Here’s how an abortion works from week 13

Same day abortion signs. (Oupa Nkosi)

In South Africa, both medical and surgical abortions are allowed.
By South African law only a surgical abortion is possible when you’re over 12 weeks pregnant and only a doctor may do it.
In the second video of a three-part series on abortions, Boitumelo Lewele, a clinical manager at Marie Stopes South Africa, tells Mohale Moloi how surgical abortions work and what to expect.

In South Africa, you can choose to get an abortion up to 12 weeks of pregnancy. After 12 weeks, an abortion can only be done in special cases.

A special case can be if the mother or foetus’ life is at risk, if a woman was raped or the parents are too poor to look after the baby.

There are two types of abortions.

A medical abortion can be done up to 12 weeks of pregnancy. For this, two pills are taken. Only a surgical abortion can be done after 12 weeks.

Here are 10 things you need to know about surgical abortions.

1) How does a surgical abortion work?

Boitumelo Lewele: When we do a surgical procedure, what we do is that we take a speculum. The speculum is an instrument that most women know when they go for their pap smears. So we introduce a pap smear [device] into the vagina, and it allows us to visualise the opening of the cervix, which is what we would call the womb. Then we do a manual vacuum aspiration [gentle suction], where we remove the pregnancy. That is why it’s called surgical because it’s more of a procedure, unlike the tablets where it’s more of a process.

2) Can you have a surgical abortion before 12 weeks?

Boitumelo Lewele: If their pregnancy is less than nine weeks, they can have the pill. But there are women that [say] ‘I’m six weeks pregnant, I cannot take my medication home with me, I live with my…’ whoever they live with. ‘I don’t want them to be aware that I’m

undergoing this process. I need a procedure where I’m going to come to the facility [and] everything is going to happen in the same day.’ And in those cases, we then provide the surgical termination of pregnancy.

3) How long does the procedure take?

● If you are under 12 weeks pregnant it takes about 15 minutes

● If you are over 12 weeks it can take about 30 minutes because the pregnancy is more advanced

4) Do you need to be sedated?

Boitumelo Lewele: At Marie Stopes South Africa, we do offer the option of having it done under sedation — conscious sedation. That’s where we give medication for you to be ‘asleep’. With conscious sedation, it’s very different from when you’re going for like a hectic operation. If I had to, tap on you and say your name, the patient would respond, but they’re not fully aware of what’s happening around them. So it’s just a procedural sedation.

A facility that offers surgical abortions must:

● Give medication to lower the risk of infection and to manage pain

● Have a recovery room where patients can be monitored

● Have oxygen, blood pressure, temperature and heart-rate monitors ● Explain different contraceptive methods to you before you are

Discharged

5) What happens when the procedure is done?

Boitumelo Lewele: We take the client to recovery. We need to monitor their bleeding, to make sure that they’re not bleeding excessively. We need to make sure that their vital signs – their blood pressure, their temperature, their heart-rate, their respiration rate – it’s [all] normal or within the normal ranges that exist, and then once she’s comfortable, she’s good, we assess and then we discharge.

6) What might you feel like afterwards?

Boitumelo Lewele: After the procedure you’re going to be in discomfort. Remember, as the procedure is occurring, the uterus or your womb is getting empty. And because it’s getting empty the womb starts to contract. So those contractions, you would feel them as lower abdominal pains. There is going to be bleeding. However, obviously we don’t want to be excessive so we also monitor for that. The medication, Misoprostol that we use for priming, they do have some side effects. The most common one is shivers, feeling hot and cold.

Priming is when misoprostol pills are given to help widen the cervix – making it easier for a surgical abortion to be done.

7) Do you have to stay overnight?

Boitumelo Lewele: The surgical procedure is a same-day procedure even though it can take the whole day. But ideally, women come in the morning and by the afternoon they get discharged.

8) Do you need to get someone to take you home?

Boitumelo Lewele: With our conscious sedation procedures, [for] 12 hours after the

procedure, you are not allowed to drive so we do advise women that they need to arrange for transportation. But if you’re doing the procedure without sedation, you would have been discharged in a condition where you would be able to drive yourself home.

9) Could complications occur?

Although complications are rare, the following could happen:

● An infection might develop but antibiotics can help to treat this

● You could experience severe pain, discomfort or heavy bleeding. In such a case, you should see a doctor

Boitumelo Lewele: At Marie Stopes South Africa, if you have medical aid, we’re able to call the nearest private hospital. Usually discuss with the Gynaecologist on call, [and] it’s the same with our public hospitals. If there is any complication and you need to be referred to a hospital, we contact our ambulance that then transfers to and that cost is settled by Marie Stopes South Africa and not the client.