Abortion Methods
There are several reasons for aborting a pregnancy, all of which involve medical and emotional processes. Every initiated procedure for terminating a pregnancy in Israel must be approved (under the law) by the pregnancy termination board. A pregnancy may be terminated either through medication or by surgical procedure, depending on the week of pregnancy. The method depends on the week of pregnancy, the medical condition and the decision of the attending staff. In some cases, and depending on the decision of the medical staff, they may choose to combine several different methods.
- Until week 23 and 6 days of pregnancy, the procedure will be the responsibility and will require the approval of the pregnancy termination board.
- From week 24, the pregnancy is defined as “viable”, and termination therefore requires approval of a special committee known as the Committee for Termination of Viable Pregnancy” or “Higher Committee”. Several hospitals in Israel allow for the convening of this Committee and for the abortion to be performed from this week.
Read more about the pregnancy termination boards here.
Pre-abortion assessment
The physician in the community will assess you, ask about your medical history and will perform, with your consent, a physical examination, an internal ultrasound to determine the age of the pregnancy as well as the location and number of gestational sacs in the uterus. They will also send you to undergo tests for blood typing, blood count and clotting function.
You should know: the blood type test is done to determine whether the administration of Anti D is necessary after the pregnancy termination procedure.
The next step in the process is called informed consent, during which you will receive a detailed explanation of your options, inform you about every possible procedure and list the advantages and disadvantages, complications and risks of each procedure. At the end of the explanation, you will be asked to sign a consent form for the procedure you choose.
Where abortions are performed in Israel
Abortions in Israel are preformed in recognized medical institutions that are authorized to perform abortions based on the age of the pregnancy.
| Abortion | Week from last menstrual cycle | Venue at which the procedure can be performed | Notes |
| Medical abortion | Until week 9 |
Hospital or licensed surgical clinic |
According to the reform under law, abortions can be performed in the community but preparations in the HMOs have not been completed |
| Surgical abortion | Until the end of week 12 | Hospital or licensed surgical clinic | From the age of 18 only |
| Surgical abortion | From week 12 + 0 and until week 24 | Hospitals that are permitted to perform the procedure | |
| Surgical abortion | From week 24 | Licensed hospitals that are permitted to perform abortions around the borderline of viability |
Abortion due to fetal abnormality
If you are forced to terminate the pregnancy due to a fetal abnormality and an abnormal pregnancy, the experience may be difficult and tumultuous, because the pregnancy was a wanted pregnancy. In such a situation, the processes during and after the pregnancy termination board can be more emotionally challenging and complex. You can contact the board's social worker and use her to process the experience and prepare yourself for what comes next.
Note
Note
If you have not yet reached week 9 and are deliberating about the method of abortion, medical or surgical, we recommend that you consult the medical staff of the board.
Medical abortion
A medical abortion is a procedure in which the pregnancy is terminated through medication. This procedure can be performed up to 9 weeks of pregnancy from the date of the last menstrual cycle. The procedure includes a combination of two medications, a medication known as Mifegyne (Mifepristone), and 48 hours later, another medication known as Cytotec (Misoprostol). The combined action of the two medications causes a termination of pregnancy and evacuation of the uterus.
Note: if you breastfeed, it is important that you inform the doctor during the examination and the doctor will instruct you accordingly, since you must not breastfeed while under the influence of the medicine.
Medications for abortion
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Mifegyne
A drug that blocks the effect of the hormone progesterone, which is a hormone that supports pregnancy and designed to protect the pregnancy. Mifegyne causes the uterine lining to become thin, thereby preventing the pregnancy from implanting in the uterus and growing.
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Cytotec
The medication causes contractions and bleeding to empty the uterus, softens the cervix and allows the gestational sac to exit the vagina.
Circumstances in which medical abortion is not possible
- Sensitivity to one of the ingredients of the medication: Mifegyne, Cytotec or prostaglandins.
- Adrenal insufficiency.
- Long-term use of corticosteroids.
- Blood clotting disorders or if you are using anticoagulants.
- IUD - the physician will need to remove it before the procedure.
- When the pregnancy is ectopic.
Stages of medical abortion
Possible side effects following a medical abortion
Some of the women who underwent a medical abortion reported experiencing weakness, nausea, diarrhea, vomiting, stomach pains or headaches, fever and chills several hours after taking Cytotec. Some women also reported heavy vaginal bleeding (similar to the menstrual cycle), accompanied by uterine cramps. Most of these effects were mild and disappeared after a short period of time. Heavy bleeding slowed down after 24 hours, and bloody staining may continue for several weeks. In case of pain or discomfort, you can use pain killers such as Acamol or Optalgin.
Medical monitoring following a medical abortion
Two to three weeks after the medical abortion, you will be scheduled for a check-up with a gynecologist to undergo an ultrasound to confirm that the procedure has been completed and that the uterus has properly emptied.
Efficacy of a medical abortion
The success rate of a medical abortion stands at approximately 90%. The success rates are higher the earlier it is performed in pregnancy and especially before week 9. Sometimes, following the procedure, the retained products of conception in the uterus must be surgically removed.
If there are no adverse events, your regular menstrual cycle will return within 4-6 weeks following a medical abortion. You may feel that your period is irregular, and this is normal. These disruptions are caused by hormone changes surrounding the abortion.
Unusual risks in a medical abortion
- Allergic reactions to one of the medications.
- Need to complete the procedure by curettage due to retained products of conception in the uterus.
- Unusually heaving bleeding and will occur on rare occasions.
- Infection.
Side effects and symptoms that require medical examination
- Increased bleeding that requires the bandage to be replaced extremely frequently (at least once an hour).
- Severe pain that does not disappear or stops with pain killers.
- Fever over 38 degrees.
- Vaginal discharge with an unusual odor.
- If after 8 weeks, you period has not returned.
Recommendations for reducing risk of infection
- It is important that you avoid baths, swimming pools or bathing in the ocean until the bleeding passes and preferably until the last visit.
- On the day bleeding days, avoid use of tampons or cups (until the next menstrual cycle).
- It is important to not have sexual relations (including vaginal penetration) until one week after bleeding stops.
- It is extremely important that you maintain hygiene and change pads when necessary. Note, intimate douching is to be avoided.
- It is important that you avoid becoming pregnant until the least visit with the physician. If you find it difficult to avoid sexual intercourse, it is recommended that you contact a gynecologist to obtain suitable birth control.
- Avoid drinking alcohol and smoking for several days according to the instructions of the physician treating you.
Surgical abortion
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Abortion with aspiration and curettage (VACUM aspiration)
Where it is performed: in private and public clinics, hospitals.
Until when abortion with aspiration and curettage can be performed: until week 12 in private clinics and hospitals. In public hospitals, the procedure can also be performed in the more advanced weeks of pregnancy.
Curettage performed after week 13 of pregnancy: requires slightly more complex preparation of the cervix. In these cases, the process of dilating the cervix may take several hours and up to two days.
The procedure: cervical dilation is performed with various methods according to hospital procedures and can be performed by inserting an accessory called laminaria tent forceps or by using Cytotec pills inserted through the vagina. Uterine content can be emptied through special devices. After dilating the cervix, the doctor who will treat you will insert a thin tube through the cervix, through which the uterine cavity will be emptied, and the gestational sac will be suctioned out. At the end of the operation, the uterine cavity is inspected to make sure it has been properly emptied. The entire procedure takes approximately fifteen minutes and is usually performed under general anesthesia. After several hours, you will be discharged home with instructions for further treatment and follow-up.
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Abortion through dilation and evacuation (D&E, Dilation and evacuation)
Where it is performed: in hospitals.
Until when abortion through dilation and evacuation can be performed: an abortion performed with this method may be performed until week 20 of pregnancy, and generally from week 14.
The procedure: in this procedure, the cervix is dilated with special measures after which the uterine contents are evacuated. At the end of the procedure, they confirm that all the tissues lining the uterus have been removed. The procedure is performed under general anesthesia and takes approximately 20 minutes. After several hours of observation or several days (depending on the week of pregnancy), you will be discharged home with instructions for further treatment and follow-up.
Possible side effects following a medical abortion
- Bleeding of blood clots.
- Cramps.
- Nausea, vomiting.
- Weakness.
You should know
You should know
Most women experience vaginal bleeding, similar to menstruation, for two to four days after the procedure. At the same time, the next day, you may not experience any side effects.
When to seek medical attention following a surgical abortion
- If large blood clots appear.
- If you experience heavy and unusual bleeding.
- If your vaginal discharge has a bad odor.
- If you have a high fever that is not resolved.
- If you experience pain or cramps that worsen instead of becoming better, particularly after 48 hours.
Risks of a surgical abortion
Most women do not experience complications beyond the common side effects, but it is important to know that the more advanced in the pregnancy that the abortion is performed, the greater the chances of complications that include immediate risks. These risks can appear right around the procedure and there are also later, largely rare, risks that can manifest themselves in the future.
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Immediate risks
Significant bleeding to the point of needing a blood transfusion or hospitalization, acute infection, perforation in the uterine wall that will require surgical intervention. On rare occasions, the cervix may be injured, or complications from anesthesia may occur.
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Delayed and rare risks
Cervical insufficiency that may cause premature birth in a future pregnancy or missed abortions, pelvic infection or uterine adhesion that may cause difficulty in becoming pregnant in the future.
Abortion after week 24
From week 24, the fetus is defined as a ‘viable fetus’. Abortion in this case will be subject to approval of a special committee known as the Committee for Termination of Viable Pregnancy” or “Higher Committee”. The procedure is performed in several hospitals that are recognized for this specific procedure. The procedure requires medical intervention designed to result in the cessation of the fetal heartbeat. This intervention is performed by a specialist physician in the Ultrasound Institute. At this stage, the medical staff will induce labor, similar to inducing a normal birth, adapted to the gestational age and obstetric history of the woman (for instance, if she had a C-section in the past). The delivery will then take place in the delivery room.
For more information about a stillbirth - abortion after week 24
The emotional aspect of abortion
Women seek an abortion for a variety of reasons. This decision has various emotional impact on the relationship. A range of emotional reactions that may occur following an abortion are natural and it is important that they be given space.
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Emotional aspect
You may feel anger, guilt, disappointment, fear, sadness, isolation or relief. A storm of emotions is natural in your condition. You are not to blame. If possible, you should share your emotions with someone close to you. Additionally, the social worker of the pregnancy termination board and the social worker during the procedure are available for you both to facilitate the implementation of the procedure and for emotional support and counseling.
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Impact on your relationship
The impact of the abortion on the relationship also varies in each case. Sometimes the event brings the couple closer, sometimes it distances them and sometimes it opens up past wounds. If there is a disagreement between you and your partner regarding the continuation of the pregnancy, you should seek mediation on the matter. You are also welcome to involve the board's social worker in the dilemma.
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Coping in case of termination of a healthy pregnancy
If you are forced to terminate the pregnancy due to a fetal abnormality and an abnormal pregnancy, the experience may be difficult and tumultuous, because the pregnancy was a wanted pregnancy. In such a situation, the processes during and after the pregnancy termination board can be more emotionally challenging and complex. You can contact the board's social worker and use her to process the experience and prepare yourself for what comes next.
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Coping in case of pregnancy due to non-consensual intercourse or rape
Remember it is not your fault. We recommend that you involve the pregnancy termination board's social worker. Informing the social worker of the circumstances of the pregnancy will help prepare the attending staff to provide sensitive and gentle care. You can also contact a rape crisis center at 1202 to request support during the abortion process or to anonymously and confidentially receive emotional support.
Birth control after an abortion
It is important that you visit a doctor or gynecologist within 6 weeks from the date of abortion in order to receive advice, as needed, regarding birth control and contraction of sexually transmitted diseases.