In the weeks leading up to my abortion I developed a single-minded, day and night obsession with researching what the procedure was actually like. Having never had any sort of surgical procedure before I was extremely nervous, and that led me to googling “surgical abortion experience” like that shit was my job.
If you’re reading this right now then chances are you’ve gone down a similar internet rabbit hole; please know that you are not alone, and you are not overthinking it or 'being crazy'. The impetus for writing this whole guide came from years of late night conversations with friends who had either had an abortion or were about to.
During these conversations the most recurrent theme was the sense of urgency (either current or remembered) in wanting to know exactly what takes place during an abortion. Hospital procedures don’t really inspire good vibes to begin with, and when the particular procedure comes with additional millstones of secrecy, stigma and isolation it’s pretty reasonable that you’d want to ask questions of people who’ve come through it.
So, with the help of contributors (who, again, I’m extremely thankful to) I’ve written this section to outline the abortion procedure as thoroughly as possible. I’d firstly like to point out and apologise for the fact that this description only covers the surgical procedure — the women who contributed to this guide all underwent surgical abortion, but I do acknowledge that many women choose medical termination, either by preference or out of necessity. If you have chosen, or are thinking about, medical termination then abortion.org.nz has one of the better run-downs on what to expect. The website So Feminine also has a number of first hand accounts from women who experienced medical termination, although the site is UK based.
At current there are 11 medical centres in New Zealand that offer medical abortion: Auckland Medical Aid Centre, Epsom Day Unit (Auckland), Surgery on Shakespeare (Auckland), Tauranga Family Planning, Gisborne Hospital, Wairarapa Hospital (Masterton), Te Mahoe clinic (Wellington), Nelson Hospital, Lyndhurst Clinic (Christchurch), Dunedin Hospital, and Southland Hospital (Invercargill).
As discussed in Part One of this guide, delays within our public system — both mandated and circumstantial — mean that the wait time to accessing a termination can stretch out over weeks, making it a likelihood that you will experience some degree of pregnancy symptoms and side-effects. Of the six contributors I spoke with (again, all of whom had first trimester terminations) five experienced morning sickness prior to their termination; all experienced one, or a combination of, other symptoms, such as tiredness, backaches, mood swings, headaches or food aversions.
A set of invasive, unfamiliar symptoms combined with the anticipation of an invasive, unfamiliar procedure can make for some pretty miserable going, so if you are in a position to take some time off work/study/school prior to your abortion then this may be worth doing. Drink plenty of water, eat whatever you can stomach (even if it means living off toast and apples for a week or so), don’t overload yourself with social obligations and, most importantly, be kind to yourself — your priority here is physical and mental wellbeing for yourself as a pregnant woman, not yourself as a vessel for a foetus.
On the day of/night before your procedure get your bed/couch/general chill space fluffed up and ready to snug into. Have some movies or TV shows lined up, assemble a selection of your favourite snacks (most clinics will require you to stop food and water intake several hours before your procedure, so you are likely to be hungry even if you don’t think you will be) and generally set your spot up in a way that is comfortable, comforting and befitting of the brave and awesome queen you are. Choose comfy, loose fitting clothing to wear to and from the hospital, and also set aside a pair of “period undies” (you know the ones) and a couple of maxi-pads. If you have long hair it’ll need to be tied back, so chuck a couple of hair-ties in your bag also.
If your appointment is early in the morning, set your alarm the night before and have transport pre-arranged (you cannot drive yourself home from the hospital so there’s not much point in driving yourself in). If you have a support person taking you in then triple check that they have the correct time. Allow wiggle room for any traffic delays or parking hassles—this is particularly important if you’re travelling into Auckland’s Epsom Day Unit, as traffic around there can get hectic. Clinics tend to be strict on punctuality, and if you’ve already been waiting weeks for this appointment the last thing you want is to be told that you have to reschedule.
In New Zealand first trimester surgical termination is, as standard, an outpatient procedure performed under "conscious sedation” — meaning you are awake, but made drowsy through a combination of benzodiazepine (anti-anxiety) and short-acting narcotic (pain relief) medications. In Auckland, Wellington and Christchurch you may have the option of having the procedure performed under general anesthetic; however, due to the risks and costs associated with general anesthesia it is generally only made available to women who have pre-existing medical conditions, or who are experiencing severe anxiety over the procedure, as was the case for one contributor:
“I was so wound up... and feeling general anxiety about people getting up in my nether regions — I have been through many pap smears with an awesome GP, as well as an IUD insertion and removal, and still squirm at the idea of people doing things to my vagina/cervix…the doctor said [general anesthetic] was possible and it would also be funded at no extra cost. I believe this was only granted due to my extreme anxieties around having someone perform the termination whilst I was awake.”
If you do feel that general anesthetic is the right option for you then this is something you will need to discuss with your first Certifying Consultant well in advance of your procedure date — you can not simply ask for it on the day. The surgery will need to take place at a general hospital, as opposed to an abortion clinic, and there are also only a limited number of spaces available each week.
If you have chosen to have your abortion under conscious sedation then this is a composite run-through of what you can expect on the day:
When you arrive at the clinic you’ll be asked to produce ID at reception before being sent through to the waiting area. The level of privacy you’re afforded from this point on is dependent on where your appointment is taking place. Because the procedure itself is so fast clinics tend to run Day Two appointments in scheduled blocks, i.e an early morning block and an early afternoon block. This means that if your check-in time is, for example, at 8.15 in morning you’ll be arriving at the same time as several other women (and their support partners), and will be waiting with those same several other women through the morning.
If this sounds daunting then just remember that everyone is there for the same purpose — there’s no pretending otherwise at this point — and, as one contributor recalls, seeing first hand that you are far from alone in your situation can actually provide a source of comfort on what is likely a nerve-wracking day: “It might sound weird but I don’t think I’ve ever really felt such a strong current of empathy in a room. The atmosphere certainly wasn’t chatty but it was more like there was this mutual understanding like ‘hey, you’re gonna be alright’.”
There are a multitude of personal, complex reasons that led a diverse group of women to sharing the same clinic waiting room as you; these reasons are of no concern to you, just as yours are of no concern to them. The one common factor is that you’ve all made the same choice, and for a few hours of a single day in your lives you are kindred in that choice. Respect that brief mutuality, and trust that the women you are sharing those outdated magazines and faded waiting room couches with do too.
Once everyone has checked in you are taken through to a second, smaller waiting room with the other patients — your support person is asked to stay behind in the general waiting area, and will not be able to rejoin you until shortly before your procedure. Each woman is called through one at a time to meet with the second certifying consultant. This appointment takes about five minutes, with the second consultant going over notes from the first, answering any questions you may have and once more confirming that the decision is yours and it’s one you are sure of. You will also be required to sign a document to this effect. You then go and sit back out in the smaller waiting room until a nurse arrives to take you through to your bed-space/surgical wait area.
As mentioned above, privacy is not really high on the list of priorities for public clinics, and one thing you do not really get told beforehand is that the bed-spaces are literally bed spaces — as in a row of beds separated by curtains (private clinics — living up to their name — provide patients with their own waiting and recovery rooms, which I guess you’d expect for the money). All patients are taken to their bed-space in order of their surgery, i.e. if you’re second to be taken through to your bed you will be second to go through to surgery.
As you can imagine, this set-up means you may be privy to all sorts of post-surgery reactions, as one contributor explains, “from memory I was in bed space five, but I didn’t hear anything until the girl who went in right before me came back to her bed crying, which freaked me the fuck out! I looked at the nurse like ‘oh my God’, because I was already so nervous, but she was really lovely and just told me that everyone reacts differently… that the drugs and sudden hormonal drops can make some women quite emotional… that it was nothing to do with pain or anything like that.”
At your bed-space you’re introduced to a nurse (hopefully awesome like the one above), who will take care of your for the rest of your stay. You’re given a gown to change into (the maxi-pad that you packed earlier will need to be placed in your undies ready for post surgery) and then you’re asked to hop into bed to stay warm.
Shortly after you get settled in your nurse returns with a little plastic cup containing three pills. The first of these pills is a standard ibuprofen. The other two pills are Misoprostol. These hexagonal tablets are given to soften your cervix in preparation for the procedure; they are also an abortifacient in themselves and because of this the nurse administering them is VERY clear that once they’ve been taken the termination process is essentially underway.
The tablets are placed under your tongue and left to dissolve for around 15-20 minutes—there’s no taste but the texture of the slowly disintegrating pills is pretty gross, particularly if you’re already feeling nauseous, so try not to move your tongue around too much. Misoprostol can cause uterine contractions, and some women may experience cramps and/or bleeding, which is why you are given the ibuprofen with them. Once you have taken these pills your support person will be allowed to come through and join you in your little cubicle, where they can hug you, or hold your hand, or tell you silly jokes, or just do anything to help you relax a little bit.
Around 40 minutes before your procedure your nurse returns with a small dosage of antianxiety medication (usually either midazolam or lorazepam). What constitutes a “small” dosage I guess really depends on your own tolerance and experience with Benzodiazepine medications—if you’re feeling particularly freaked out, or are used to using benzos for anxiety, then you could always ask for a higher dosage, but do keep in mind that the aim here is to have you feeling calm, not completely out of it. I asked the women who contributed to this story what they did to stay chill while waiting for surgery and here are some suggestions:
- Stay chatting with support person or nurse, about anything
- Practice breathing exercises or light meditation
- Remind yourself that this whole experience will be over very soon
- Listen to music
- Make a mental list of all the things you want to achieve in the next year, or think about something you are looking forward to.
At this point the nurse also inserts a cannula into your arm in preparation for pain relief — this is probably the only physically uncomfortable part of the surgery experience.
When it’s time to go into surgery your nurse comes through to help you get into a pair of surgical slippers and a hairnet (this is where that aforementioned hair-tie comes into play) before leading you through. For safety reasons your support person is not permitted to join you in surgery. Early abortion may be a surgically minor procedure, but it’s still an emotionally charged one, and the priority for surgical staff is your comfort and safety, not that of an extra person whose emotional or physical reactions they cannot predict.
In surgery the nurse sets you up on the bed before hooking you up to a drip of fentanyl — a strong and very effective pain reliever. A second nurse may also be there to put your feet into stirrups and to assist the doctor during the procedure. I asked contributors about their experience with the surgical nurses and all of them spoke in some way about the kindness and compassion they were shown—the nursing staff really do their upmost to keep you relaxed and comfortable.
After a minute or so the fentanyl will be kicking in and you should be feeling physically very relaxed, if not a little woozy. A nitrous oxide mask may also be given, however, some contributors reported that they found this unpleasant and dizzying—if you have this reaction then speak up or just take the thing off your face.
The question I’m sure you have at this point is “does it hurt?” In short answer: No. I personally did not experience any pain, and neither did any of the contributors I spoke with. From my own perspective any discomfort I did feel (which again, was extremely minimal and mainly concerned the anesthesia aspect, which I wasn’t used to) paled in comparison to experience of being pregnant when I didn’t want to be, of morning sickness and the feeling of not being in control of my own body, and of fear at the thought of raising a child that I simply wasn’t ready or equipped for.
The doctor starts by basically disinfecting your whole vagina, before administering a shot of local anesthetic to your cervix (you are very unlikely to feel this; Fentanyl is no joke). They then begin the procedure, explaining every step as they do it (if you want them to). You will be shocked at how quickly and painlessly it is over — the most uncomfortable part of the whole five or so minutes is at the end when the doctor puts antibiotics in your butthole — it is over now though, and the painlessness of the surgery and proficiency of those performing it is what you deserve. You are awesome.
After surgery you are helped back to your bed-space and given some juice, a small snack and a bit of chill out time. A nurse will monitor your blood pressure but unless it is very low you should be free to leave after about 30-40 minutes. And that’s it.
When you arrive home get into the snug space you prepared earlier, line up your movies and try to eat something. Keep a large bottle of water handy and also be prepared for a potential bit of rough going—some contributors (myself included) experienced nausea, vomiting and moderate to severe cramping within about two hours of the procedure. Other contributors had no issues and simply napped or chilled out for the rest of the day.
Your emotional response to what you’ve just been through is your own — some contributors spoke of feeling nothing but relief; others experienced profound sadness, as one women shares:
“For me, I knew I did not want this baby and have never ever regretted the choice I made. However I love the man who was the father of this baby and I grieved the fact that this had happened to us and we were forced to make a decision. It is okay to grieve — your grief and loss may be hidden from loved ones, friends and society. Some people may not understand or think you are allowed to grieve what has happened… but you are.”
Hopefully that night you sleep like someone who was faced with a shitty decision, who went through a shitty time, and came out of it with a new-found appreciation for their own strength and autonomy.
Your body. Your choice.