Abortion:

What happens at the consultation appointment?

• You will see a counsellor and then one of our health care professionals (either a doctor or a nurse). The consultation normally takes up to two hours.
• You will have a urine pregnancy test and then an ultrasound scan to asses your stage of pregnancy this will help us decide which type of treatment you will have. Please note you will not see any pictures during the scan. You may also have a simple blood test.

What happens during the abortion procedure?

• Abortion procedures vary according to the stage of the pregnancy. Usually, women can choose the procedure that they feel is most suitable for them and their circumstances.
• Details of the different procedures can be found below.

Medical Abortion

Up to 9 weeks

• Two medicines are given, either 6-8 hours apart or 1-3 days apart. An overnight stay is not required.
• At the first visit, the client swallows one tablet of a medicine called mifepristone. Mifepristone blocks the action of the hormone progesterone on the uterus. This stops the growth of the pregnancy and causes the lining of the uterus to shed. Some side effects such as light bleeding, nausea or vomiting may be experienced before the next appointment.
• At the second visit, tablets of misoprostol, a prostaglandin, are placed in the vagina near the cervix. This medicine causes the uterus to contract and also causes bleeding and cramping. This medication is normally administered using a tampon and if you are comfortable using tampons you can insert this medication yourself.
• Most women go home straight away with advice on what to do after the misoprostol is placed in the vagina. Most abortions will happen within 4-6 hours.
• Vaginal bleeding alone does not necessarily mean the abortion is complete and follow-up either with a visit or by phone is important to confirm that the medicines have been effective.

9-23 weeks 5 days

• Two medicines are given 24-28 hours apart. An overnight stay may be required.
• At the first visit, the client swallows one tablet of mifepristone.
• Women who have a pregnancy of 22 weeks or more may have an additional procedure at this visit. The doctor will put a needle into the uterus and inject medicine to stop the fetal heart. This may be carried out under local anaesthetic or a light general anaesthetic.
• At the second visit, the client is admitted to the treatment unit. Tablets of misoprostol are placed in the vagina near the cervix. Misoprostol causes the uterus to contract and also causes bleeding and cramping. The client may also experience nausea, vomiting or diarrhoea. She will be given medication for pain and other symptoms as needed to keep her comfortable throughout the abortion.
• Repeated doses of 2 tablets of misoprostol will be given by vagina or by mouth every 3 hours until abortion occurs. Most women will have the abortion within 6-8 hours of using the misoprostol but for some women stay of at least one night will be required.

Surgical

Manual Vacuum Aspiration

• This procedure may be carried out in an operating theatre or a procedure room.
• An oral analgesic (typically ibuprofen) is given and local anaesthetic is injected into the cervix before the procedure begins. The client will also have Entonox (“gas and air”) available to use if needed.
• The cervix is then gently stretched open using thin metal rods called dilators and the uterus is emptied using a gentle manual or electric vacuum.
• The procedure typically takes 10-15 minutes and recovery time is 30-45 minutes.
• An overnight stay is not required.

Vacuum Aspiration

• This procedure is carried out in an operating theatre.
• A short-acting general anaesthetic is injected into a vein in the hand or arm.
• The cervix is then gently stretched open using thin metal rods called dilators and the evacuation is carried out with either a gentle manual or electric vacuum.
• The procedure typically takes about 10-15 minutes and recovery time 1-2 hours.
• Clients do not need to stay overnight.

Dilatation & Evacuation (D&E)

• Prior to a D&E, the cervix is prepared. Misoprostol softens the cervix and dilators are placed inside the cervix to slowly stretch the cervix open.
• Clients who have a pregnancy of 22 weeks or more will have an additional procedure carried out the day before the surgery. The doctor will put a needle into the uterus and inject medicine to stop the fetal heart. This may be carried out under local anaesthetic or a light general anaesthetic. The client may be able to go home and return to the clinic the following day for removal of the pregnancy.
• The D&E is performed in an operating theatre under a light general anaesthetic.
• Forceps are used to remove the pregnancy and any remaining tissue is removed using vacuum aspiration.
• An overnight stay is not required. Most women are fit to leave the clinic within 6 hours of arriving.

Is there any risk?

• Abortion procedures, especially in the early weeks of pregnancy are very safe but no clinical procedure is entirely without its risk. There is no long term proven association between abortion and any ectopic pregnancy or infertility.

What about infection?

• One of the highest risks after an abortion is infection. All our clients are given a course of antibiotics to minimise this risk. We also advise women to avoid having sex for two weeks after treatment and to use sanitary towels instead of tampons. It is normal for some women to experience some bleeding for several days after the abortion.

How will I feel after the abortion?

• Different women experience different feelings after an abortion and will cope in different ways. Many women find it useful to have someone with them after their abortion. Some women take time off work, while others feel able to go straight back the next day – both responses are quite normal.
• After treatment, some women find that their hormones levels swing quite dramatically whilst their bodies adjust. This may result in mood changes and it is common for women to feel a bit sensitive and irritable.
• After an abortion, some women feel a sense of loss, even if they believe their decision was right. Others may feel relief.

Will I need counselling?

• All women are different and there is no standard amount of time that it takes for a women to put her abortion experience behind her. Bpas can provide post-abortion counselling at any time after an abortion.