Abortion during the second (week 13 to 27) or third trimester (from week 28) of pregnancy is sometimes called “late abortion”.
Although some people refer to abortions that occur later in pregnancy as “late”, this term is medically inaccurate.
A “late” pregnancy exceeds 41 weeks gestation – and pregnancies only last 40 weeks in total. In other words, the delivery has already taken place, making “late abortion” impossible.
Most people terminate a pregnancy in the second or third trimester undergo a surgical abortion. This procedure is called dilation and evacuation (D&E).
D&E can usually be done on an outpatient basis in a clinic or hospital.
The first step is to soften and dilate the cervix. This can be initiated the day before the D&E. You will be positioned on the table with your feet in stirrups, much like you would for a pelvic exam.
Your clinician will use a speculum to widen your vaginal opening. This allows them to clean your cervix and apply local anesthesia.
Next, your clinician will insert a dilator stick called a laminaria stick into your cervical canal. This stick absorbs moisture and opens the cervix, as it swells. Alternatively, your clinician may use another type of dilator stick called Dilapan, which can be inserted on the same day as surgery.
Your clinician may also choose to give you a medicine called misoprostol (Cytotec), which can help prepare the cervix.
Right before the D&E, you’ll likely receive intravenous sedation or general anesthesia, so you’ll likely be sleeping through the entire procedure. You will also receive your first dose of antibiotic therapy to help prevent infection.
Your clinician will then remove the dilator stick and scrape the uterus with a pointed instrument called a curette. Vacuum aspiration and other surgical instruments will be used to extract the fetus and placenta. Ultrasound guidance may be used during the procedure.
It takes about half an hour to complete the procedure.
The circumstances under which second or third trimester abortions are permitted vary from state to state.
After the overthrow of Roe c. Wade, multiple states’ abortion laws have changedwith further changes expected in the coming weeks due to trigger laws or the lifting of temporary blocks on those trigger laws.
Currently, 44 states prohibit certain abortions after a certain stage of pregnancy. Of the 19 states that prohibit abortion at or after a specific week of gestational age, 10 prohibit terminating a pregnancy approximately 20 weeks after fertilization.
Are you trying to understand the limits of your state? Our state-by-state guide to abortion restrictions can help.
According Planned parenthood, a D&E can cost up to $750 in the first trimester, with second-trimester abortions tending to cost more. Having the procedure done in a hospital can cost more than having it done in a clinic.
Some health insurance policies cover abortion in whole or in part, but many do not. The clinician’s office can contact your insurer on your behalf.
If you don’t have insurance or are underinsured, meaning your insurance doesn’t cover much, you have other options for financial assistance.
Many organizations across the country can work with you to help fund the procedure. To find out more, see the National Network of Abortion Funds.
Before scheduling the procedure, you will have a thorough meeting with a doctor or other healthcare professional to discuss:
- your general health, including any pre-existing conditions
- any medications you are taking and whether you will need to skip them before the procedure
- the specifics of the procedure
In some cases, you will need to see your clinician the day before surgery to begin dilating your cervix.
Your clinician’s office will provide you with pre- and post-surgery instructions that you will need to follow. You may also be advised to avoid eating for about 8 hours before the procedure.
It will be helpful if you do these things in advance:
- arrange transportation home after surgery, as you will not be able to drive yourself
- prepare a supply of sanitary napkins as you will not be able to use tampons
- know your birth control options
You will need a few hours of observation to make sure you are not bleeding too heavily or having other complications. During this time, you may experience cramping and spotting.
When you leave the hospital, you will receive antibiotic therapy to help prevent infection and you will be told exactly how to take it.
For pain, ask your clinician if you can take acetaminophen (Tylenol) or ibuprofen (Advil) and how to take them. Avoid taking aspirin (Bayer) or other medications that contain aspirin, as it can cause you to bleed more.
Recovery time can vary greatly from person to person, so listen to your body and follow your clinician’s recommendations for resuming your daily activities.
You might feel fine the next day, or you might need a day off before returning to work, school, or other activities. It’s best to avoid strenuous exercise for a week, as it can increase bleeding or cramping.
Common side effects
Some potential side effects are:
- cramps, most likely between the third and fifth day after the procedure
- nausea, especially the first 2 days
- tender breast or chest tissue
- light to heavy bleeding for 2-4 weeks – tell a healthcare professional if you soak more than two maxi pads per hour for 2 or more hours in a row
- clots which may be as large as a lemon – tell a healthcare professional if they are larger than this
- mild fever – call a healthcare professional if over 100.4°F (38°C)
Menstruation and ovulation
Your body will immediately start preparing for ovulation. You can expect your first period within 4-8 weeks after the procedure.
Your usual cycle may return immediately, but it may take several months for your period to return to normal. For some people, periods are irregular and lighter or heavier than before.
Due to the risk of infection, you will be advised not to use tampons for at least a week after the procedure.
Sex and fertility
It’s best to avoid having penetrative vaginal sex — including fingers, a fist, sex toys, or a penis — for at least a week after a D&E. This will help prevent infections and allow your body to heal.
Your clinician will let you know when you have completed your recovery and are ready to have penetrative vaginal sex again. The procedure should not affect your ability to enjoy sexual activity.
Your fertility will not be affected, That is. It’s possible to get pregnant right after your D&E, even if you haven’t had your period yet.
If you’re not sure which type of birth control is best for you, talk to a healthcare professional about the pros and cons of each type. If you use a cervical cap or diaphragm, you will need to wait about 6 weeks for your cervix to return to its usual size. In the meantime, you will need a backup method.
As with any surgery, some potential complications related to D&E may require additional treatment.
- allergic reaction to medication
- excessive bleeding
- blood clots larger than a lemon
- severe cramps and pain
- laceration or perforation of the uterus
- cervical incompetence in future pregnancies
Another risk of D&E is infection of the uterus or fallopian tubes. See a doctor as soon as possible if you experience:
- fever over 100.4°F (38°C)
- tremors and chills
- severe pelvic or abdominal pain
- strong smelling discharge
To help prevent infection, avoid the following for the first week:
- vaginal sex with penetration
- bathtubs (shower instead)
- swimming pools, hot tubs and other bodies of water
Whether or not you’ve made your final decision, it’s important to consult a healthcare professional you trust. They should allow plenty of time for questions so that you fully understand the procedure and what to expect.
It might be a good idea to have your questions and concerns in writing before your appointment, so you don’t forget anything.
Your clinician should be willing to provide you with information on all of your options. If you are not comfortable speaking with them or feel that you are not getting all the information you need, do not hesitate to consult another doctor if possible.
Emotional reactions to the end of a pregnancy are different for everyone. You may experience sadness, depression, a sense of loss, or a sense of relief. This may be partly due to the hormonal fluctuations involved.
If you are feeling persistent sadness or depression, you may find it helpful to speak with a healthcare professional about your feelings.
If you are considering terminating a pregnancy in the second or third trimester or are having difficulty navigating your options, help is available. A gynecologist, GP, clinic worker or hospital advocate can refer you to an appropriate mental health counselor or support group.