Dilatation and evacuation (D&E)This is used after 14 weeks of pregnancy. It involves inserting special instruments called forceps through the cervix and into the womb to remove the pregnancy. D&E is usually carried out under sedation or general anaesthetic.
Dilatation and evacuation (D&E) is the most commonly performed medical procedure in the United States. This is used after 14 weeks of pregnancy, or when other methods of abortion have failed. It involves inserting special instruments called forceps through the cervix and into the womb to remove the pregnancy. D&E is usually carried out under sedation or general anaesthetic
Dilatation and evacuation (D&E) is a surgical procedure used to remove a pregnancy after 14 weeks of pregnancy. It involves inserting special instruments called forceps through the cervix and into the womb to remove the pregnancy.
At 14 weeks and above, your doctor might recommend a dilatation and evacuation (D&E) procedure to remove your pregnancy. This method involves inserting special instruments called forceps through the cervix, then removing the pregnancy. D&E is usually carried out under sedation or general anaesthetic.
After 14 weeks of pregnancy, you will usually have the option of a medical abortion (with mifepristone and misoprostol) or a surgical abortion. If you choose surgical abortion, there are two types: D&E (dilatation and evacuation) and induction by suction curettage.”
Abortion at 14 Weeks Recovery
There are a few types of procedures to induce an abortion that are done in clinics or hospitals. A medical abortion (mifepristone, also known as RU-486) is a prescription pill and can be taken at home used during the early part of a pregnancy. The type or abortion you get will probably depend almost entirely on how far you are along in your pregnancy.
If you’re in your first trimester, you’ll likely have a vacuum aspiration. If you’re in your second trimester (meaning that it’s been more than 13 weeks since your last menstrual period), you’ll likely have a dilation and evacuation, or D&E. If you’re further along than that, you might have a dilation and extraction, or D&X.
Almost all abortion procedures are out-patient, which means you won’t have to stay overnight in the doctor’s office, clinic, or hospital afterward.
Before the Procedure
When you schedule your appointment, your health care provider will probably give you some instructions over the phone. Because in-clinic abortions are considered surgeries, you may have to fast starting around midnight the night before your procedure.
When you arrive at the clinic, you’ll fill out some paperwork and answer questions about your medical history. You’ll then get a pre-abortion workup, which includes a physical examination, pregnancy test, blood test, screening for sexually transmitted infections, and possibly additional testing, if your case warrants it. Many providers will also use an ultrasound to confirm how far along you are in your pregnancy and check for uterine, fetal, or placental abnormalities.
All of this information, which your doctor will discuss with you during a short counseling session, will help them determine which procedure is right for you.
Your doctor will also talk to you about different types of pain management available to you during the procedure.
For an in-clinic abortion, you’ll probably get local anesthesia, meaning that your cervix will be numbed but you’ll be awake. While 600 to 800 milligrams of ibuprofen usually provides enough pain relief, your doctor might also offer you an oral medication to calm you down or mildly sedate you, so you’re awake but relaxed. If you prefer heavy sedation, meaning you’re in a light sleep throughout the procedure, you can ask if a sedative medication can be given to you through an IV.
Surgical Abortion at 5 Weeks
During the second trimester, from 14 to 23 weeks and 6 days after your last menstrual period, abortions are typically performed over a two to three day period but don’t require an overnight stay in the hospital. This procedure is known as a dilation and evacuation (D&E).
On the first day, you’ll meet your medical team at the UCLA West Med Clinic to prepare for the procedure. This first visit typically takes about 3-4 hours.
On the day of the procedure, usually a Wednesday or a Friday, you’ll meet the medical team at UCLA Ronald Reagan Medical Center. This visit will take about 6-8 hours.
In a private exam room, you will learn about your procedure, undergo an exam and ultrasound, and may receive oral pain/anxiety medications. You will receive prescriptions for pain medications and antibiotics. It is important that you follow the instructions provided by your doctor. You will have the option to discuss and choose a birth control method. You will also have the option to make arrangements for private cremation services if you choose.
Depending on your gestational age and medical history, cervical softening and dilating is performed with medication and/or small dilating sticks, called laminaria or Dilapan. Laminaria are thin sticks made from a special seaweed material that widen as they absorb moisture from your body. Dilapan are synthetic sticks that work in the same way. The dilators will stay in your cervix overnight, and allow the process of cervical dilation to happen slowly, which helps to prepare your body for the surgical procedure. Depending on your gestational age, you may come back for a second day of pre-op, during which the previous dilators will be removed and new ones will be put in. You may also receive an injection in the uterus that induces fetal demise.
During the dilator insertion, you’ll be awake. The doctor will:
- Give you pain and/or anxiety medication to help with discomfort
- Place a speculum to view inside your vagina.
- Clean the cervix with gauze soaked in soap.
- Apply numbing medication (local anesthesia) to the cervix.
- Insert laminaria (or Dilapan) into your cervix, the opening to the uterus. The laminaria insertion takes about five to 10 minutes.
After the procedure, you will rest for a few minutes. You may experience cramping and spotting. You may get dressed when you feel able. Our nurse will give you detailed instructions on how to take care of your body overnight and how to prepare for the next day’s procedure. She will also draw your blood as necessary.
Someone must drive you home if you take anti-anxiety or opiate pain medications. If needed, you and a support person can ride home together in an Uber/Lyft. Note: your driver/support person does NOT need to know you are having an abortion. They just need to be someone you can trust to get you home safely afterwards. We will not disclose your health information to anyone without your explicit consent. Rest at home until the medications wear off. It is recommended that you continue to relax at home for the rest of the day after your pre-op visit.
Don’t eat or drink after midnight on the day of your surgical procedure.
On the surgical day, you’ll check-in at the hospital reception area at UCLA Ronald Reagan Medical Center then go to the pre-operative area, where you’ll meet your medical team. They will begin to get you ready for the procedure.
Once you are in the procedure room, medication will be administered intravenously (IV) in your arm to induce anesthesia or loss of consciousness. Most patients fall asleep and don’t remember the procedure. After you’re well relaxed, the doctor will remove the laminaria and use gentle suction and gynecological instruments to empty your uterus, with ultrasound guidance. If you desired a contraceptive implant or intrauterine device, it will be placed in the operating room after your procedure. You’ll be in the operating room for about an hour but the procedure will likely only take about 15 to 30 minutes.
In the recovery room, nurses will monitor you for about two hours. You may have some cramping and spotting. The procedure and recovery period at the hospital usually takes about six to eight hours in total. Because of medications administered, you shouldn’t drive until the medications wear off. Please make arrangements ahead of time for someone to take you home directly. You can expect to return to normal activities, such as work and school, the next day.
If you don’t have anyone to accompany you home, contact ACCESS Reproductive Justice, a reproductive rights organization that may have a pro-choice volunteer driver to assist you. This must be coordinated with our clinic before your appointment, so please make arrangements as soon as possible. ACCESS can be reached via phone call or text message at 800-376-4636. Their usual hours are Monday-Friday, 10:00 am to 4:00 pm PST.
You will have a follow up appointment one to two weeks after your procedure to confirm that your procedure is completed and that you are healing well. This visit is typically done via telehealth, though you can also be seen for an in-person evaluation. At this visit, you can also get a prescription for birth control.
Safety and Effectiveness
Second trimester surgical abortion is one of the safest medical procedures. Although rare, possible complications include a blood clot in the uterus that can cause pain or require a repeat suction procedure; infection, which is generally easily identified and treated; a tear in the cervix that can be easily repaired with suture; perforation of the uterus; retained pregnancy tissue requiring a repeat suction procedure; and excessive bleeding requiring a transfusion. Complications from a surgical abortion are considerably rarer and much less serious than those associated with giving birth.