How an abortion is carried out

In Nigeria, under the existing Abortion Act 1967, abortions can only be carried out in either public hospital or a licensed clinic. In most cases, an abortion will be carried out as a day procedure and you won’t need to stay overnight.

Before the abortion

When you go for your first appointment, you should be given the opportunity to talk about your situation. You’ll be informed about the different methods of abortion, and which method is suitable for your stage of pregnancy. You will also be advised about any related risks and complications.

The doctor or nurse will take your medical history to make sure the type of abortion you are offered is suitable for you.

You’ll have a blood test to find out your blood group to see if you’re anaemic.

You should also be tested for sexually transmitted infections (STIs), and may be given antibiotics to stop an infection developing after the abortion.

Before having an abortion, you may also need to have:

• an ultrasound scan (if there is any doubt about how many weeks pregnant you are)
• a vaginal (internal) examination
• a cervical screening test for infections (if appropriate)

If you have never had a vaginal examination before, the healthcare professional examining you will be aware you are anxious and will be as careful as possible. You should let them know if you are anxious and have not been examined internally before.
You may also be given information and advice about which method of contraception to use after the abortion. Finally, before having the abortion, you will be given a consent form to sign.

Methods of abortion

There are a number of different methods of abortion. The method recommended for you will depend on how many weeks pregnant you are. This is usually calculated by counting the number of weeks from the first day of your last period.

Broadly speaking there are two types of abortion – medical and surgical. A medical abortion is carried out using medication while a surgical abortion involves a minor operation.

The methods of abortion are described below.

Early medical abortion (up to nine weeks of pregnancy)

An early medical abortion involves taking two different medicines 36-48 hours apart. The effect of the medication will be similar to having an early natural miscarriage – this means you will have some bleeding and some pain when the abortion happens.

After your initial visit to see the doctor, you will have two more appointments on different days.

On your first visit you will be given an abortion pill called mifeprex. Mifeprex (mifepristone) is a synthetic steroid (or hormone) that is used for the medical termination of intrauterine pregnancy through 49 days of pregnancy. The tablets are available in generic form. Mifeprex blocks the hormone that makes the lining of the womb suitable for the fertilised egg. After taking the first tablet, you will be able to go home and continue your normal everyday activities.

Very little will happen while you are waiting for the second part of the treatment. A few women will have mild cramps and a little bleeding, but most will not. If you have heavier bleeding or significant pain, you should contact the hospital or clinic.

Two days later, on your second visit to the hospital or clinic, you will be given the second medicine, prostaglandin. Within four to six hours of taking prostaglandin, your womb lining will break down and be lost, along with the embryo, through bleeding from your vagina. This part of the process can be painful, but you can take a painkiller.

Medicines used during an early medical abortion may make you feel sick and you may have diarrhoea.

Vacuum aspiration or suction termination (from seven to 15 weeks of pregnancy)

Vacuum aspiration, or suction termination, is a procedure that uses gentle suction to remove the foetus from the womb. The procedure usually takes five to 10 minutes and can be carried out under a local anaesthetic or general anaesthetic.

Your cervix (womb entrance) will be dilated (widened) to make accessing your womb easier. A tablet may be placed inside your vagina a few hours before the abortion to soften your cervix and make it easier to open. Sometimes, an alternative ‘preparing’ tablet is given by mouth.

A small, plastic suction tube connected to a pump will then be inserted into your womb and used to remove the foetus and surrounding tissue.

After having a vacuum aspiration abortion, you will usually be able to go home the same day. However, following the procedure, you will usually experience some bleeding which can last for up to 21 days. The average length of bleeding is about nine to 10 days.

In most cases, the bleeding will be quite heavy for two to three days before settling down. Some women only bleed for three to four days in total. You may experience mild or moderate cramps for which you can take simple painkillers.

Late medical abortion (from nine to 20 weeks of pregnancy)

As well as being used for early abortion, mifepristone and prostaglandin can also be used for abortion later in pregnancy. However, the abortion will take longer and more than one dose of prostaglandin may be needed. This type of abortion is similar to having a late natural miscarriage.

After having a late medical abortion, you will usually be able to return home on the same day. However, sometimes an overnight stay in hospital may be required.

In rare cases, a second course of prostaglandin tablets may be required. This will be discussed with you. In a small number of cases (less than one in 20), the placenta or afterbirth does not pass. In this case, you may need to have a small operation under a general anaesthetic to remove the placenta.

Surgical dilation and evacuation (from 15 weeks of pregnancy)

Surgical dilation and evacuation (D&E) is a procedure carried out under general anaesthetic. Your cervix will be gently stretched and dilated and forceps and a suction tube will be used to remove the foetus and tissue within the womb.

Surgical D&E usually takes 10-20 minutes to perform and, if you are healthy and there are no complications, you may be able to return home the same day. The clinic or hospital will advise if you need to stay in hospital overnight. As with vacuum aspiration, you may experience some bleeding for up to 21 days.

Late abortion (20-24 weeks)

There are two options for a late abortion carried out at 20-24 weeks. Both require an overnight stay in hospital and are described below.

• Surgical two-stage abortion – stage one stops the heartbeat of the foetus and softens the cervix. Stage two is carried out the following day and involves removing the foetus and surrounding tissue. Both stages are carried out under general anaesthetic.
• Medically induced abortion – this is similar to a late natural miscarriage and involves the medicine, prostaglandin, being injected into your womb, making it contract strongly (as in labour). Contractions can last six to 12 hours. You will remain awake during the procedure and will be given medicines to help control the pain if needed. D&E may then be used to ensure the womb is completely empty.

Seek medical assistance

You should seek immediate medical help if, after having an abortion, you:

• experience heavy bleeding
• are in severe pain
• have a high temperature

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