Surgical Abortion (First Trimester)

Surgical abortion in the first trimester (up to 13 weeks and 6 days), also known as suction aspiration or D&C abortion, can be performed as a one or two-day procedure. This can be done in a doctor’s office with local anesthesia and oral pain-relieving medications, or in a hospital setting under sedation. Your preparation will be the same whether the procedure is done the office or the hospital setting, with the exception of a pre-procedure COVID test required for the hospital setting.

You will be in a private room during your health education, exam, procedure and recovery. The entire visit will take around three hours, but can be up to 5-6 depending on your gestational age and other medical indications. All sensitive exams will be conducted in the presence of a trained chaperone. Please arrange for someone to drive you home after the procedure. 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.

Preparation

Unless explicitly told to fast, please eat a light meal before your appointment. See the bottom of the page for details on what to bring and what not to bring to your appointment.

When you check in for your appointment, we will verify your insurance information, collect your co-payment/deductible if applicable and ask you to complete some forms. Termination services at UCLA are integrated into the general OB/GYN practice. Patients are not identified in the reception area as desiring pregnancy termination and there are no signs advertising our clinic. This ensures the privacy and safety of our patients and staff. If you feel uncomfortable at any time, please inform a member of our staff.

Shortly after you are checked-in, one of our medical assistants (MAs) will bring you into a triage room, where they will take your vitals; this includes blood pressure, pulse, temperature, and height and weight. They will also update your medication history. The MA will then bring you to a private exam room where you will meet your medical team. We will review your medical history, and perform an ultrasound exam to determine your pregnancy's gestation. We will discuss the abortion options that are available to you, and confirm if the surgical option is the best one for you based on your medical history, what you prefer, and what the provider recommends. If you are interested, birth control counseling with a health educator is also available. UCLA OB/GYN offers all methods of birth control, and most can be started immediately after the abortion. If you brought a support person with you, they may be able stay with you during the health education/discussion portion of the visit if it would be helpful to you.

UCLA is a teaching hospital and your medical team will be comprised of an attending obstetrician-gynecologist (OB/GYN) with specialized training and interest in abortion care and complex family planning, fellow and resident physicians (physicians who have graduated medical school and are doing additional training), and possibly a medical student and/or health educator. All medical care will done under the close supervision of the attending physician.

Procedure in the Office

Before the procedure begins, you will receive oral pain and/or anxiety medications as needed. We may also give you additional medicine to soften your cervix. Patients usually describe most of the pain felt during the procedure as similar to period cramps, though the intensity level of the cramps may be higher than what you usually experience during your period.

You will be awake during the procedure, but the medicine we give you will alleviate your discomfort. The doctor will:

1. Use a speculum to view inside your vagina
2. Clean your vagina and cervix with gauze soaked in soap
3. Apply numbing medication to your cervix
4. Dilate (open up) your cervix (the tight opening to your uterus) a small amount with thin metal rods
5. Insert a narrow flexible tube into your uterus
6. Use gentle suction to the other end of the tube to remove all of the pregnancy tissue

Ultrasound guidance may be used during your procedure.

Toward the end of the procedure, you may feel heavier cramping in your uterus, as it is shrinking down to its usual size. Most of the procedure time is spent preparing your body for the procedure. The entire process usually only takes about 15 minutes, with the most uncomfortable part often being less than 5 minutes. An ultrasound will be done to confirm that the procedure was complete. If you desire to have a birth control device placed (such as an IUD or implant), this can be done immediately afterwards.

Procedure in the Hospital

If you prefer, or if the provider recommends, the same D&C procedure can be done in a hospital setting under anesthesia. This is done over two appointments, often a few days apart. The preparation will be the same, and is often called the “pre-op” visit. A COVID test will also need to be completed 24-48 hours before your procedure. The procedure itself is the same; it is just the setting and your level of sedation that is different.

Procedure Awake versus Asleep

There are pros and cons to both having the abortion while you are asleep and while you are awake.

• Doing the procedure in the office while awake is a faster process; it is one visit, and you leave the office that day with the abortion complete. Being asleep for the procedure will take place over two visits (pre-op and procedure), plus a COVID test appointment.
• There can be painful cramping during the procedure. If you are asleep during this process, you typically do not experience any pain or remember the procedure.  
• Having the procedure done in the office may be less expensive than having it done in a hospital setting.
• If you are more medically complex, it may be safer to do the procedure at the hospital where other resources are immediately available.

Recovery

After the procedure, you should remain resting. You will probably have some cramping and spotting. We will provide you with a heat pack and a menstrual pad. When you feel ready, you may get up and get dressed. There is no rush, and you can take as much time as you need afterwards. If you had the procedure under anesthesia, you will stay for a longer time in recovery.

Your nurse will then give you instructions on how to take care of your body. The doctor will give you antibiotics to prevent an infection. If you desire, you can also be given a birth control prescription. You will have arranged ahead of time to have someone drive you home. You should go home to rest and let the medications wear off. It is okay to stop by the pharmacy on your way home to pick up medications if needed. It is recommended that you spend the rest of the day after your procedure relaxing at home. We encourage you to have a heating pad available at home and to take ibuprofen as needed/as directed by your doctor. You should be able to return to normal activities, such as work and school, the next day. If needed, a doctor’s note for work or school can be provided.

Follow-Up Visits

You will be scheduled for follow up appointment one to two weeks after your procedure to confirm that your procedure is completed and that you are healing well. This follow-up is typically done via telehealth, though if you prefer or the provider recommends, it can be done in-person instead. It is important that you attend this appointment so your doctor can check for any problems. If you prefer, you can also follow-up with your primary OB/GYN if you do not typically go to UCLA for your care.

What to bring with you to the appointment

• Photo identification (ID) card
• Insurance card
• List of all your medications, including prescription and over-the-counter
• Name and location of your preferred pharmacy
• Comfortable/warm clothes
• Light snack
• Headphones to listen to relaxing music to during the procedure if you will be awake
• Supportive person whose presence will be comforting to you and who can make sure you safely get home after your procedure.
  If you do not feel comfortable disclosing the reason for your visit to this person, that is okay. They just need to be able to get you safely home.

What not to bring

• Children
• Valuables
• More than one visitor/support person
• Pets (with the exception of certified service animals)