Abortion in the Third Trimester - Why It is a Rare Decision?

The third trimester is the last stage of pregnancy. It occurs between weeks 27 to 40 (the 7th, 8th, and 9th months) of pregnancy. During the third trimester, the baby grows and changes position to prepare for delivery. The baby can hear, smile, cry, see, and suck on its thumb. The lungs and kidneys of the baby mature, and the brain continue to develop. Furthermore, the third trimester can be challenging for the woman.

It can be complicated and challenging to carry out an abortion in the third trimester of pregnancy. Additionally, women are not allowed to get abortions in India after 24 weeks unless there are complications. Abortion during the third trimester is, therefore, a rare choice.

Read the blog below to learn more about the process, side effects, and possible complications of abortion in the third trimester.

There are two main reasons for which women seek abortion in the third trimester, which include:

1. New information about the health of the foetus (foetal anomalies) and the mother. For instance, a woman may need an abortion if the brain of the foetus has not developed. It could be also due to other serious genetic or structural conditions. The couple may also decide to end the pregnancy if it has life-threatening complications for the mother.
2. Barriers to abortion before the third trimester. It includes social stigma, lack of information, inability to pay, or policy restrictions.

The opponents of abortion often argue against the termination of pregnancy due to foetal anomalies. According to these people, even children born with a disability can lead a good life. But, the couple may still choose abortion as an ideal choice because of the emotional and financial cost of raising a disabled child. Furthermore, raising a child who might need constant medical attention and suffer from pain may seem unfair.

Women who end their pregnancy in the third trimester need a surgical abortion procedure called Dilation and Evacuation (D&E). It is an outpatient procedure performed in a hospital or clinic. Before the procedure, you will have an in-depth consultation visit with your healthcare professional to discuss the following:

1. Your pre-existing medical conditions
2. Your health
3. The medications you take and whether you need to stop taking them before the procedure
4. The details and steps of the abortion procedure

Your healthcare team will also provide instructions to follow before and after the procedure. Additionally, you will have to stop eating or drinking anything 8 hours before the procedure. In some cases, you will have your cervix dilated a day before the procedure.

The D&E procedure involves the following steps:

1. Step 1: Dilation
   1. Your doctor will soften and dilate your cervix the day before the procedure. 
   2. You will have to place your feet in the table’s stirrups, like in a pelvic exam. 
   3. The doctor will use a duck-bill-shaped speculum device to widen your vaginal opening. 
   4. Next, they will clean your cervix, and the anaesthesiologist will apply a local anaesthetic. 
   5. The doctor will insert a laminaria (dilating stick) into the cervical canal to open the cervix by absorbing moisture. 
   6. They may also decide to administer a drug called Misoprostol for preparing the cervix. 
2. Step 2: Evacuation
   1. On the day of the procedure, the anaesthesiologist will administer general anaesthesia to make you sleep through the procedure. 
   2. They will remove the dilating stick and use a curette (a sharp-tip instrument) to scrape your uterus. 
   3. They will use other instruments like vacuum suction and forceps to evacuate the foetus and placenta, emptying the uterus. 
   4. Some doctors may even inject a medication to ensure foetal death before evacuation. 

Some potential side effects after the abortion include:

1. Breast tenderness
2. Nausea during the first two days after the procedure
3. Cramping between the third and fifth days
4. Light to heavy bleeding for two to four weeks 
5. Lemon-sized clots
6. Low-grade fever

There are some possible complications from D&E in the third trimester that may need additional treatment. These complications include:

1. Reaction to medication
2. Severe cramping
3. Clots larger than lemon
4. Excessive bleeding
5. Perforation of the uterus
6. Incompetent cervix (the cervix opens in the second or early-third trimester of pregnancy) in future pregnancies

Call your healthcare professional if you experience the following:

1. Heavy bleeding that soaks more than two maxi-pads an hour for more than two hours in a row
2. Clots larger than a lemon
3. Signs of infection in the uterus, including:
   1. Fever above 100.4 ℉
   2. Chills
   3. Foul-smelling vaginal discharge
   4. Severe pain in the pelvic or abdominal region that does not improve with medications

To reduce the risk of infection, you must avoid the following for the first week after the procedure:

1. Tampons
2. Bath
3. Swimming pools and hot tubs
4. Penetrative vaginal sex
5. Douching

It is essential to consult your healthcare professional while taking your final decision about abortion in the third trimester. Since abortion in the later stage can pose more risk to the mother’s life, consulting with an expert before making a decision is highly critical. You can contact the team of doctors at HexaHealth anytime to discuss all your options and decide the best line of action. Moreover, we will help you understand the procedure and what you should expect before and after the abortion. Make sure to write down the questions you may have for the doctor so that you don’t forget anything during the appointment. 

Emotional Support After a Third Trimester Pregnancy

Abortion at any stage during the pregnancy can bring about a range of different emotions. However, pregnancy in the third trimester can be particularly challenging. Why? Because of the social stigma and lack of support attached to it. Apart from social factors, you may experience negative emotions like depression, sadness, or a sense of loss due to hormonal fluctuations. You may want to consult a mental health professional if you experience constant grief or sorrow. Your gynaecologist can refer you to a therapist, counsellor, or support group to help you process your emotions. 

As the weeks of pregnancy increase, your risk of complications may also increase. The doctor may recommend an abortion at this stage only when it is necessary to preserve your health or to prevent death. The increasing complications, legal restrictions, and social stigma are reasons for abortions in the third trimester being a rare decision. While third-trimester abortions are relatively uncommon compared to first-trimester abortions, sometimes, abortions in the later stage may be the ideal choice. Talk to your healthcare professional to make a safe and legal decision.