At 14 weeks of pregnancy, abortion is most commonly performed using a surgical procedure called dilation and evacuation (D&E). This is a two-step process: first the cervix is gradually opened, then the pregnancy tissue is removed using suction and instruments. The entire visit, including preparation and recovery, typically takes five to eight hours, though the procedure itself is much shorter.
Why D&E Is the Standard at 14 Weeks
Fourteen weeks falls right at the start of the second trimester, and D&E is the most widely used method at this stage. The alternative, medication-based abortion that induces labor contractions, is also possible but carries a significantly higher complication rate. A study comparing both approaches between 14 and 24 weeks found an overall complication rate of 4% for D&E versus 29% for medication-based methods. For this reason, D&E is generally considered the safest approach for second-trimester procedures.
Cervical Preparation the Day Before
At 14 weeks, the cervix needs to be dilated wider than it would for an earlier abortion, so providers begin preparing it hours or even a day in advance. This preparation uses one or both of two approaches: small rod-shaped devices called osmotic dilators and medications that soften cervical tissue.
Osmotic dilators are thin sticks made from seaweed (laminaria) or a synthetic material (Dilapan-S). A provider inserts them into the cervical opening, where they slowly absorb moisture and expand over several hours, gently stretching the cervix open. Some clinics place these the evening before the procedure so they can work overnight, while others use same-day options that work faster.
Medications can be used alongside or instead of dilators. One common approach involves a tablet placed in the cheek that softens the cervix. Another medication, taken by mouth 24 to 48 hours beforehand, blocks a hormone needed to maintain pregnancy and helps the cervix respond to other softening agents. The specific combination depends on the provider’s protocol and the patient’s needs.
What Happens During the Procedure
Before the evacuation begins, the provider confirms the size and position of the uterus through a physical exam. An ultrasound may also be used, though it’s not always required. You’ll be asked to empty your bladder beforehand.
The active surgical portion is relatively brief. Once the cervix has been adequately dilated, the provider removes the osmotic dilators if they were used and may widen the cervix a bit further with tapered metal instruments. Then a suction tube (cannula) is inserted through the cervix into the uterus. At 14 weeks, the provider typically needs a larger cannula than what’s used in first-trimester procedures, connected to an electric vacuum device that provides steady suction.
Suction alone removes much of the pregnancy tissue, including amniotic fluid. The provider also uses specialized grasping instruments to ensure all tissue is completely removed. Afterward, a final pass with suction confirms the uterus is empty. The provider may gently check the uterine walls with a smooth instrument. Sharp scraping of the uterine lining is not recommended. The entire evacuation usually takes around 10 to 20 minutes.
Anesthesia and Pain Control
Several options exist for managing pain and anxiety during a 14-week D&E. Some clinics offer deep sedation through an IV, which keeps you in a sleep-like state without full general anesthesia. This approach is increasingly preferred over traditional general anesthesia with a breathing tube, as evidence shows deep sedation without intubation is safe through 24 weeks of pregnancy and is often more comfortable for patients overall.
Other clinics use moderate sedation, sometimes called “twilight” sedation, which keeps you relaxed and drowsy but semi-aware. Local anesthesia injected around the cervix (a cervical block) is typically part of any approach and numbs the area directly. The combination you’re offered depends on the clinic, your medical history, and your preference. If you receive any sedation or anti-anxiety medication, you will need someone to drive you home.
Recovery After the Procedure
After the evacuation, you’ll rest briefly and then move to a recovery area where nurses monitor you for about two hours. Cramping and light spotting are normal during this time. The cramping is similar to menstrual cramps and typically manageable with over-the-counter pain relief.
Most people can return to work, school, and other normal activities the next day. Spotting may continue for days to a couple of weeks. You’ll likely receive instructions about when to resume physical activity and what signs might indicate a problem, such as heavy bleeding, fever, or severe pain that worsens rather than improves.
Risks and Complication Rates
D&E at this gestational age has a strong safety record. The most common complication in D&E procedures is a small tear to the cervix during dilation, which becomes more likely at later gestational ages. At 14 weeks, the risk is relatively low since less dilation is needed compared to procedures at 18 or 20 weeks.
Serious complications like heavy bleeding requiring a transfusion, infection, or injury to the uterine wall are uncommon. Using more osmotic dilators for cervical preparation has been associated with lower complication rates for surgical abortions, likely because adequate dilation reduces the force needed during the procedure. Overall, studies consistently find that D&E complication rates are well below those for medication-based second-trimester methods, with one large comparison reporting 8.4% for D&E versus 17% for medication approaches at 16 to 24 weeks. At 14 weeks, where less dilation and instrumentation is needed, the risk profile is even more favorable.