risk. Surgical abortion is not recommended after 24 weeks gestation due to the increased risk of complications.


Many women who are considering this type of abortion wonder what the process is like. They may feel scared to have a baby but equally afraid to have an abortion. Women are often misinformed when it comes to abortions. So, what can they expect?

  • An in-clinic pregnancy test is performed and/or ultrasound to verify pregnancy.
  • A blood test will check blood type in case a blood transfusion is needed.
  • A speculum will be used to view the inside of the vagina.
  • The vagina and cervix will be cleaned to help prevent infection.
  • Local analgesics will be injected into the cervix and other pain control methods will be implemented.
  • A tapered dilator and/or medical dilator will be used to stretch and open the cervix.
  • A suction tube will be inserted into the uterus.
  • The suction will be applied to remove the embryo, fluid, and placenta.
  • Antibiotics will be given post-procedure to prevent infection.

Risks and possible complications

Women wonder what possible complications with surgical abortion are. They may ask, How much blood will I lose?Every woman is different, and the efficiency of processes varies. So, this information is difficult to determine.

With natural birth and c-sections, women experience a wide range of bleeding, anywhere from mild spotting to heavy bleeding. However, to give a reference point, normal c-section blood loss is about 2 cups.

As with any surgical procedure, pain is expected. Normally, the medical professional performing the procedure will use local analgesics to numb the cervix and other pain medication to reduce overall pain.

All surgical procedures come with varying degrees of risk. Some complications associated with an instrumental evacuation are as follows…

  • Incomplete removal of embryonic tissue and placenta.
  • Infection of reproductive organs.
  • Hemorrhage.
  • Damage to reproductive organs.
  • Infertility.
  • Depression.

“When should I call my doctor?”

  • 100.4 temperature or greater.
  • Severe pain in the lower abdomen.
  • Heavy bleeding (soaking through a maxi pad within an hour).
  • Strong, foul vaginal odor.
  • Pain in your calf.

What to know after the procedure

Women need to know this may be a stressful event, both physically and emotionally. Giving yourself time to heal is vital. Understanding common physical and emotional implications may also help.

Pain and cramping: The most reported post-procedural symptoms are pain and cramping.

Vaginal discharge: It is common to experience thick vaginal discharge. This discharge could be a variety of colors…red, purple, brown, or black.

Chills: Some women experience chills, which are normally the result of physical stress. If a temperature is also noted, contact your medical provider immediately.

Tiredness: It is common to feel weak and fatigued.

Depression: Many women experience unexpected depression. If you have thoughts of hurting yourself or others, don’t hesitate to talk to a professional for support.

Medical abortion

Medical abortion is the termination of pregnancy with the use of two medications: Mifepristone and Misoprostol. These two medications work in conjunction to inhibit the continued development of the embryo and cause uterine contractions.

Mifepristone, a progesterone antagonist, is used to block progesterone from its receptors. Progesterone is a natural hormone vital for blood and nutrient supply to the developing embryo. Misoprostol causes the uterus to contract and expel the embryo, placenta, and amniotic fluid.

Medical abortion, also known as chemical abortion, can be performed at home before 11 weeks gestation and in the hospital setting after 15 weeks gestation. The hospital setting is important for women greater than 15 weeks pregnant or those who are anemic, so that blood transfusions are quickly available if needed.


Medical abortions are 95% effective in terminating pregnancies that are 8 to 9 weeks gestation, and approximately 90% effective in pregnancies 9 to 11 weeks. Effectiveness post-11 weeks may require additional medication.

What are some pain relief measures?

  • Heating pad.
  • Over-the-counter pain medications, like Tylenol. Avoid meds containing aspirin as they may increase the risk of bleeding.
  • Support bra for breast tenderness.

Risks and possible complications

  • Termination failure.
  • Hemorrhage.
  • Infection.
  • Depression.

The National Institute of Health (NIH) reports that there is insufficient attention given to medical abortion’s impact on infertility, and re-evaluating the link between the two is warranted.

Though there is no current evidence that indicates a need to “pump and dump”, Mifepristone and Misoprostol can get into breastmilk.

It is recommended that mothers avoid breastfeeding for at least six hours after medical abortion and monitor the baby for vomiting, diarrhea, and/or poor feeding. After that point, women can return to their normal breastfeeding routine.

What to know after the procedure

Medical abortions are not always effective in the termination of pregnancy. An ultrasound follow-up and pregnancy test are recommended post-procedure to confirm the results of the abortion.

Since post-abortion women are already at risk for infection, pelvic rest is important, especially in women with STDs. Pelvic rest means…no sex, no douche, and no tampons. Discuss the appropriate length of time for pelvic rest with your medical provider.

Surgical abortion vs. abortion pill?

Though surgical and medical abortions are highly successful in terminating the pregnancy, the procedure is not pain- and risk-free. According to the World Health Organization, 40% of worldwide abortions are unsafe, though this may be directly related to the location and skills of the practicing abortion clinic.

Many women want unbiased information concerning abortion options. However, once receiving the information, they find that the weight of making the decision does not decrease. Talking to an unbiased professional may help aid the decision-making process.

Wrapping it up

In summary, a chemical abortion is less invasive and safer for women. However, this method has specific time restraints. Surgical abortions are more invasive and therefore have greater health risks.

There is a direct correlation between increased complications and increased gestation. Since more than half of women who had an abortion report receiving inadequate pre-op counseling; individualized, compassionate support is highly recommended.


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