Termination of Pregnancy (Abortion)

There are instances in which a decision is made to terminate a pregnancy for various reasons. Some of these being medical reasons and some personal reasons, pertaining to the woman herself and arising from her personal considerations. In such instances, an induced abortion will be performed, which will lead to the arrest of the development of the embryo/fetus in the uterus, and in fact, empty the uterus of its content.

In Israel, the decision to terminate a pregnancy must be approved by a special committee, and after approval, will be performed by a physician expert in abortions.

Induced abortion can be performed in three ways – medicinal treatment, aspiration abortion, and induction abortion. The decision regarding the method by which it will be performed is made depending on the time that has passed since the pregnancy began, the woman’s health status and additional medical considerations.

It should be noted that termination of pregnancy is a very complex decision, mainly emotionally, for most women, and it is therefore important, to also focus on the emotional and mental aspect. Prior to performing the procedure, it is recommended to consider preparatory emotional treatment, so that the procedure is completed in the best possible way from all aspects.

When can termination of pregnancy be carried out?

There are three defined time periods in which termination of pregnancy can be carried out:

• Week one until the end of Week six: Abortion using medicines
• Week seven until the beginning of Week 14: Vacuum aspiration and curettage
• Week 14 until the beginning of Week 20: Induction abortion

General information about abortion

As mentioned above, termination of pregnancy begins with a meeting of the woman with a special medical committee – a committee whose role it is to approve the termination of pregnancy. Without this approval, termination of pregnancy cannot be performed. The application will be considered in accordance with various criteria, mainly depending on the woman’s request and the reason for which she seeks to perform the abortion – age too young or too old, a pregnancy outside of marriage, embryo/fetus with severe defects, and more.

After approval of the committee, the phase of medical treatment will begin. First, you will undergo general examinations connected to pregnancy (and in accordance with the medical history that is certainly held by your gynecologist), and in accordance with the status of the pregnancy and your medical status, a decision will be made regarding how to perform the termination of pregnancy.

If the pregnancy is at a very early stage, up to the end of Week six, the abortion may be performed using medicines – a procedure that is considered to be relatively easy and that does not require any hospitalization. If the pregnancy is at a more advanced stage, surgical intervention will be required. It should be noted that abortion will usually be approved only up to Week 24 of the pregnancy, but in special cases, abortion can be performed even at more advanced stages – subject to the approval of a special committee, a ‘supreme committee’.

Preparation for termination of pregnancy

Early abortion, performed using medicines, needs no anesthesia and will not even necessitate hospitalization, as mention above. The only preparation needed here, then, by the woman’s decision, naturally – is mental and emotional preparation, due to the significance of the procedure. Abortion is more advanced stages is usually performed under general anesthesia, with all that this entails. On occasion, it can also be performed under regional or local anesthesia, by anesthetizing the region of the cervix.

The course of the procedure

If the termination of pregnancy is performed from Week seven onwards, it can be done by two methods: vacuum aspiration or removal of the uterine content using appropriate tools. Generally, vacuum aspiration will be performed up till Week 14, since after this the fetus is considered quite large and cannot be removed by this method.

In either case, you will be asked to undergo “preparation” of the cervix before the procedure itself: the region will be dilated using medicines or using special rods (laminaria), in a process that may take several hours or a few days, and is performed in order to make the course of the abortion itself easier.

After the cervix is sufficiently dilated, the procedure begins. In case of vacuum aspiration, a special tube will be introduced via the vagina, which works as a suction pump facilitating the abortion in this way; if vacuum aspiration is not suitable, the abortion will be performed, as mentioned above, using special instrumentation. In either case, the physician will then perform curettage using a curette, in order to make sure that no remnants of the pregnancy remain in the uterus.

The entire procedure takes half an hour at the most. After you recover from the anesthesia, you will remain under observation in the hospital for a few hours and will be discharged to your home, usually on the same day. It is recommended to rest for at least 24 hours after the procedure, in order to enable your body to recover.

Aspiration abortion and curettage

In case the termination of pregnancy is performed at a later stage, medicines can no longer help and surgical intervention is needed – aspiration abortion. Prior to the aspiration itself, the physician will introduce a special substance to the cervix, causing it to dilate. This procedure helps preserve the structure of the cervix, with the aim of not impairing the chance for a normal pregnancy later in the woman’s life.

After dilation of the cervix, the woman will be transferred to the operating room, where she will be anesthetized. A tube introduced into the uterus will suck its contents into an empty container, effecting the termination of the pregnancy. After that, on occasion curettage is performed, using a special instrument, in order to ensure that no remnants remain that could cause infection in the uterus.

Aspiration abortion is a procedure that requires only one day of hospitalization. After the woman recovers from the anesthesia and returns to full consciousness, she is discharged to her home – except, of course, for cases in which fever appears or some other health problem is discovered.

Side Effects

Apart from side effects sometimes caused by general anesthesia (mainly nausea and vomiting), many women suffer from certain pains in the region of the vagina and uterus, and may also suffer from various intensities of bleeding, for about two weeks. Due to the emotional difficulty, depression, anxiety, and sadness could also accompany the initial days after the procedure.

There are various complications that could be caused by the abortion, such as infection in the uterus, bleeding due to tissue remaining in the uterus (if curettage was not done completely) and perforation of the uterine wall, but today, these cases are very rare. These complications could also impair the ability to become pregnant in the future, but since these are rare cases, such impairment due to abortion is considered very rare.

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