Surgical Aspiration (D&C)
A surgical D & C is the most common method, generally used between 6-14 weeks of pregnancy. It involves the use of general or local aenesthetic and artificially dialating the cervix often using compressed seaweed called laminaria which swells as moisture is absorbed, forcablly causing the cervix to open. A tube is then inserted into the uterus, which and attached to a suction machine. The suction tears the fetus into small parts, which are then sucked up through the tube and collected in a bottle or pail.
A sharp, loop-shaped knife called a curette is often used to loosen any remaining tissue to be suctioned out. The fetal parts are then rearranged by staff to account for all the parts and ensure nothing has been left in the uterus to cause infection.
Dialation & Evacuation (D&E)
A D&E abortion is usually done after 13 weeks when the fetus has grown more significantly and it's bones are harder. It involves the use of forceps to dismember and extract the fetus instead of, or together with, suction. The cervix must be opened wider, and the head of the fetus is large and must be crushed before it can be removed. Bone fragments are sharp and must be carefully removed to avoid damage to the uterus and cervix. The fetal parts removed must be identified to make sure the abortion is complete and no parts are left in the uterus. Suction is used for a final clean out of any bits of fetal or placental tissue that may remain.
Sometimes medications such as digoxin or potassium chloride are injected into the fetus through the woman’s abdomen, to kill it before the D&E procedure. After 19 to 20 weeks, a solution of urea or saline is sometimes injected into the amniotic sac before the abortion. This kills the fetus and stimulates contractions. Urea also begins the breakdown of fetal bones and other tissue to make removal of the parts easier for the abortionist and less painful for the mother. Oxytocin may be used to stimulate contractions and bring about delivery of the fetus.
Dilation and Extraction (D&X) (partial birth abortion)
The D&X abortion method is used after 20 weeks of pregnancy. Laminaria treatment over several days causes wide cervical dilation. The abortionist, guided by ultrasound, uses forceps to grasp the fetus and position it face down and feet first. The fetus, intact and often still alive at this point, is delivered up to the head. The head is too big to pass through the cervix. After puncturing the base of the skull, the brain is suctioned out, the skull collapses, and the dead fetus is delivered. Digoxin, potassium chloride, saline or urea are sometimes used to kill the fetus before delivery.