- Virginia Women’s Wellness
How Is It Actually Done? The Pill and In-Clinic Procedures, Step by Step
There are three ways, depending on how far along you are. The abortion pill: mifepristone, then misoprostol a day or two later, and you pass the pregnancy at home. An aspiration, in the first trimester: the cervix is gently opened and the pregnancy removed with suction, in about 10 minutes. An induction and evacuation, in the second trimester, adds cervical preparation and instruments. For procedures, you choose awake, twilight, or asleep.
Key Facts
- Abortion pill : Through 14 weeks and 6 days · two medicines · passed at home
- Aspiration (suction) abortion : First trimester, 4 weeks to 14 weeks 6 days, about 10 minutes · almost 100% effective
- Induction and evacuation : Second trimester, through 27 weeks and 6 days · requires 2 days of cervical preparation on the first day, evacuation on the 2nd day
- Before any method Anesthesia for procedures : Counseling, an ultrasound, and lab work, usually in the same visit Awake with local numbing, twilight sedation, or fully asleep - your choice
- After : Recovery, written instructions, a phone line for questions, and follow-up
What happens before any abortion?
Every abortion at our office starts the same way, usually in the same visit:
Check-in and paperwork
Including your consent. If you chose Anonymous Abortion, nothing here asks for your name.
Intake Counseling
A counselor makes sure you have the information you need, answers your questions, and confirms that the decision is yours. Abortion Counseling
Ultrasound
To confirm how far along you are and that the pregnancy is in the uterus. Ruling Out Ectopic Pregnancy
Lab work
In our own office - your Rh blood type when it’s needed and any other tests your clinician needs. Labs for Abortion
Final Counseling
The counselor reviews your ultrasound and lab results with you and discusses your options. You make a final decision about whether you want an abortion and what type of abortion you want.
A conversation with your clinician
About your options, your anesthesia choice, and your questions.
For the full sequence of your visit, see What to Expect: 8 Steps. For how long you’ll be with us, see How Long Is an Abortion Appointment?.
How is the abortion pill done?
Mifepristone.
You take one pill by mouth - at our office or at home. It blocks progesterone, the hormone a pregnancy needs to continue. Most women feel little or nothing from it; some have light bleeding or nausea.
Misoprostol, 24 to 48 hours later.
You place the tablets in your vagina or in your cheeks (between cheek and gum) or under your tongue and let them dissolve for 30 minutes, then swallow what’s left. Misoprostol makes the uterus contract, cramp and empty.
Passing the pregnancy.
Cramping and bleeding usually start within 1 to 4 hours and are heaviest for several hours, with clots, as the pregnancy passes. Most women pass the pregnancy within 24 hours. But for some women the process can take several days to work – or it may never work.
A second dose, when needed.
After 9 weeks, a second dose of misoprostol is part of the regimen; past 11 weeks, a third dose is used.
Afterward.
Bleeding becomes lighter, like a period, and may continue on and off for one to two weeks.
Confirming it worked.
A follow-up check - a pregnancy test at home at about two weeks, a blood test, or a visit - confirms the abortion is complete.
You’ll go home with written instructions, and a number to call. Mifepristone Available | Telehealth Abortion in Virginia
How is a first-trimester aspiration abortion done?
- Your anesthesia : If you choose twilight sedation or to be asleep, an IV is placed and the medicine given. If you choose to be awake, you take pain medicine beforehand Anesthesia and Asleep Abortion Options
- Positioning : You lie on the exam table with your feet in supports, for a pelvic exam.
- Speculum and cleansing : The clinician places a speculum and cleans your cervix.
- Numbing : Medicine is injected around the cervix to numb it (a paracervical block). You may feel a pinch, or nothing if you’re sedated.
- Opening the cervix : The cervix is gently opened with a series of thin rods called dilators. Medicine is given beforehand to soften the cervix, so this is easier.
- Aspirationou : A thin tube is passed into the uterus, and gentle suction removes the pregnancy. This takes a few minutes.
- Checking : The clinician confirms the uterus is empty, often with ultrasound, and examines the pregnancy tissue to confirm the abortion is complete.
- Recovery : You rest in our recovery room until you’re ready to go home - longer if you have had sedation.
How is a second trimester done?
An induction and evacuation is the procedure in the second trimester. The main difference from an aspiration is that the cervix must be opened more, and that is done gradually and gently beforehand.
- Cervical preparation : Before the procedure, the clinician softens and opens your cervix — with medicine (misoprostol), with small sterile dilators placed in the cervix that slowly expand over several hours, with a catheter placed inside the uterus or all three. Depending on how far along you are, this begins earlier the same day or the day before. The cervix can be prepared with medications, with a catheter placed into the uterus, or with laminaria sticks which swell and dilate the cervix. After 18 weeks, 2 days are required.
- Preparation : Later in the second trimester, medication may be given beforehand, by injection, to slowly and gently slow and stop the fetal heartbeat.
- Your anesthesia : For all second trimester abortions, asleep anesthesia is automatically included and recommended. Second trimester procedures can be done under local anesthesia, safely, but it is painful.
- The procedure : After dilation of the cervix, the uterus is emptied. Sometimes this happens naturally. Sometimes this is facilitated using various techniques.
- Checking and recovery : The clinician confirms the procedure is complete, and you rest in recovery until you’re ready to go home with the person driving you.
Bleeding afterward is usually lighter than a period and lasts a few days to a couple of weeks. Second-Trimester Abortion | Abortion Care to 27 Weeks
What happens after any abortion?
- Written instructions : explaining what’s normal and when to call.
- A phone line : for questions.
- Warning signs : to call about right away: bleeding that soaks through five pads an hour for two hours in a row, severe pain that pain medicine doesn’t help, a fever over 100.4°F that lasts more than a day, or feeling very sick.
- Follow-up : to confirm you’re well and, if you’d like, to talk about contraception. After Your Abortion | Abortion Follow-Up Care
Why women choose Virginia Women’s Wellness
- Every method under one roof : the pill, aspiration, and D&E through 27 weeks and 6 days.
- Your choice of awake, twilight, or fully asleep : for any procedure.
- Ultrasound and lab work in our own office : in the same visit.
- An all-female team of licensed clinicians : who explain each step before it happens.
- FAQ’s
Questions Women Ask
How long does an abortion procedure take?
A first-trimester aspiration takes about 10 minutes; a second-trimester D&E takes 10 to 20 minutes for the procedure itself, plus cervical preparation beforehand. Your whole visit takes longer – see How Long Is an Abortion Appointment?.
Is an aspiration the same as a D&C?
Will I be told what’s happening during my procedure?
Can I see the ultrasound or the tissue?
Only if you want to. Many women don’t; some do. Tell us your preference and we’ll follow it.
Don’t wait – call 757-540-1595 or book online now. Women in Virginia can also start a telehealth visit.