Illustration by Frances Cannon
by Maya Dusenbery
When I accidentally became pregnant at 23, I was working a reproductive rights advocacy organization and surrounded by pro-choice friends. Yet, incredibly, I didn’t know anyone who’d had an abortion—at least that I knew of. Of course, once I started telling people about my own plans to terminate my pregnancy, I found two co-workers and a family member who could tell me about their abortions.
I had lots of questions. Though I talked about abortion in the abstract every day at my job, a lot of what I knew was not so useful now that I needed to get one. I didn’t know basic facts about the procedure, like how long it would take, how painful it would be, and how much I would bleed afterward. Deciding to end my pregnancy was easy, but I wasn’t sure whether to get a surgical or medication abortion or whether or not to stay awake for the procedure.
As someone with no moral qualms about my choice, I realized any stress I felt about the prospect of getting an abortion was largely a product of a dearth of information. Thanks to the silence surrounding the procedure, it felt like I was entering a black box—which seemed ridiculous considering I was doing something that nearly 1 million people in the U.S. alone do every year. While getting an abortion is in many ways a very individual experience, here are some things to know about what to expect and how to prepare.
Figure out how you’re going to pay for it.
Since I happened to be in-between health insurance plans when I got pregnant, like roughly half of abortion patients, I ended up paying for my procedure out of pocket. It wasn’t cheap: In the U.S. the average cost of a procedure at 10 weeks of pregnancy is just over $500; a second-trimester procedure can be over twice as much.
If you are privately insured, call to find out if your plan covers abortion care (and, of course, double-check that the clinic is in-network). Though laws in many states forbid insurers from covering abortion, some people end up paying for the procedure themselves simply because they didn’t realize their plan covered it. If you have Medicaid, the Hyde Amendment bans federal dollars from being used for abortion coverage for you, but 15 states employ state funds to cover abortions that are deemed “medically necessary.”
Prepare for any anti-choice restrictions or protesters.
The majority of U.S. states have at least one law that creates uneccesary hurdles to receiving an abortion. In several states, abortion providers are required to perform an ultrasound—even if it’s not medically necessary—and offer you the chance to see the image of the fetus. In a handful, they’re forced to actually show and describe the image to you. In others, your provider must give you false information about the procedure’s risks, like a non-exist link to breast cancer or infertility.
The physical discomfort of normal pregnancy symptoms can be an emotionally stressful reminder of the unwanted process happening in your body.
While you can’t avoid these restrictions, you can go into the procedure forewarned. You’ll especially want to know if you live in one of the 14 states with waiting period laws that require you to get in-person counseling 24 hours (or even more) before your procedure, since that means you’ll have to make two trips to the clinic. And if you’re under 18, make sure you know your state’s requirements on involving your parents. Finally, when you make your appointment, ask the staff if you can expect there to be anti-choice protesters outside the clinic. If so, they may have escorts that will walk with you; if not, consider bringing a friend.
Figure out which kind of abortion procedure you want.
Up to 10 weeks of pregnancy, you can usually choose to have either a surgical or a medication abortion, which are two very different experiences. In the first trimester—which is when nearly 90 percent of abortions occur—the doctor will use a suction device to remove the contents of your uterus out through your cervix in a procedure called vacuum aspiration. It takes several minutes and, if you choose, can be done under local anesthesia while you are awake (more on that later). In the second trimester, a somewhat more complicated procedure called dilation and evacuation (D&E) is usually used and stronger anesthesia to put you to sleep is advised.
In a medication abortion, you will take pills that effectively induce a miscarriage: first mifepristone (taken either at the clinic or once you’re home, depending on your state’s law) to interfere with the hormones that support a pregnancy, followed— up to 72 hours later—by misoprostol to induce cramps that expel the contents of your uterus. You’ll have heavy bleeding for a few hours, as well as perhaps some nausea, vomiting, fever, chills, diarrhea, and a headache.
A surgical abortion may be your best option if your priority is to “know without a shadow of doubt that it is done with immediately,” says Dr. Angela Marchin, an ob/gyn in Colorado and a fellow with Physicians for Reproductive Health. “It’s over in about five minutes and we can confirm that the pregnancy is out of the uterus that same day.” A medication abortion, in contrast, happens over the course of a few hours and you’ll typically be advised to come back to the clinic for an ultrasound in a week or two to make sure that it was complete. The recovery time is also more drawn-out: Bleeding after a surgical abortion can last for a week or two, but with a medication abortion, it typically lasts 2 weeks or even up to a month.
On the other hand, while a surgical abortion is extremely safe, it is still an invasive procedure performed in a medical setting—not the comfort of your own home. “Some people choose to do a medication abortion because they want to avoid surgery at all costs,” Marchin says. With a medication abortion, you have more control over when and where the process happens. You can be around only people you know and love—or you can do it entirely alone. You have access to your favorite sweatpants and streaming show.
Decide how much anesthesia and pain medication you want.
For a first trimester surgical abortion, you’ll usually have the option of a range of anesthesia levels—from Ibuprofen and local anesthesia to numb the cervix to heavy-hitting sedation delivered through an IV that puts you in a light sleep. If you have a medication abortion through a provider, you’ll likely be given a prescription pain killer.
If you are awake for the procedure, you’ll likely have some pain or discomfort, but just how much is difficult to predict. “People’s pain experiences with both medication and surgical abortion are really variable,” says Marchin. Though many patients report that it feels like some intense—but short—menstrual cramps, some find it much less painful and some find it much more so. Some experience nausea and vomiting right after the procedure. You should follow your own knowledge of your pain tolerance to determine what level of anesthesia you think is best for you. And keep in mind that emotional distress can amplify physical pain.
Given that roughly one in four women in the U.S. will have had at least one by age 45, you almost certainly know someone who has been through the experience.
Other factors to consider: if you choose sedation, you’ll have to spend longer in the recovery room. You’ll also be required to have someone pick you up afterward. And the cost typically rises with stronger anesthesia. Apart from the pain, those who stay fully awake for a surgical abortion sometimes find the sound of the suction machine to be disturbing. Ask the clinic if you can bring earbuds and listen to music or a podcast to distract yourself.
Ease unwanted pregnancy symptoms.
There’s a good chance you’ll have to wait at least a few days once you’ve decided to have an abortion and before you actually do. This period will likely feel like an eternity. When you’re about to have an abortion, the physical discomfort of normal pregnancy symptoms can be an emotionally stressful reminder of the unwanted process happening in your body.
Cramping is a frequent complaint in the first trimester. While people who are continuing their pregnancy are told to avoid most pain medications besides Tylenol because of their effects on the fetus, if you’re committed to ending your pregnancy, feel free to take Ibuprofen, Marchin says. For nausea, you can try over-the-counter Benadryl or Dramamine. “But if you are really having morning sickness, it may warrant a trip to urgent care or a doctor to get a prescription for something for nausea,” says Marchin. (Anecdotal reports suggest weed may help both cramps and nausea.) Constipation, which is also very common, is fine to treat with an over-the-counter medication. And Marchin adds advice that holds true post-abortion as well: “Definitely stay hydrated.”
Find other people—in your IRL community or online—who’ve had an abortion.
Given that roughly one in four women in the U.S. will have had at least one by age 45, you almost certainly know someone who has been through the experience. But if your community is more conservative than mine, it may feel risky to open up about what you’re going through. Indeed, research has found that if you tell friends or family about your abortion and they are less than 100% supportive, it tends to negatively affect you even more than not telling anyone. So choose your confidants carefully.
Maybe you don’t want to discuss your decision with anyone else, but would still like to hear about other people’s abortions to help demystify the experience and break the illusion—a product of the stigma and silence surrounding the choice—that you are alone. Thankfully, these days, you can find many first-hand accounts of the experience online in forums like Shout Your Abortion or We Testify or the 1 in 3 Campaign. “Sometimes that can help alleviate some of the stress and stigma just by seeing how many people out there have gone through this,” Marchin says. And though you should feel zero obligation to share your own story, for some, doing so “can be very empowering.”
Find a loved one or abortion doula to accompany you.
Decide if you want company or solitude. I decided to go alone to my abortion appointment and my roommates picked me up afterward. In retrospect, I’d probably have someone stay with me—if only because there was so much waiting around. Though the actual procedure is very quick, between counseling, waiting, prepping, and recovery time, the appointment usually takes a few hours. (If you do go alone, make sure you bring things to listen to or read.)
If you aren’t lucky enough to have anyone in your life who will be a calm, judgment-free presence, you may be able to find a doula who will. Like birth doulas who offer physical, emotional, and practical support to pregnant people during labor and delivery, abortion doulas provide the same kind of support during a termination. “Full-spectrum” doulas work across the whole range of pregnancy outcomes—from abortion to miscarriage to birth.
Everything from devastation to elation to total indifference is A-okay—though the vast majority of abortion patients report feeling relief.
“A lot of [a doula’s role] is just keeping somebody company, helping them focus their mind or distract them depending on what that person needs at that moment,” says Jessica Byrne, a partnership coordinator for The Doula Project in New York City. During and after the procedure, a doula can hold your hand, wipe your brow, give you a heating pad. Their mere presence as someone “who is not poking and prodding or monitoring you” can help mitigate pain, Byrne says, and they’ve usually been trained in breathing and visualization techniques that can help, too.
Many doula collectives partner directly with clinics, but if your clinic doesn’t offer them, see if you can bring your own support person—a friend, family member, partner, or independent doula—and how much of the process they’ll be able to accompany you for. Depending on your clinic’s policy, they may or may not be allowed for the procedure itself. To find an full-spectrum doula, check out Radical Doula’s list of doula organizations by state or ask your local NNAF abortion fund if they have recommendations.
If you’re going it alone—and even if you’re not—check out The Doula Project’s DIY Doula zine, which provides self-care advice and resources for those who don’t have a support person or doula.
Prepare for your recovery.
Take a sick day the day of your surgical procedure—or, if you choose a medication abortion, the day you take the misoprostol—and potentially the day afterward as well, if you can. Physically, how soon you are ready to get back to your normal routine depends on your unique physiology, what kind of abortion you got, and how far along in pregnancy you were.
People’s emotional responses vary just as dramatically as their physical ones. “When a pregnancy ends, it doesn’t necessarily mean someone is going to be sad or happy,” Byrne says. After all, people get abortions in wildly different circumstances. My experience terminating an unintended pregnancy as a staunchly pro-choice 23-year-old was undoubtedly nothing like the experience of someone morally opposed to abortion or someone ending a much-wanted pregnancy. If I got an abortion today, at age 33, I might be far more ambivalent about whether or not to continue an accidental pregnancy than I was a decade ago.
“There is no right or wrong way to react to going through one of these procedures,” Byrne says, so try to let go of any expectations about how you should feel. Everything from devastation to elation to total indifference is A-okay—though, whatever else they may feel, the vast majority of abortion patients report feeling relief.
Above all, remember that you deserve to feel supported in your choice. “If you can’t find support among your family and friends, find ways to support yourself,” Byrne says. “Self-care is incredibly important. And that can take all forms: It can be sitting on the couch and watching Netflix and eating ice cream. It can be going for a walk or producing art or writing.” Maybe you want to take some time to celebrate not being pregnant anymore—or to mourn it. Maybe you want to talk about your feelings with a friend, or counselor, or a non-judgmental stranger through Exhale Pro-Voice’s talkline. Or maybe you just want to carry on with your life ASAP and never think about this experience ever again.
Just as only you could decide if an abortion was the right choice for you, you’re the only one who will know what you need afterward—and you should claim it unapologetically. As Byrne says: “Every person deserves care and respect.”
Maya Dusenbery is a journalist, editor, and author of Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick. Follow her on Twitter at @mayadusenbery.