How do I choose between an abortion procedure in clinic and pill abortion?

How far along is your pregnancy?

An in-clinic abortion procedure is available in Wisconsin up to 21 weeks + 6 days, Illinois up to 23 weeks +6 days and in Minnesota up to 21 weeks +6 days. Pill abortion via clinic care is available up to 11 weeks from your last period (this means 9 weeks from conception). Aid Access is available to anyone in any state and offers pill abortion up to 12 weeks from your last menstrual period. If you know the first day of your last period, you can calculate your weeks using an online pregnancy calculator.

If you don’t know how far along your pregnancy is before scheduling your clinic appointment, an ultrasound can be done at your clinic appointment or you may want to arrange an ultrasound through your usual healthcare provider for dating first. The ultrasound will determine your pregnancy weeks and help your decision-making around pregnancy and abortion options.

Is location a concern?

Some people choose an abortion procedure in clinic because they feel most comfortable and safe in a clinical setting, with doctors and nurses present.  Pill abortion typically takes place in a person’s own home with the support of a doula, friend, and/or partner.

Is time a concern?

Some people choose an abortion procedure in clinic because they need to know that their abortion will be completed when they leave the clinic. Pill abortion is a more body-led process that can take up to 24 hours. Some people need or prefer the more controlled medical procedure of in-clinic abortion.

In Wisconsin, you must have 2 separate visits to the clinic. At the first visit, an ultrasound and lab work is done and the consent forms are completed. At the second visit, you have the procedure or obtain the pills. By law in Wisconsin, these visits must be at least 24 hours apart. Often the visits are several days and up to 1 week apart.

In Illinois and Minnesota, only one visit is required with everything happening at the same visit.

Health and safety concerns

Both an abortion procedure in clinic and pill abortion are safe, common, and effective ways to end a pregnancy. They do not increase any health or fertility risks, or lessen your ability to carry a future pregnancy to term. There can be individual home or health circumstances that may make one type of abortion a better option for you, so be sure to share all important details with clinic staff and let them know about any concerns you have.

Cost concerns

When needed, there are national and state abortion funds that can help pay for abortion. It is important that you tell clinic staff that you need funding assistance. Inform them when you call and again at your appointment that you need funding assistance. Wisconsin abortion funds are dedicated to help people from Wisconsin to afford the cost of abortion – wherever your abortion takes place. But typically, payments are made only to clinics or other abortion funds, not directly to callers.

If you live in northwestern Wisconsin, you can contact the Options Fund directly for possible assistance. If you are an indigenous pregnant person, you can contact Indigenous Women Rising directly for possible assistance. If you are seeking abortion services in Illinois, you can contact the Chicago Abortion Fund and the Midwest Access Coalition. If you are seeking abortion services in Minnesota, you can contact Our Justice for help with abortion costs.

Wisconsin Medicaid (BadgerCare) typically does not cover abortion care, because current federal and state laws prohibit public funds from paying for abortion. Some private insurance companies cover all or part of the cost for an abortion. Your clinic can help you determine how much, if any, services are covered.

The cost of an abortion procedure in clinic can vary but typically starts around $600. After 13 weeks of pregnancy, the cost of an in-clinic abortion increases according to how far along your pregnancy is. Pill abortion is often less expensive, especially if obtained through on-line providers.

If you are a teen

In Wisconsin, parental consent is required if you are under 18. Consent may also be provided by an “adult family member” which includes a grandparent, aunt, uncle, brother or sister if they are at least 25 years old. The parent or adult family member must be present for the clinic visits.

If you cannot get consent from a parent or family member, another option is judicial bypass. A judicial bypass allows you to waive the requirement for parental involvement. If you’re a minor who would like help navigating the judicial bypass process, contact the clinic where you will get abortion care or the If/When/How Judicial Bypass (JB) Helpline. To contact the JB Helpline, call 844-868-2812 or submit a request online.

As of June 1, 2022, Illinois no longer requires parental consent for a teen to get an abortion. As of fall 2022, Minnesota no longer requires parental notification for a teen to get an abortion.

What to expect when you arrive at the clinic

When you arrive at the clinic you may need to show a photo ID (a driver’s license, school ID, passport, or identification card from your country of origin). Immigration status does not have to be disclosed to enter the clinic and will remain confidential, along with all health information. 

You will be asked to complete a health history and have your blood tested for anemia and Rh type. An ultrasound will likely be performed and you may view the image if you wish to. You may ask as many questions as needed and change plans at any point during your visits. Be sure to share any medication questions, preferences, or allergies with clinic staff.

In Illinois, unlike Wisconsin and Minnesota, advanced practice nurse practitioners (APNPs), as well as physicians, may provide abortion services. Therefore, the term “clinician” is used in the text below.

In-clinic aspiration abortion

Procedure medications

Before the procedure, you may be asked to take an antibiotic pill for prevention of infection. If your pregnancy is advanced, your cervix might need extra help to open. In this case, the clinician will discuss common medications that are used. One medication is Misoprostol, which helps soften and open the cervix. Other medications are Dilapan or Laminaria, which are placed in the opening of your cervix to help it open over the space of several hours.

Comfort medications

Your comfort is a priority. Pain medication is available if desired, and a nurse or clinic assistant stays with you for support. Options vary by clinic location. An anti-anxiety pill, such as Valium, is often available for people who feel a little nervous or tense. Stronger medication, called “moderate sedation,” is available to people further along in pregnancy or who are very nervous or fearful of pain. This is given through an IV and may make you feel relaxed and sleepy while staying awake and aware (moderate sedation may reduce your ability to remember the procedure later). Some clinics may have an anesthesia specialist who can offer deeper sedation, where you are asleep during the procedure. If you plan to request pain medication, you may be required to have a support person with you when you leave the clinic, even if you take a taxi.

The procedure

The procedure itself usually takes only five to ten minutes. It begins with a pelvic exam, where the clinician places two fingers in your vagina and a hand on top of your belly to feel the size, shape, and direction of your uterus. This may feel like gentle pressure. The clinician then places a speculum into your vagina, a simple plastic or metal tool that helps to see your cervix, which is the opening to your uterus. Then the clinician applies numbing and relaxing medication to your cervix. After your cervix is relaxed, a series of thin, round-tipped rods are used to open your cervix. This may feel like pressure, or cramps that come and go. After your cervix is open, a thin plastic tube with suction is inserted to remove pregnancy tissue. You may feel pressure, cramping, or gentle tugging, and then a stronger cramp at the end, as your uterus returns to its pre-pregnancy size. If your pregnancy is more advanced (more than 14 weeks), additional tools may be used to ensure that all pregnancy tissue is released. Some clinicians use ultrasound to assist them. Unless you ask to view it, the ultrasound screen will be visible to the clinician but not to you. Lastly, the clinician removes the speculum, and the nurse or clinic assistant helps you to dress and move to the recovery room. While you rest before going home, a nurse will check your heart rate, blood pressure, and bleeding.

Pill abortion

At the clinic

The clinician will give you two different types of pills that work together to help your body release the pregnancy. The first abortion pill is called Mifepristone (Mifeprex). This pill begins blocking a pregnancy hormone and starts the abortion process. 200mg of Mifeprex is taken by mouth and typically does not cause any noticeable symptoms. The second abortion pill is called Misoprostol and you will be asked to take these at home.

Comfort Medications

The clinic typically will give you Ibuprofen for cramping pain and Promethazine for nausea relief, to use at home if needed. Be sure to share any questions or concerns you have around pain and support needs with clinic staff.

At home

Four Misoprostol pills (800 mcg) are taken at the same time within 48 hours after you took the first abortion pill in the clinic. You will be instructed to let the pills dissolve in your mouth along your gums and cheek, or to insert them into your vagina. Some clinics provide four additional Misoprostol pills to take again four hours later.

After taking the Misoprostol, you can expect gradually increasing cramping and bleeding that lasts 2-6 hours. If your pregnancy is very early, these effects may take longer to start, and you may experience minimal bleeding and very manageable cramping. If your pregnancy is further along, the effects of Misoprostol may start sooner, and your bleeding and cramping may feel intense. You may also experience nausea and shakes during the peak of cramping. Having a reassuring support person with you after taking the Misoprostol is recommended.

Comfort strategies that can be helpful include: breathing and relaxation techniques, guided imagery, music, bathing, a heating pad, and/or the medications listed below can all be helpful. If you would like phone support or help in finding an abortion doula in Wisconsin, feel free to contact POWERS.

Pregnancy tissue usually releases and passes within 12 hours but can take up to 24. After the tissue passes (often in the toilet), bleeding and cramping should noticeably decrease. Normal period-like bleeding can continue for up to two weeks.

If you have any questions or concerns at any time during the process, clinic staff is typically available 24/7 to offer reassurance and advice. Pregnancy tests can remain positive for several weeks after an abortion, so if you wonder whether the pills worked, you can go to any Planned Parenthood clinic or other trusted medical practitioner in Wisconsin for assessment and if needed, referral for further treatment.