What is a D&E abortion?

After 14 weeks or so, the most common abortion procedure is called dilation and evacuation (D&E). You might also hear it called a “procedural abortion” or “surgical abortion.” Some people say D&C (dilation and curettage) instead. The main difference between a D&C and a D&E is how far along the pregnancy is. D&E procedures are very safe and are one of the most common types of abortion care.

What if my abortion is under 20wks?

Before 16 or 17 weeks, a D&E usually takes only one day.

After 16 or 17 weeks, depending on the clinic or hospital, you may have a two-day procedure. You won’t stay overnight at the clinic—it’s called a two-day procedure because the first visit involves placing small dilators inside your cervix. This helps prepare your body and makes the procedure even safer and faster on the second day. Depending on your personal risks, you may either come back the next day or stay overnight in a hospital if seeking hospital-based care.

What if my abortion is over 20wks?

At around 20 weeks or later, you may have 2-3 appointments depending on the healthcare center and your particular situation.

Here’s what you can generally expect at those appointments (there is more detailed info below):

• First appointment: you’ll go through the initial intake process and then receive an injection that stops fetal cardiac activity (if you want to learn more, see below section What is induced fetal demise? ).

• Second appointment: After the injection, your pregnancy is no longer developing. However the fetus will need to be removed to complete your abortion through a short procedure. The provider will insert dilators into your cervix (the small canal that connects the vagina to the uterus). Depending on how your body progresses, you may complete your abortion on this day. 

• Third appointment: if needed (generally if you were over 27wks pregnant), the procedure itself happens to remove the fetus.

Once your procedure is complete, you will have time to rest and recover before being discharged.

How long does a D&E take? 

On the day of your procedure, plan to be at the clinic or hospital all day. If you have an appointment before your procedure day, such as to insert dilators or get an injection, expect to be there for about 2 to 4 hours. You can bring something to pass the time, like a book, magazine, or phone charger.

The D&E procedure itself is short, usually lasting 30 minutes or less. However, providers and nurses need time to do important preparation work, such as blood tests and setting up the room. Because of this, there may be a lot of waiting before the procedure.

As one provider explains, “Lots of things can make a procedure take longer, but that doesn’t make it more dangerous. If we’re taking more time, it’s just because we need to be careful.”

D&E procedures can take place safely in both outpatient clinics and hospitals. People with certain medical conditions or a history of C-section may be referred to a hospital instead.

Hospital procedures are also safe, but they may involve more preparation visits and can cost more if you don’t have insurance or if the hospital doesn’t take your insurance. (See Section 2: Paying for Your Appointment )

How does a D&E work?

Different providers have different processes. If you have been told you will have a 2-day process, this is what you can expect:

Day 1:

• You will undergo an evaluation process including taking your medical history, obtaining an ultrasound. 

• The provider may perform an injection to stop fetal cardiac activity (for more, read What is induced fetal demise? section below)

• The provider places dilators (small rods, like tampons) into your cervix so it slowly opens.

• The dilators help prepare your body so the procedure can be as gentle as possible.

• You may feel some cramping or discomfort afterward.

• Depending on the clinic and how far along you are, you may also receive some medications to help the cervix soften before the procedure on day 2.

• Most clinics should provide you pain medications to take before and after the dilator placement. Ask about this when you schedule the appointment so you know whether to pack your own pain meds. 

• You’ll go home or back to where you’re staying overnight.

Day 2:

• You return to the clinic or hospital for the procedure.

• Depending on the clinic and how far along you are, you may be asked to place a set of pills called Misoprostol in the vagina or on the inside of your cheek before your procedure. 

• When the team is ready for you, you’ll go into a room like a small operating or exam room.

• A nurse or anesthesiologist may give you medicine through an IV to help you relax or sleep.

• The provider uses gentle suction and medical tools to empty the uterus.

• The procedure usually takes about 30 minutes. The procedure will be over once the medical team is sure that your uterus is empty and your bleeding is under control.

Pain management:

• You can take pain medicine like Advil or Tylenol to help with cramping.

• The clinic may also discharge you with a stronger oral pain medication.

Will I feel the procedure?

During a D&E, we see a range of patient experiences when it comes to pain. You will be given sedation; however, there are a few different types of sedation and people have different levels of pain tolerance.

For instance, some people just have a lower pain tolerance or perhaps you’re regularly using medications or substances which affect the sedation medications’ ability to be 100% effective. So you’re most prepared, know that some people do feel pressure, and even some pain. But the medical teams at the clinics will do their best to keep you as comfortable as they can.

There are also some people who experience outpatient D&Es with moderate or deep sedation (for example, with medicines like fentanyl, Versed, propofol, or ketamine) and feel very little pain at all. One provider explains it this way: “Most people either don’t remember the procedure or are relaxed and chatting during it. When I’m done, they often say, ‘Wait, that’s it?’”. Procedures in outpatient settings with deep sedation (Propofol) will be entirely asleep.

Some people choose to have their procedure in a hospital because they want to ensure they will be under general anesthesia, which means being completely asleep. If you have general anesthesia, you’ll wake up afterward in a recovery area and rest until you feel ready to go.

Even though general anesthesia makes you fully asleep, most people who get moderate sedation say they don’t feel awake or aware during the procedure either.

Induced Fetal Demise (IFD) is a medical injection that stops the fetal heartbeat before the procedure to remove or deliver the pregnancy. It may also be called a “feticidal injection.” This step is done to make the procedure as safe as possible for you because your safety is always the main goal.

The injection goes through either your vagina or your abdomen, depending on how far along you will be, and your clinic’s practice. 

Does the injection hurt?

• For abdominal injections, it will feel like a shot similar to what you get in the arm, followed by some pressure/cramping when the medication goes in. These are temporary and should resolve once the injection is done (about 5-10 minutes). Some providers numb your belly with lidocaine numbing medicine before performing the injection.

  • It can feel uncomfortable, similar to other medical shots or an amniocentesis (a common pregnancy test). 

  • One provider describes an abdominal injection this way: “Most people say the pain is about a 2 out of 10, if they feel anything at all, and many feel a sense of relief once it’s done.”

• For vaginal injections, the provider numbs your cervix and lower uterus with lidocaine (a numbing medicine).

  • This helps make the procedure more comfortable.

  • Most people do not need sedation (medicine to make you sleepy).

  • Some clinics use lidocaine gel before placing the speculum to reduce discomfort.

  • Depending on the clinic, you may be able to insert the gel yourself if you prefer.

The best way we can describe an induction abortion is that it’s taking medicines to start a birthing-like process that your body naturally knows how to do.

People may choose this type of abortion for different reasons:

• It may be the only option at a certain stage of pregnancy.

• Some people want to experience labor, or take time to say goodbye.

• Timing: usually done after 24 weeks, but sometimes as early as 22 weeks.

• Not every clinic offers induction abortions, but some providers do.

How it works:

• You get an injection to end the pregnancy, either through your stomach or through your cervix (see section above on “What is ‘induced fetal demise?’”).

• Once fetal cardiac activity has stopped, clinics may use dilators and medicines to help open the cervix. You may need multiple medications. This process can take several hours or even over a day.

• You go through a process like labor and delivery, however unlike a birth, you will deliver a stillborn.

• Some people start the process at a clinic and deliver at a hospital.

• The medical team will then monitor you for a little while to make sure your bleeding is controlled and your pain is improving. You can then go home.

Why a hospital might be needed:

• Some people prefer a hospital to be close to their OBGYN, midwife, or family.

• A D&E abortion may not be available nearby.

• Certain medical conditions may require hospital care for safety.

Note: Induction procedures may use osmotic dilators (Laminaria and/or Dilapan) for dilation, then use labor induction techniques (with medication like Misoprostol and possibly Pitocin) to get even more dilation, usually (but not always) resulting in intact fetal remains.

Cesarean abortions are very rare. You might need one if you have a placenta accreta or placenta previa, which are medical conditions that affect where your placenta is in the uterus. This may also be safest if you have had several c-sections in the past.

Providers usually check for these conditions with an ultrasound in the office. If it looks like you might need a cesarean abortion, your provider or medical team will talk with you first and help you understand the next steps.

First: if you do not want to see the products of your pregnancy after your abortion, that is ok. However, if you do, it is possible. Some patients get handprints or footprints after their abortion. Your provider may mention it, but if they don’t, you can always ask. They may also have other options for memory-making like sonogram pictures or videos.

Viewing the pregnancy after a later D&E can be hard for some. Not all clinics have experience with this, or may not have a culture of letting people choose if they want to see it. Ask the clinic at the time of scheduling if this would be a possibility. Some clinics may ask you to schedule an induction abortion instead of a D&E, which may mean waiting several weeks until you are farther along in the pregnancy. If you feel viewing the pregnancy will be essential to your experience, call around to later abortion clinics and schedule somewhere that can honor your wishes. 

If you have an induction abortion, the experience is more like labor, and what you see may be closer to what you expect.

One provider says:

“Your body did something, and if you want to know about it, how could I keep that from you? You are the best person to decide whether or not to view. If you feel you want to see, see — don’t let fear stop you. If you feel you’ve found a way to say goodbye in your heart, let that be your comfort.”

You may also be able to arrange a private burial or cremation. If you are interested, ask your clinic. The clinic can help coordinate with the funeral home, but you would need to pay for the burial or cremation yourself. Practical support organizations may also be able to help you with this cost. Be sure to ask the clinic or the PSO if you need financial support with this.

Note: whatever your circumstances or reasons for having a later abortion, you deserve to acknowledge it how you wish. You’ve been through a lot to get to this point and no one can tell you what is or isn’t appropriate after what you’ve experienced. 

One patient said: 

“Just because I didn’t know I was pregnant doesn’t mean I didn’t feel loss. I see some women get a lot of acknowledgement because they wanted their babies but somehow it’s my fault so I don’t get anything. I wish someone had said to me ‘I’m sorry for your loss’ because I grieved too.”

Many people ask if a fetus can feel pain. Right now, the best science shows that fetuses do not experience pain. The oxygen level in a fetal brain is very low—about the same as the oxygen a person would have on top of Mount Everest. This is not enough for the brain to have conscious awareness.

For comparison, think about birth. During vaginal delivery, a baby’s head is squeezed to fit through the pelvis and birth canal. No one would ever do this to a newborn on purpose, and yet no one suggests giving fetuses anesthesia before birth.

Some people feel distressed by fetal movement they see on ultrasounds. In pregnancy, these unconscious movements are necessary to prepare a brain and body for future consciousness, but don't indicate awareness.

In short, the body is not set up for a fetus to consciously experience pain at any stage.