The second step of the D&E procedure is to evacuate, or remove, everything inside of the uterus. The woman is given a local anesthetic to numb part of her body or a general anesthetic to put her to sleep. The doctor will then put a cannula (a medical tube) into the uterus, through the vagina. The cannula is attached to a bottle and a pump that create a vacuum. The cannula is used to vacuum (or suction) out everything that is in the uterus, including the fetus. The doctor may use forceps to take out any tissue that is still in the uterus. The doctor may also use a curette to scrape out the lining of the uterus. The vacuum can then be used again to make sure that the uterus is completely empty. This is to prevent infection from tissue left behind by accident.