The Aspiration Abortion Procedure: the Right Way

Posted by drjoan on Mon, Aug 8, 2011 @ 6:18 AM

I had a patient come to my office last week for an early abortion.  She was clear in her decision to end her pregnancy, but scared to actually get an abortion.  She was relieved when she came across the Early Options website and learned about the aspiration procedure.  She felt confident that the Aspiration Procedure was the best early abortion method.  It was quick, safe and simple, and could be completed in a regular doctor’s office.  She then started doing more research and called different abortion clinics in New York City to compare prices. 

Some clinics said they offered the aspiration procedure.  But, when she asked more questions, she discovered that the clinics did the aspiration procedure in an operating room, and she was told not to eat or drink from the night before.  She asked if they scraped the uterus, and the person on the phone said she didn’t know the answer.  She asked if her husband could come into the room with her, and she was told that he would need to stay in the waiting room. 

Unfortunately, these clinics are not doing the aspiration procedure the right way.  The advantage of the aspiration procedure is that there is no scraping, no metal instruments, no electric suction, and no sedation.  This avoids the complications of a surgical D&C procedure.  At Early Options, the aspiration procedure is completed in a regular doctor’s examination room, not a scary operating room.  You can eat or drink normally before and after your procedure. It is a personalized experience, and you can have a companion be by your side. There is immediate recovery and you leave the office feeling ready to resume your normal activities.

Why are some abortion clinics saying they are doing the aspiration procedure when they are clearly not offering it in the right way?  Abortion clinics don’t offer personalized care.  They do not specialize in early procedures.  They are concerned with efficiency, not quality of care. 

This patient was happy that she spent a few hundred dollars more to come to Early Options®.  She left the office knowing that her abortion was completed in the most safe and natural way.  She felt good about her decision and her medical experience.

Ask Doctor Joan: Safe Abortion Methods

Posted by drjoan on Sat, Dec 12, 2010 @ 10:08 PM

Questioner: E
Subject: Safest Early Abortion Method Aspiration Procedure

Hii i had an abortion on may with the aspiration method and now i’m pregnant again im definitely cant have this baby but im so afraid of the risks of a second abortion.. Everybody is scaring me that it would be harmful for my body and that i should definitely have this baby because a second abortion is not safe…i really need the answer because i already made an  appointment but im so scared.

Dear E,
The most wonderful thing about the Aspiration Abortion method and the Abortion Pill is that they do not cause risks for future pregnancies.  The Aspiration Procedure and the Abortion Pill are the safest early abortion methods.  They are both nonsurgical methods, and allow the uterus to naturally release the early pregnancy lining (which is similar to a heavy period).  Surgical abortion is extremely safe, and there is virtually no risk from getting repeat surgical abortions.  However, if you are able to get an Aspiration procedure or the abortion pill, they are the safest methods, since they do not utilize scraping, electric suction, or general anesthesia.  Compare your options to make a decision.

Good luck with your decision,
Doctor Joan
New York City

Is Discharge Normal after Surgical Abortion?

Posted by drjoan on Mon, Jun 6, 2010 @ 2:37 PM

Name: Jo

Question: Hi – I was 9 weeks along when I got a surgical abortion 4 days ago. I had cramps and little bleeding right after the abortion that same day for about a half hour. I have not bled AT ALL since the day of the abortion nor have I had any cramping. I have only had a bit of white/yellowish discharge. Should I be concerned? Or is this normal?

Dear Jo,
It is normal to have minimal or no bleeding after a surgical abortion.  There is nothing to be concerned about.  Don’t be alarmed if if you get some bleeding and cramping again within weeks of the abortion procedure.  Sometimes it takes some time for the uterus to contract and when it does, it may expel some blood, clots, or tissue.  White or yellowish discharge without an itch or an odor is common and normal.  If you are concerned about a sexually transmitted disease and they did not test you for it during your procedure, you may want to get tested for chlamydia.  Chlamydia is a common sexually transmitted infection that can have no symptoms, or a white or yellow odorless discharge.  There is more information on vaginal discharge after abortion on our website.
I hope this is helpful,
Doctor Joan

Ask Doctor Joan: Am I having a miscarriage?

Posted by drjoan on Fri, Nov 11, 2009 @ 7:20 AM

Questioner: Daisy
Subject:  miscarriage
Date Answered: 2009-11-06 on

Dear Doctor Joan,
I think I am having a miscarriage.  I have some bleeding, almost as heavy as my period.  I am having bad cramps. I understand that cramping and bleeding are signs of a miscarriage. I had a prenatal visit last week and everything was normal.  I am 9 weeks pregnant.  How do I know for sure if this is a miscarriage? If it is, do I have to get a D&C?

Dear Daisy,
Thank you for your question about miscarriage. You are correct that cramping and bleeding that is almost as heavy as a period are indicators that you are having a miscarriage.  Sometimes pregnancy symptoms can be another sign of miscarriage. Nausea can start to decline within 24-48 hours and can be another indication that the pregnancy is not continuing.  However, you can also have cramping, bleeding, and changing patterns of nausea in a normal pregnancy.  The only way to know for sure is to get an evaluation at a doctor’s office.  I don’t know if this was a planned pregnancy for you, so if it was, I’m sorry this is happening.  You can be reassured to know that early miscarriage is completely normal, and does not indicate that you will have a problem with future pregnancies.

If it you are only 9 weeks pregnant, the doctor should give you several choices to help complete the miscarriage process.  1) you can do nothing, and let it pass naturally on its own; 2) you can take misoprostol to help this process; 3) you can choose the nonsurgical Aspiration Procedure; 4) the doctor may offer a D&C procedure. 

If the pregnancy is not passing naturally, or if it is emotionally difficult to wait for this process to occur, I personally recommend the Aspiration Procedure.  Unfortunately most women don’t know about it, and it can be difficult to find a doctor who offers this option.  The Aspiration Procedure is a simple, nonsurgical procedure that can be completed in a regular doctor’s office in just a few minutes.  It does not involve electric suction, uterine scraping, or general sedation.  The reason I recommend the Aspiration Procedure is that it only takes a few minutes, there is significantly less bleeding or cramping than any of the other options, pregnancy symptoms decline quickly, and it only involves one visit to the doctor.  Emotionally, it can be a relief to get the procedure completed, rather than waiting for unpredictable bleeding to occur.

Personally, I do not recommend a D&C procedure for treatment of miscarriage. It has been associated with scarring of the uterus and fertility problems.  If you do need to get a surgical procedure, make sure that they don’t scrape the uterus.  There is no need for the use of a “curette” in a first trimester miscarriage or abortion.

I hope this information is helpful to you, and good luck.

Doctor Joan

Ask Doctor Joan: Private abortion services

Posted by drjoan on Sun, Oct 10, 2009 @ 10:30 PM

Questioner: Lisa
Subject: private abortion services
Date Asked: 2009-10-13 12:19:41
Date Answered: 2009-10-13 15:06:45 on

Dear Doctor Joan,
Where do I find a private doctor that offers confidential abortion services?  I do not want to go to an abortion clinic.  I don’t want to be in a crowded waiting room with other women who are getting abortions.  Are all abortion services provided at abortion clinics? Why is it so hard to find private abortion services?  I am early in my pregnancy, so if you can answer soon, that would be great.
Thank you!

Dear Lisa,
Click here for the best resource for finding a doctor who provides private early abortion services.  This website lists private family doctors who offer nonsurgical early abortion services: the Aspiration Procedure and the Abortion Pill.  These are the safest, most natural abortion methods, and are completely safe for future wanted pregnancies.

There are other resources for finding doctors who offer private abortion services.  These resources include:,, and  However, some of the clinics listed on these sites may say they are private, but they do not really provide private abortion services.  If you are concerned about high volume clinics, ask these questions regarding private abortion services when you make your appointment:

Will I have a scheduled appointment or do you have many women arrive at the same time?
Will my care be in a private examination room?
Can I bring a companion to be with me the entire time?
How many hours should I expect to be in the office?
Will I meet my doctor to discuss my options?

Another option is to find a doctor who provides the Abortion Pill.  Appointments for the Abortion Pill tend to be more private compared to surgical abortion services.
I hope this is helpful,
Doctor Joan
New York City

Ask Doctor Joan: Manual Vacuum Aspiration Abortion

Posted by drjoan on Sun, Oct 10, 2009 @ 10:26 PM

Questioner: Jen
Subject: Is the Aspiration Abortion Procedure the same as Manual Vacuum Aspiration?
Date Asked: 2009-10-12 18:35:47
Date Answered: 2009-10-12 18:49:36 on

Dear Doctor Joan,
I just learned about the Aspiration Abortion Procedure.  I think this would be the best option for me because I am only 3 weeks pregnant. I heard the Aspiration Procedure is the best early abortion method.  Is it the same as Manual Vacuum Aspiration or Menstrual Extraction?  How is it different from surgical abortion? I am trying to find a doctor who offers Aspiration Abortion.  How do I find a doctor? Why is it so hard to find a doctor who does Manual Vacuum Aspiration?  This is very confusing.
Thanks for taking the time to answer my questions.

Dear Jen,
Manual Vacuum Aspiration (MVA) is the most safe and simple early abortion method.  It is also known as the Aspiration Abortion procedure, “mini-vac” and Menstrual Extraction.  Technically, Manual Vacuum Aspiration is a medically advanced version of Menstrual Extraction.  Menstrual Extraction was developed in the 1970’s, and was used by feminist health groups.  Menstrual Extraction was so simple that women used to do it on each other in their own homes!

Manual Vacuum Aspiration was later developed by an organization called IPAS, dedicated to international access to safe early abortion procedures.  In the United States, Manual Vacuum Aspiration was introduced to the medical mainstream abortion community in the early 90’s.  Since then it has been used by the most progressive abortion doctors.  Unfortunately, most high volume abortion clinics are still using surgical abortion, even though it is too invasive for ending early pregnancy.

Manual Vacuum Aspiration is safer than surgical abortion for three main reasons: there is no scraping; there is no electric suction; and there is minimal discomfort so there is no need to be put to sleep.  The Aspiration Abortion Procedure can be completed in a regular doctor’s examination room (not an operating room) and takes only a few minutes to complete.  It is nonsurgical and noninvasive.  Within minutes, there is complete recovery.  Women can leave the office and resume their normal activities.

Why is it so difficult to find doctors who offer the Aspiration Abortion Procedure?  Unfortunately, most abortion clinics do not offer it, or offer it in the same way they offer surgical abortions – in an operating room setting.  Menstrual Extraction is no longer practiced since Manual Vacuum Aspiration was developed.

Click here for the best resource for finding a doctor who performs Manual Vacuum Aspiration. These offices practice Manual Vacuum Aspiration correctly – in a private examination room where companions are welcome, with no uterine scraping, and in scheduled private appointments (not a clinic setting).

I hope you find this helpful,

Doctor Joan
Early Abortion Specialist

Ask Doctor Joan: Best Early Abortion Methods

Posted by drjoan on Sun, Oct 10, 2009 @ 10:24 PM

Questioner: Erica
Subject: Abortion Pill, Aspiration Procedure, Early Abortion Methods, surgical abortion
Date Asked: 2009-10-12 17:55:44
Date Answered: 2009-10-12 18:10:52 on

Dear Doctor Joan,
I am pregnant and need to get an abortion.  I am early in my pregnancy.  I missed my period 2 weeks ago, and I’m pretty sure of the date I got pregnant – about 6 weeks ago.  I heard about the abortion pill.  Do you think the abortion pill is the best early abortion method?  Is the abortion pill the same as RU486? I had a friend who took it, and she bled for a long time, but it went fine and she was ok.  I don’t want to have a surgical abortion.  I am afraid of getting surgery.
What do you think?

Dear Erica,
There are two nonsurgical early abortion methods that are safe and noninvasive: the Abortion Pill, and the Aspiration Abortion Procedure.  I recommend both of these methods over a surgical abortion.  The Aspiration Abortion procedure is different from a surgical abortion because 1) there is no scraping; 2) there is no electric suction; 3) there is minimal discomfort so there is no need to be put to sleep; 4) there is immediate recovery; 5) it can me done in a private examination room, not an operaing room; 6) it is nonsurgical so you can eat and drink before your visit; and 7) you can resume your normal activities when you leave the office.  You can click here to compare your early abortion options.

I also recommend the Abortion Pill as another nonsurgical early abortion method.  The abortion pill is actually two pills: you take one pill in the office, and the second one at home 24-72 hours later.  Most women who choose the abortion pill like it because it feels more natural.

At our office, over 90% of women choose the Aspiration Procedure over the Abortion Pill because there is much less bleeding, it can be completed in one visit, and there is minimal discomfort.  Most women who take the Abortion pill can have bleeding for weeks to months, and usually experience hours of discomfort when they go through the miscarriage.

At our office, we do not offer surgical abortion as an early abortion method.  It is much too invasive, like getting stitches when you only need a bandaid.  Medically, early abortion is simple to complete.  The Aspiration Procedure has no major complications and does not interfere with future pregnancies.

I hope this is helpful,

Doctor Joan
Early Abortion Specialist

Ask Doctor Joan: Failed Medical Abortion

Posted by drjoan on Sun, Oct 10, 2009 @ 9:27 PM

Questioner: marilyn
Subject: medical abortion failed, incomplete abortion, aspiration procedure, abortion pill, cytotec
Date Asked: 2009-10-19
Date Answered: 2009-10-19 on

QUESTION: I’m very anxious about having an aspiration abortion..please respond ASAP.
I was 6 weeks pregnant when i came in for a medical abortion. They did the vaginal ultrasound and i’m qualified for the pill but the doctor check my pelvic and he said that i have an inverted uterus. There might be a chance that the pill not going to work but i can try. I got my first pill (Ru-468) in the office and 44 hours later, i took 4 tablets of cytotec BUCALLY. I started to bleed 1 hour later and continue for to pass tissue and large clots for 6hours and continue to bleed for a week. I came back for the follow-up  at the office on week after i took the first pill (Ru-468) and they did the vaginal ultrasound and the nurse said i haven’t completely passed all the tissue. My endometrium still thick so they give me 4 more tablets of Cytotec (800mcg total) and asked me to inserted RECTALLY this time instead of BUCALLY. After i inserted rectally, i got cramp for about 1 hour but barely i bled anything. The next day, i didn’t bled at all. Today is the third day since i had the second dose of cytotec and i just rarely spot anything…but if i do spot…just dark brown discharge came out (look like a string of blood) ..very little but thick. They asked me to come back to the office 1 week later for the follow up. So my questions are: Can cytotec be given RECTALLY for medical abortion? I hardly bleed after the second round of cytotec, does this means i have to have aspiration surgery because i still didn’t expel enough tissue? Is it possible for me to have another round of  Cytotec (800mcg) given BUCALLY this time? Do you think another round of cytotec (800mcg) would work?
thanks for all your help!!!!

ANSWER: Dear Marilyn,
I’m glad you asked these excellent questions.  Here are my thoughts regarding your situation:
1) If you are no longer pregnant, one option is to DO NOTHING.  It is common and normal to have some tissue remaining after a miscarriage or the abortion pill.  This happens more commonly if you have an inverted uterus.  So, one option is to do nothing.  Things that can help cause your uterus to contract and expel the tissue naturally are taking baths, and massaging your lower belly or pelvic area; having sex stimulates the uterus to contract; heat to your lower abdomen and massage.  Eventually, it will pass.  There is no additional risk of infection.  You should only choose this option if this will not cause you emotional distress.  If you are concerned about the tissue, you should get it resolved.
2) If you want to follow up with the doctor and you both decide you want to try again to intervene, you should know that taking misoprostol rectally is no more effective than taking it buccally.  You can take it another time to see if it works.  It is completely safe.
3) The Aspiration Procedure is the safest and most simple method to treat incomplete abortion, miscarriage, and early abortion.  There is nothing to be afraid of.  I have been an advocate of this procedure for over a decade, and I am thrilled that you are being offered this option.  Unfortunately it is very hard to find a doctor who does it, so I would love to know where you are getting your medical care.  It is especially easy to complete the Aspiration Procedure in the situation of a miscarriage or incomplete abortion, because your cervix is already dilated.  The procedure only takes a few minutes.  There is no scraping, no electric suction, no heavy sedation, so there are no major complications. I would recommend the Aspiration Procedure over misoprostol because in a few minutes, the problem is resolved, and you will not have to keep following up and getting examinations.

I hope this is helpful,
Doctor Joan
New York City
———- FOLLOW-UP ———-

QUESTION: Dear Dr. Joan…
I’m very thankful that you responded to my email so quick.
I’m getting my medical care in U.S. and abortion is legal in my state.
Aspiration procedure was the first option the the doctor recommended but i turned it down b/c i don’t like anything invasive. So i chose the pill  instead.
Dr. Joan, i do have some more questions to ask you:
Last week, i came back for the follow up at the clinic after 7 days since i took the first pill (Ru-486). They did the vaginal ultrasound and said i still retained some tissue as well as my endometrium lining is not thin enough the way they want it to. Therefore, the nurse offered me the second set of 800mcg of cytotec taken rectally.
So my questions are:
1)Does every clinic measure the thickness of your endometrium to determine if the abortion is complete or incomplete? I look up alot clinical studies and it shows that there’s no correlation between incomplete pregnancy and thickness of uterus. The clinic i’m going now look at my endometrium lining to determine if the pregnancy is complete or not
2) Is the thickness of uterus have to do with progesterone level? i know that the progesterone in the body decrease after the abortion. So do i have to bleed alot in order to decrease the thickness of the uterus or automatically the thickness would decrease as the progesterone decrease in your body after abortion?
2)Based on your recommendation from above, if my vaginal ultrasound shows that i’m no longer pregnant and still retained some tissue the option is DO NOTHING. But what happen if my doctor force me to do the aspiration procedure. Can i just said NO? Before i did the pill, the clinic asked me to sign a form said that if the abortion is incomplete i have to do the surgery! Is it legal for me to say NO if i don’t want to do the Aspiration procedure?…i just want to pass it naturally..
Please help..thank you so much for answering all these questions. Dr. Joan without u idk what to do..You are awesome :) GREATLY APPRECIATE !!!!


Dear Marilyn,
You have excellent questions. I am always impressed with women who do their research when they need to get an abortion.  Most women do not know all of their options in the area of early abortion.

Here are my thoughts on your questions:
1) No – measuring the thickness of the endometrium DOES NOT correlate with retained products or incomplete abortion.  The only reason to do an aspiration abortion procedure after a medical abortion is if 1) there is a continuing pregnancy; 2) the pregnancy is over but a sac remains, and the women does not want to pass it naturally. 3) A woman experiences lengthy or heavy bleeding or continued cramping.  I would not recommend a procedure for just a small amount of remaining tissue, because in my experience it will pass on its own.  In fact, “retained products” or incomplete abortion is not defined by seeing something on ultrasound.  It is defined by a patient’s symptoms of unusual bleeding and cramping, and this corresponds with an ultrasound.  It is a common mistake with doctors who are less experienced with medical abortion.

2) Doing a procedure for thickened endometrium is not indicated, because thickened endometrium is normal at this stage.  It will go back to normal after the abortion.

3) You can absolutely do nothing.  The paper you signed said that you would do a procedure if the pregnancy CONTINUES. This is in the contract because the abortion pill causes birth defects, and for a very small number of women who fail, some women want to continue the pregnancy.  This would not be an option.

Now, I hope this helps you let go of the idea that there is something wrong, and let your body come back to it’s natural state as it will in its own time.

Doctor Joan

Early Options: Family Practice is better than Family Planning

Posted by drjoan on Thu, Oct 10, 2009 @ 3:39 AM

I am a family doctor by training.  The specialty of family practice emphasizes “patient centered care.”  Family doctors often have philosophical differences in how they approach medical care, compared to doctors from other Western medical specialties. 

Family doctors believe:

  • A patient must be an active participant in their medical care. 
  • The relationship between a doctor and their patient is a critical component of good medical care
  • Emotional health is not separable from physical health
  • A patient’s family and community are important participants in their health care
  • Noninvasive approaches are always the preferred option

I saw my first abortion during my third year of residency training in Family Practice in NYC.  I had the opportunity to get trained in abortion procedures at Planned Parenthood.  There were many excellent and caring staff and doctors, but I felt that the model of abortion services was not consistent with family practice principles of medical care. I observed what I would call a “family planning” approach to abortion care, and I thought there should be a better way.  I realized that the field of family practice had an important contribution to make in the area of abortion services. 

What is a “family planning” approach to abortion services?  Medical care is focused on the procedure, not the patient.  Everything is organized toward an efficient model of care.  Patients are seen by multiple staff members for vital signs and lab testing, ultrasound, counseling and consent.  The patient never gets to talk with the doctor about their options.  They meet the doctor in the operating room, right before their abortion procedure.  Companions or family members are not able to participate in any of the medical care.  A patient must see a counselor to talk about their decision, whether or not she wants to be counseled. 

This “family planning” model of abortion care was inconsistent with my training in family practice.  I felt that the principles of family practice were especially relevant to abortion care.  It was important for a woman to meet her doctor and have the opportunity to talk about her decision, her abortion options, and expectations.  It was important to have a dedicated staff member, rather than multiple people involved in the abortion care.  It was important to be able to include a friend or family member in the medical visit.  It was important to use the most noninvasive methods available.  It was important that the emotional aspects of having an abortion were part of the medical care and not dealt with separately.  It  was most important that women have a positive medical experience while going through a difficult situation of an unwanted pregnancy. 

In the next years, I developed the Early Options model of abortion care. Early Options is a pioneering family practice or primary care based approach to early abortion. 

The Early Options model is consistent with principles of family medicine:

  • You meet your doctor to discuss your options and to feel comfortable with your medical care;
  • You have a dedicated clinical assistant to support you during your entire visit;
  • You are able to include your husband, family member, or companion in any part of your medical visit;
  • You are offered noninvasive,  nonsurgical early abortion methods: the Aspiration Procedure, and the Abortion Pill;
  • The entire visit is organized to support a positive physical and emotional medical experience;
  • Early abortion care is part of medical care, and not a “segregated” medical service.

How Menstrual Extraction became the Aspiration Abortion Procedure

Posted by drjoan on Wed, Oct 10, 2009 @ 8:38 PM

imagesI am a pioneer, educator, and advocate of the Aspiration Abortion Procedure (Manual Vacuum Aspiration) for ending early pregnancy and for treating miscarriage. I have been providing the Aspiration Procedure for over a decade to thousands of appreciative patients. I continue to be astounded at how few people know about this simple procedure that can be completed in a regular doctor’s office in a few minutes. The procedure has an interesting history, and I thought it would be valuable to summarize this for those who have learned about this amazing device.

The Aspiration Procedure (Manual Vacuum Aspiration) is the most safe, simple, and natural procedure to end early pregnancy. The clinician inserts a thin cannula (straw) through the natural opening of the cervix. She then attaches a small handheld device that applies gentle pressure. This pressure or suction then releases the menstrual lining and early pregnancy tissue into the device. Within minutes, the pregnancy is over, and the patient can return to her normal activities. The Aspiration procedure is best used under 10 weeks of pregnancy, but can be used later depending on the clinician’s judgment.

The Aspiration Procedure is considered a non surgical abortion procedure, because there is no scraping, so there is no entry into the uterine wall. The device simply causes a natural release of the thickened menstrual lining, which would have shed with the menstrual period. Compared to surgical abortion, there are no major complications, because there is no scraping and no strong electric suction.  There is minimal discomfort so that the procedure can be completed with a safe local anesthetic.

Manual Vacuum Aspiration is a modernized form of an interesting procedure called Menstrual Extraction. It has its history in the feminist “take back your health” movement. It is worth learning about the history of this remarkable procedure:
American feminists Carol Downer and Lorraine Rothman developed menstrual extraction in 1971 as a method American feminist activist Carol Downer and Lorraine Rothman developed menstrual extraction in 1971 as a method of removing a woman’s menses to avoid an inconvenient period or, more importantly, to end a pregnancy at an early stage. They introduced their work to fellow activists in Los Angeles in the same year the Roe v. Wade case was in court, before the legality of abortion had been established. The two activists wanted to create a safe, simple, affordable means of ending a pregnancy at a time when U.S. law and culture severely limited women’s legal and medical options concerning reproductive health.

Rothman fabricated a device called the Del-Em, constructed of easily obtainable laboratory supplies: a jar, rubber stopper, plastic tubing, a cannula, a one-way valve, and a syringe. Downer and Rothman organized self-help clinics for women and demonstrated the uses of the Del-Em. These self-help groups were formed not simply as an introduction to menstrual extraction, but as a broader forum within which women could educate themselves and each other about their bodies and reproductive health in an informal, nonmedical setting. Self-examination with a speculum was one technique employed at the meetings to demystify the female reproductive anatomy. It was within this context of underground, politically oriented sexual health education that Rothman and Downer developed and disseminated the technique of menstrual extraction.

To demonstrate menstrual extraction at self-help meetings, a woman about to begin her period (or who suspected she was pregnant) would volunteer to undergo the procedure, while the other women would watch. The procedure involves the insertion of a flexible 4mm cannula into the os, or cervical opening. The cannula is attached to a long piece of plastic tubing connected to one of two small openings in a rubber stopper covering a jar. A second piece of plastic tubing is connected to the other hole in the stopper; a one-way valve is attached to this piece to control the flow of the contents and attached to a syringe. Once the kit has been assembled and the cannula inserted into the cervix, the woman undergoing the extraction pumps the syringe to gently suction the contents of her uterus, which are caught in the jar. Because she is holding the syringe, she can control the speed and pressure of the extraction, moving at a pace she finds comfortable. The extraction process could be finished in about five minutes.
Copied from:

In the early 90’s, Manual Vacuum Aspiration entered the mainstream medical world in the United States. Jerry Edwards published a seminal paper describing a device manufactured by IPAS  ( which had significant advantages over surgical abortion for early termination of pregnancy (Edwards, Jerry and Mitchell D. Creinin. 1997. Surgical abortion for gestations of less than 6 weeks. Current Problems in Obstetrics and Gynecology and Fertility, January/February: 11-19.) Edwards presented his findings at a National Abortion Federation conference.

I was at this conference, and remember my astonishment when I learned about this simple procedure. I had finished my residency training and was training in surgical abortions (D&C’s) at a Planned Parenthood clinic in NYC. I couldn’t believe how simple the procedure was, and how much potential it had to transform the provision of early abortion services. Years later, when I was finally able to access training in the procedure, I was able to perform my first Manual Vacuum Aspiration. I was surprised that the patient barely felt anything, sat up immediately after the procedure, and gave me a big hug! Since then I have been at the forefront of trying to make this procedure available to all women by developing the Early Options® model for early abortion services.

For more information, there is a reprint of an excellent paper by Carol Joffe on the history of abortion at: