One in three women in Australia will have an abortion at some point in their lives, but if it hasn't happened to you, you might not know much about the actual process. Outdated horror stories involving iron forceps still loom large in the public consciousness, when the majority of abortions today begin with taking a pill.
There are two main types of abortion: medical (using pills to induce a miscarriage) and surgical (where the pregnancy is removed during a minor operation). Exactly what happens and how long it takes varies from woman to woman, and, obviously, depends on how far into the pregnancy you are. But if you're going for a medical abortion, here's a rough idea of what you can expect to happen during the 72 hours afterwards.
First up, it's important to know that a medical abortion happens in two stages, using two different types of medication. If you're less than ten weeks pregnant, these can be taken on the same day, but more commonly you'll return to the clinic for a second appointment, one to two days after the first one.
Hour 1: At your first appointment, you'll take the abortion pill Mifepristone, which works by blocking the hormone progesterone. Without progesterone, your body can't continue the pregnancy and the lining of your uterus (AKA the endometrium) begins to break down. Mifepristone also works by making your uterus more sensitive to the second abortion pill, Misoprostol.
Then, depending on your individual circumstances, you'll either go home straight away, or you'll stay at the clinic to take the second round of medication. If you're under ten weeks pregnant and take the second pill on the same day, most clinics recommend that you get a lift home afterwards, as the bleeding can start quite quickly in early pregnancy – not something you want happening on the bus.
Hour 1 to Hour 24: Assuming you're taking the abortion pills over two separate appointments, you'll probably find that not a lot happens during the first 24 hours after Mifepristone. You might get a bit of bleeding, nausea and period-type cramping, but basically, you should be fine to carry on with life as normal.
"Quite often there are no symptoms at all, and women panic; they'll ring you up and say, 'Nothing's happened.' That's OK; you don't necessarily feel anything particularly after you have the first tablet," explains Dr Kate Guthrie, a Consultant Gynaecologist and spokesperson for the Royal College of Obstetricians and Gynaecologists. However, if you're sick within an hour of taking Mifepristone, you should let the clinic know as soon as possible.
It's pretty unlikely that Mifepristone by itself will cause you to miscarry, but if you're in early pregnancy (i.e. less than ten weeks) and experience heavy bleeding between your two appointments, tell the clinic so they can check it out.
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Hour 24 to Hour 26: Again, this varies from person to person, but after one or two days you'll return to the clinic for your second appointment. The second pill is called Misoprostol and – rather than swallowing it – is placed either in your vagina, or between your gum and your cheek, where it dissolves for quicker absorption.
Hour 26 to Hour 28: Misoprostol causes your womb to contract, basically mimicking a miscarriage. Bleeding and cramping usually start around two hours after taking Misoprostol, but it's different for everyone.
Hour 28 to Hour 30: The contents of your pregnancy typically make their way out of your vagina in the form of clots and tissue around four to six hours after taking Misoprostol. You'll stay in the clinic during this entire time, with a toilet or bedpan on hand to bleed into.
You don't have to look at what's coming out, but it's important to be aware that, the further along in your pregnancy you are, the more likely you are to see something that's recognisably a foetus. At ten weeks, the foetus is about the size of a large grape, whereas, at 24 weeks, you're looking at something the size of a small melon.
While the foetal tissue is passing, you'll get very heavy bleeding and cramping, which, according to Dr Guthrie, is "usually worse than period pain, but not as bad as labour pain". If you've had a miscarriage before, that's the kind of pain level to expect. You'll be given painkillers before it gets too bad, and the nurses will be keeping an eye on what comes out to make sure you've passed the foetus and the afterbirth.
It can take longer than six hours, particularly with later term pregnancies. As a general rule – and for obvious reasons – the more developed the foetus, the harder the uterus has to work to expel the pregnancy. If it takes a particularly long time, you may also be given extra doses of Misoprostol every few hours, to help the abortion along.
Hour 30 to Hour 72: For most women, the abortion will be complete within 12 to 24 hours of taking Misoprostol, and the heavy bleeding will then start to calm down. At this point, your newly emptied womb cramps down, nipping shut the blood vessels that supply your uterine lining, and replacing the heavy bleeding with a light ooze. This usually happens quite quickly – between 30 minutes and a couple of hours afterwards – but some women will continue to bleed heavily for up to 48 hours.
You'll probably have some light bleeding and cramping for a few days afterwards, and you may also get symptoms like sore breasts, diarrhoea and nausea – but these should be fairly short-lived.
72 hours+: The bleeding can last up to three to four weeks, on and off, but should get lighter and lighter each day, going from a light bleed to a pink or brown discharge. You can carry on taking painkillers for any pain or discomfort, and it's best to use pads rather than tampons for the first few weeks.
In fact, says Dr Guthrie, don't put anything in your vagina until the bleeding has stopped, just to reduce the risk of infection – no tampons, no fingers, no pensises, or anything else!
You'll also be fertile again much quicker than you might expect, so most clinics will chat to you about contraception before you leave, and make sure you're kitted out with condoms, the pill or your contraceptive of choice.
If you notice anything weird in the days and weeks after an abortion, get in touch with the clinic to have it checked out. Complications are pretty rare, but warning signs to look out for include large clots, unusual smells and pain suddenly getting worse. Most clinics will give you a 24-hour helpline number to call if you're concerned.
For more information and advice on abortion and family planning, contact Pregnancy Counselling Australia on 1300 737 732