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According to the CDC‘s most recent report, at least 629,000 abortions were performed in the United States in 2019. (The actual figure is likely to be higher.) Most take place during the first trimester of pregnancy.

It is sometimes called a “Later-term abortion” when it is done during the second and third trimesters.

About 6 percent of the reported abortions in 2019 occurred between the 14th and 20th weeks of gestational age. Less than 1 percent took place at or after the 21st week.

The phrase “late-term” is medically incorrect and is used by some people.

A “late-term” pregnancy is past 41 weeks gestation — and pregnancies only last 40 weeks overall. In other words, childbirth has already occurred, making “late-term abortion” impossible.

Stay informed

The Supreme Court of the United States overturned the 1973 ruling that legalized abortion on June 24, 2022, on the eve of the Fourth of July.

Individual states can decide their own abortion laws. More states may follow suit and ban or severely restrict abortion access.

The information in this article was accurate and up to date at the time of publication, but it’s possible the information has changed since. To learn more about your legal rights, you can message the Repro Legal Helpline via a secure online form or call 844-868-2812.

Most people ending 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’ll be positioned on the table with your feet in the stirrups, much as 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 a local anesthetic.

Afterward, your clinician will insert a dilating stick called a laminaria stick into your cervical canal. This stick absorbs moisture and opens the cervix, as it swells. Alternatively, your clinician can use another type of dilating stick called Dilapan, which can be inserted on the same day as the surgery.

The drug called misoprostol can help prepare the cervix.

Just prior to the D&E, you’ll likely be given intravenous sedation or general anesthesia, so you’ll probably sleep through the procedure. You’ll also be given your first dose of antibiotic therapy to help prevent infection.

The curette is used to remove the dilating stick and uterus. The fetus and the placenta will be removed using vacuum and other surgical instruments. During the procedure, guidance may be used.

It takes about half an hour to complete the procedure.

Is a later-term abortion safe?

Second-trimester D&E is considered to be a safe and effective medical procedure. Although there are potential complications, they’re less frequent than the complications of giving birth.

In some states, abortions in the second or third trimester are allowed.

After the overturning of Roe v. Wade, several states’ abortion laws changed, with more scheduled to change in the coming weeks as a result of the likes of trigger laws or the lifting of temporary blocks on such trigger laws.

Currently, 44 states ban some abortions after a certain point in a pregnancy. Of the 19 states that ban abortion at or after a specific week of gestational age, 10 ban ending a pregnancy at approximately 20 weeks post-fertilization.

Trying to make sense of the limitations in your state? Our state-by-state guide to abortion restrictions can help.

According to Planned Parenthood, a D&E can cost as much as $750 in the first trimester, with second-trimester abortions tending to cost more. Having the procedure done in a hospital may be more expensive than having it done in a clinic.

“Some health insurance policies cover abortion in full or part, but not all. The clinician’s office can contact your insurer.”

“You have other options if you don’t have insurance or are underinsured.”

Many organizations across the country can work with you to help fund the procedure. To learn more, check out the National Network of Abortion Funds.

Before you schedule the procedure, you need to have a meeting with a doctor or other healthcare professional.

  • Your overall health, including any conditions that have been reported.
  • Do you need to skip any of your medications before the procedure?
  • The procedure details.

You will need to see your clinician the day before the surgery to begin having your cervix dilated.

Instructions for the surgery will be provided by your clinician. You may be advised to avoid eating for 8 hours before the procedure.

It will be helpful if you do these things in advance.

  • “You won’t be able to drive yourself home after the surgery, so arrange for transportation.”
  • “You won’t be able to use the pads because of that.”
  • know your birth control options

“You will need a few hours of observation to make sure you don’t have any problems. You may have some symptoms during this time.”

When you are discharged, you will be given antibiotics to help prevent infections and will be advised how to take them.

For pain, ask your clinician if you can take acetaminophen (Tylenol) or ibuprofen (Advil) and how to take it. Avoid taking aspirin (Bayer) or other medications containing aspirin, because it can cause you to bleed more.

“Recovery time can vary from person to person, so listen to your body and follow your clinician’s recommendations for resuming everyday activities.”

You might need a day off before you return to work, school or other activities if you feel fine the next day. Heavy exercise can increase bleeding or cramping, so it is best to avoid it for a week.

Common side effects

There are some possible side effects.

  • The most likely time for the problem to occur is between the third and fifth days.
  • nausea in the first 2 days
  • The breast or chest tissue is tender.
  • If you soak through more than two hours of pads an hour, tell a healthcare professional.
  • If a clot is larger than that, it should be reported to a healthcare professional.
  • If the temperature is less than 100.4F, call a healthcare professional.

Menstruation and ovulation

Your body will start preparing for ovulation. You can expect your first period after the procedure.

It may take several months before your usual cycle returns, but it may happen right away. Some people have periods that are lighter or irregular.

You will be advised not to use feminine hygiene products for at least a week after the procedure.

Sex and fertility

It’s best to avoid having vaginal sex — including fingers, a fist, sex toys, or a penis — for at least a week after having a D&E. This will help prevent infection and allow your body to heal.

“When you are healed, your clinician will let you know if you can have vaginal sex again. The procedure shouldn’t affect your ability to have sex.”

Your fertility won’t be affected, either. It’s possible to get pregnant right after your D&E, even if you haven’t had a period yet.

If you’re not sure what type of birth control is best for you, talk with a healthcare professional about the pros and cons of each type. If you use a cervical cap or diaphragm, you’ll need to wait about 6 weeks for your cervix to return to its usual size. In the meantime, you’ll need a backup method.

As with any surgical procedure, there are some potential complications from D&E that may require additional treatment.

These include:

  • allergic reaction to drugs
  • excessive bleeding
  • Blood clot larger than a lemon.
  • There is severe pain and cramping.
  • The uterus can be laceration or perforation.
  • In the future, there will be incompetence in the cervix.

Another risk of D&E is an infection in the uterus or fallopian tubes. Seek medical attention as soon as possible if you’re experiencing:

  • The temperature is above 100.4F.
  • shaking and feeling cold.
  • There is severe pain in the abdominal area.
  • The discharge was strong.

Avoid the following for the first week.

  • There are feminine hygiene products.
  • Douching.
  • vaginal sex
  • baths and shower
  • There are swimming pools, hot tub, and other bodies of water.

It is important to consult with a healthcare professional you trust if you have made your final decision. They should allow plenty of time for questions so you can fully understand the procedure.

It is possible to have your questions and concerns written down in advance of your appointment.

Your clinician should be willing to provide you with information on all your options. If you’re not comfortable talking with them or don’t feel you’re getting all the information you need, don’t hesitate to see another physician if possible.

Emotional reactions to ending a pregnancy are different for everybody. You may experience sadness, depression, a sense of loss, or feelings of relief. Some of this may be due to the hormonal fluctuations involved.

If you experience persistent sadness or depression, you might find it helpful to talk with a healthcare professional about how you feel.

If you’re considering ending a pregnancy in the second or third trimester or if you’re having difficulty navigating your options, help is available. A gynecologist, general practitioner, clinic worker, or hospital advocate can refer you to a mental health counselor or appropriate support group.