Definitions and Guidance for Abortions at Different Stages 

Following on from our first guide on abortion laws and rights in the UK, this blog will unpack some of the main differences between different methods of abortion and abortions at different stages of pregnancy. 

At Spark, we are committed to sharing information that supports people through life’s complex experiences. While we are not healthcare providers, we believe in making trusted resources and guidance accessible. This series of guides has been created in partnership with Ad’iyah Collective, an abortion and miscarriage supportive service for Muslims. This guide explores different ways pregnancies can end, acknowledging the varied experiences people go through, whether planned or unexpected. We aim to provide clear, compassionate, and non-judgmental information to support individuals navigating these moments.

We encourage you to speak with a qualified healthcare professional or access specialist services if you need medical advice or support. We are not healthcare professionals, and the contents of this blog should not be taken as medical advice.

Types of Abortion

In the UK, medical and procedural abortions are available: 

• Medical abortion is an abortion that uses medication to release a pregnancy. 
• Procedural abortion is an abortion where a procedure is involved to expel a pregnancy. Medication may also be used. 
• Surgical abortion: Sometimes, procedural abortions are referred to as surgical abortions, but technically, procedural abortions do not involve a type of surgery as no incisions are made.

The type of abortion you have depends on a number of things, including: 

• How many weeks pregnant are you 
• Abortion law considerations 
• Any pre-existing health conditions
• Your personal preference 
• If it is safe to pass a pregnancy at home, and more.

There is no wrong or right method for your abortion, and you should be able to discuss your preferences with your provider.

Medical abortion

Medical abortions are available up until 9 weeks and 6 days of pregnancy in the UK. After this, a person must have a procedural abortion.

To have a medication abortion, a person has to contact an abortion provider (BPAS, NUPAS, MSI), their local GP or sexual health clinic. Usually, the provider will arrange a time to call you back with a follow-up appointment. Abortions are time-sensitive, and these appointments are usually within a few days.

In this appointment, the person will be asked questions about their health, lifestyle, last menstrual period, and preferences. The provider will also use this call as an opportunity to check the abortion falls within the legal parameters and may ask additional questions to ensure the two doctors involved are satisfied. It can be helpful to prepare in advance for these questions and write down key things like your last period, why you want to have an abortion, any health conditions you have, and any questions you have for the provider.

When the provider is satisfied that your abortion fits into the legal criteria and that it is safe for you to have an abortion at home, the abortion pills will be posted to a person’s home or available for pick-up at a clinic.

Sometimes, a person may be asked to visit a clinic for an ultrasound. This can be to confirm how many weeks pregnant a person is or to confirm that it is safe to have a medication abortion. It is an established medical fact that abortions by pills are safe for the majority of the population. They can be unsafe for people with IUDs (Intrauterine Devices), certain health conditions, and a history of and/or current concerns of ectopic pregnancy.

How a medication abortion works

A medical abortion involves taking two prescribed medications, mifepristone and misoprostol. It can be done at a clinic or at home if the pregnancy is under 10 weeks. For more information on this, please visit the NHS website page on how and abortion is done here. 

Included in a medical abortion package is: 

• 1 x Mifepristone
• 4–8 x Misoprostol
• Higher-sensitivity pregnancy test
• Condoms
• Emergency information and helpline contacts
• Painkillers (optional)

The healthcare provider will explain how to use the medication safely and give you a booklet with diagrams and contact details for support. Please speak to a professional healthcare provider if you have any questions about the medical abortion. 

Procedural abortion

A procedural abortion is when a pregnancy is ended through a medical procedure rather than medication. These are carried out in clinics by healthcare professionals.

In the UK, there are two common types:

• Manual Vacuum Aspiration (MVA)
• Surgical Abortion (Dilation and Evacuation or D&E)

Manual Vacuum aspiration

This is a process by which gentle suction is used to remove pregnancy tissue from the uterus. This option is typically available up until 14 weeks of pregnancy. If someone has this type of abortion, they should anticipate being in the clinic for at least 3 to 4 hours. Before the procedure, most people will have ‘cervix preparation’ that involves taking abortion medication to soften your cervix. This makes it easier for the vacuum aspirator to work. 

Once the cervix has softened, the vacuum aspiration can begin. The procedure itself is quick, usually lasting about 5-10 minutes. Most people experience cramps and pain if they are awake. It happens in a clinic with a doctor and clinical staff present. Typically, these are the only people allowed in the room during the procedure, which is important to consider when developing care plans for yourself or someone you are supporting. 

A person can be put under anaesthetic for this procedure to help minimise the pain they feel during it. The clinic regulations and the week of pregnancy someone is in can influence whether this anaesthetic is local (sleepy but still awake) or general (unconscious). If a general anaesthetic is used, a person must be signed out of the clinic by an additional person and is not allowed to drive home.

After the procedure, a person will be taken to a recovery area where clinic staff will observe them and give them a snack and anti-nausea medication. The person will be kept there until the staff feel it is safe for them to go home, typically when the anaesthesia’s main side effects have worn off. 

Surgical Abortion: Dilation and Evacuation (D&E)

This is a process by which medical instruments and suction are used to remove pregnancy tissue from the uterus. This option is typically provided between 14 to 24 weeks of pregnancy, but there may be other factors that mean a person has D&E earlier. 

Like vacuum aspiration, a person’s cervix will need to be prepared before the procedure, and this can happen on the day of the procedure or the day before. Again, abortion medications are used to soften the cervix to aid the procedure. 

A person will also be administered a type of anaesthesia before the procedure can begin. For pregnancies over 18 weeks, this is almost always general anaesthesia. Pregnancies up to 18 weeks can be carried out under general anaesthetic or conscious sedation. You can ask questions about the types of anaesthesia available to help you decide which option is best for you. 

Once the cervix has softened, the vacuum aspiration can begin. The procedure itself is quick, usually lasting about 10-20 minutes. People under conscious sedation may experience discomfort and some pain during it. Again, only surgical staff are present in the room during this procedure.

After the procedure has been completed, a person will be taken to a recovery area, where clinic staff will observe them until they believe they are ready to leave. 

Additional procedures after 22 weeks

After 22 weeks of pregnancy, a person having an abortion will be recommended to have a procedure that stops the fetal heartbeat. This is in line with NICE (National Institute for Health and Care Excellence) guidelines and will always be discussed with a person before their abortion.

This procedure is sometimes called ‘feticide’. It can be upsetting to hear terms like this, especially as it is reliant on legal terminology and not the experience of the pregnant person. You can always ask a provider to use different terms to describe your experience. A person may also be given medication to stop milk production if they have an abortion after 18 weeks. If someone produces milk before 18 weeks, they can ask for this medication, too. 

Abortions beyond the legal limit

Abortions can and do happen beyond 24 weeks. These are legal in the UK when the continuation of that pregnancy is likely to result in a risk to life for the pregnant person or the developing foetus. 

Most people who have an abortion after 24 weeks will have been advised to do so by a medical practitioner following a pregnancy-related appointment or because a medical emergency has occurred. This can be a shocking and deeply upsetting experience for a pregnant person, which is heightened by the fact that they will often have to make a very quick decision about whether they would like to terminate the pregnancy or continue now that they are aware of the risks. 

If you are already in a clinic setting, the referral for an abortion will likely be done with your consent by clinicians who are already present. If a person suspects there might be something wrong with their pregnancy and they are not already in the hospital, they should contact emergency services via 999 and their perinatal unit. 

The procedure for these abortions will likely be a D&E (Dilation and Evacuation).

Following the same steps mentioned above (though it will depend on your unique circumstances). In most cases, abortions after 24 weeks are automatically investigated, regardless of whether any foetal abnormalities were suspected. Investigation results are usually shared around four months after the pregnancy ending, though it can take longer. Many trusts also offer access to a bereavement midwife and can refer you to counselling services for additional support.

These investigations are done to investigate any causes or reasons why the pregnancy was not able to continue or why the fetus was unable to develop as expected. They do not always provide definitive answers. This is optional and should be discussed with you before your abortion.

For some people, the term abortion can be challenging to use in these circumstances. Abortions are often associated with choice, and serious medical emergencies can leave you feeling like you do not have a choice in that situation. You have the right to ask your care providers to use language that affirms your experience.

Pregnancy remains

All abortions will produce some pregnancy remains or ‘products of conception.’ In earlier abortions, this might look like blood clots and larger pieces of tissue. Abortions that occur later in pregnancy can produce remains that more closely resemble what we typically understand as a foetus. 

For some people, seeing these remains can be shocking and upsetting. If you are passing a pregnancy at home, you might want to ask a trusted individual to look at them for you or flush them away. 

Other people might find it healing and important to look at the remains. Some may also wish to bury them and incorporate their cultural and/or religious traditions into this process. It is legal to bury them in your private space so long as they are in a sealed container. Several faith spaces also offer burial services, often for free. 

For abortions carried out later in pregnancy (typically 18 weeks and over), pregnancy remains may be intact after an abortion and look like a baby. Again, this can be upsetting for some people to see. Others may find it healing and helpful to see, touch or hold this.

You can ask a clinic for the products of conception. Several clinics also offer the option of donating the remains for research purposes.

Support services

Abortions can bring about a lot of emotions, some of which are difficult and complex to process. We often hear very polarising stories about abortion in the media, which can make it difficult for people who can’t relate to these things.

It’s common to feel relief, joy, grief, sadness, confusion and numbness. Sometimes, these feelings occur simultaneously. There is no “normal” way to react or feel. All emotions are valid.

It can be helpful to talk about your feelings with someone else, whether through a professional counsellor/therapist, a doula or someone in your community. When seeking a professional to speak to, you can ask clarifying questions to check their values align with yours. 

Examples include:

• Are you pro-abortion? Do you support abortions in all circumstances and at all points of pregnancy?
• I have experienced medical trauma and racism. Is that something you feel equipped to discuss? What work have you done on anti-racism?
• Do you support trans and non-binary people who have abortions?
• I’m not experiencing grief and don’t want the foundation of my counselling to be centred around grief. Are you able to hold space for the relief and joy I feel about my abortion?