Dilation and Evacuation
In the state of North Carolina for the year 2002 (the most recent year for which statistics are available at this time), 38.0% of abortions were performed using this method. This technique is used in pregnancies up to 20 weeks along.
The cervix is dilated in the same manner as suction curettage, but this method is commonly used with pregnancies that are further along, so the dilation may need to be wider to allow for larger instruments to be used in the uterus. The baby is typically too large to fit through suction tubing if this method is used, so the body parts have to be pulled out with forceps, breaking them into pieces beforehand if necessary.
Tubing that is attached to a suction machine may then inserted into the uterus to remove any remaining uterine lining or body parts of the baby. If necessary, the uterus will also be scraped, using a curette to be sure all parts of the baby, uterine lining, and placenta have been removed.
Dilation and Extraction (D&X)
This procedure is used late in pregnancy when the baby is too large for other abortion methods, typically after 20 weeks of pregnancy. The entire process takes three days to complete. In the first two days, the cervix is dilated with laminaria in two or more sessions and medication can be given for cramping.
On the day of the actual procedure, the laminaria are removed, and the membranes that hold fluid around the baby are ruptured. The patient will then be injected with Pitocin to induce contractions. The doctor will use an ultrasound to locate the baby’s legs in the patient’s uterus. The doctor will reach into the uterus with forceps, grasp a leg, and pull it into the patient’s vagina. The doctor will deliver the rest of the baby with his hands (body, shoulders, and arms) up until the head.
The doctor will then hook his fingers over the shoulders of the baby, and insert a pair of surgical scissors into the base of the skull to create an opening. Removing the scissors, the doctor will insert a suction tube into the opening and suction out the contents of the skull so that without the brain, it will collapse. The doctor will then remove the placenta with forceps and suction and/or scrape the uterine wall with a curette.