Dilation and Evacuation or D&E is the term for the surgery used to perform a second trimester abortion. The surgery is completed in two steps:
Step one: The procedure begins with the dilation (gentle opening) of the cervix. Depending on the method used the length of the pregnancy, dilation may becompleted in a few minutes, or it may take several hours. Instruments used to dilate the cervix may include the use of dilators (long metal rods), laminaria (medicinally prepared seaweed) that absorb moisture from the body and gradually open the cervix, or a suppository/tablet called misoprostol, a prostaglandin that helps to cramp the uterus and soften the cervix.
Step two: The second part of the procedure involves the evacuation of the pregnancy and pregnancy tissue. A local anesthetic may be used to numb the cervix. The uterus is emptied by using a combination of aspiration and evacuation with forceps. Most women feel menstrual like cramping during step two. Some women also experience a tugging sensation in the lower abdomen. While the uterus is returning to its non-pregnant state a woman may continue to experience cramping.