What about abortion?
Abortion is the deliberate ending of pregnancy and has been legal since 1967. It is legally available up to 24 weeks of pregnancy or up to the due date if a disability is diagnosed. Abortions take place in NHS hospitals or in private clinics. In England, the majority of women can choose to have an abortion, which is funded by the NHS, either at an NHS hospital or at a private clinic. In Scotland 98% of abortions are performed by the NHS. Abortion is not legal in Northern Ireland, so women who request to have an abortion have to travel elsewhere. Approximately 190,000 abortions are done each year in England and Wales, and about 13,000 in Scotland. There are two main methods of abortion: the medical and the surgical method. Medical abortion:Early Medical AbortionsAn early medical abortion (EMA) is one that can be carried out before 9 weeks gestation.How is an early medical abortion done?This is a two-stage procedure, which involves separate visits to the unit. - On your first visit to the hospital or clinic you will be given a tablet called Mifepristone. This works by blocking the hormone that maintains the pregnancy. This drug can make some women feel sick. If vomiting occurs within 2 hours a second dose has to be given. After taking this tablet you may start to bleed and experience stomach cramps, or experience some nausea / vomiting. Occasionally some women expel the pregnancy at home before the second stage of the procedure.
- On the second visit to the clinic you will be given 4 vaginal tablets to insert, or a medical practitioner may insert them for you. These Misoprostol tablets are a prostaglandin and cause the womb to contract and expel the pregnancy. You will be given painkillers for stomach cramp and some anti-sickness medication to take if necessary. Most women expel the pregnancy within 1-6 hours whilst at the clinic or hospital. However, if you are seen at a private clinic you may go home after the tablets have been inserted and pass the pregnancy at home. It is therefore important that you have someone with you throughout if this is the case.
- In some clinics the procedure takes place in one day. The oral tablet is taken in the morning, and vaginal tablets inserted 6-8 hours later.
- You will need a follow-up visit if you go home to complete the abortion. This is to ensure that the medication has worked.
- Sometimes, the EMA medication does not work. In this case a surgical abortion would be offered.
Late medical abortionsLate medical abortions are carried out from 9 weeks gestation.Gestation upper limits for this procedure within NHS hospitals varies across England and Wales, so you will need to ask for local information from your nearest Pregnancy Crisis Centre, GP or family planning clinic. Although you may need to travel, private clinics offer medical abortions up until the legal limit. In Scotland, there is usually an upper limit of 19-20 weeks for medical terminations, but some NHS units have an earlier limit. If the pregnancy is later than 20 weeks, and the reason for the abortion is under Clause C of the Abortion Act, (i.e. the continuance of the pregnancy would involve risk greater than if the pregnancy were terminated of injury to the physical or mental health of the pregnant woman), then the patient is referred to the private sector in England. For abortions after 20 weeks under all other clauses, the patient is offered a late medical abortion. How is a late medical abortion done? - This procedure may require an overnight visit and will involve two visits to the hospital or clinic.
- On your first visit to the hospital or clinic you will be given a tablet called Mifepristone. This works by blocking the hormone that maintains the pregnancy. This drug can make some women feel sick. If vomiting occurs within 2 hours a second dose is given. After taking this tablet you may start to bleed and experience stomach cramps, or experience some nausea / vomiting. It is rare to expel the pregnancy at home before the second stage of the procedure.
- On the second visit (24-48 hours later) you will be admitted into the clinic / ward. You will be given 4 vaginal tablets to insert, or a medical practitioner may insert them for you. These Misoprostol tablets are a prostaglandin and cause the womb to contract and expel the pregnancy. You will receive repeat doses of the tablets orally every 3 hours until the pregnancy is passed. As the uterus contracts there will be pain and bleeding. Other side effects of the medication can be nausea and vomiting, diarrhoea, hot flushes, headaches and dizziness. The nursing and medical staff will look after you throughout and medication will be given as necessary to ease the side-effects. The procedure takes on average 6-8 hours, but for some women it takes longer and an overnight stay may be necessary.
- If the procedure fails / partially fails / there is uncontrolled bleeding a surgical procedure may be required to empty the womb.
- For women over 22 weeks gestation, but sometimes earlier at NHS hospitals, there is an additional procedure under general anaesthetic during the first visit. The surgeon will put a needle into the womb to inject medication to stop the foetal heart.
- There is a possibility that you might see the foetus during the procedure. Nursing staff will be sensitive to your wishes on this.
What are the health risks of medical abortions? - Medical abortions are generally regarded as safer than surgical abortions because they don’t involve a general anaesthetic, nor pose a risk of physical damage to the cervix or the womb.
- There is a small risk of the pregnancy not being terminated. If this happened a surgical abortion would then be offered.
- The abortion may be ‘incomplete’ with some retained tissue left inside the womb. This is actually not uncommon due to the anatomy of the womb. Small bits of tissue / debris can be difficult to completely remove. This can lead to infection and abnormal bleeding, which would require medical attention. Up to 1 in 10 women have infections following an abortion.
- Abnormal bleeding can occur and may need to be treated. The risk of heavy bleeding is greater with later medical terminations.
- Late medical terminations may result in the placenta being retained inside the womb. An operation may be required to remove it. This happens in approximately 9 out of every 100 cases.
Surgical abortion:Surgical abortion is offered as an alternative to a medical abortion. However, in some NHS hospitals there might be limitations due to short surgical lists and local policy. Local information about procedures can be found through your nearest Pregnancy Crisis Centre, GP, Family Planning clinic or private abortion provider – Bpas or Marie Stopes. In private abortion clinics both methods will be available. Depending on where you live you may need to travel. Early Surgical AbortionHow is an early surgical abortion done?Under general anaesthetic
This is a day procedure and is carried out in an operating theatre. A short general anaesthetic means you will be asleep for about 10-15minutes. A tube is inserted into the cervix and suction is used to remove the pregnancy. Sometimes it is necessary for vaginal tablets to be inserted 2 hours prior to the abortion to soften the cervix.After getting up and having something to eat most women are able to leave the unit within two hours, but driving is not recommended within 48 hours. Many NHS hospitals have a 12 week limit. Under local anaesthetic
This is carried out either in an operating theatre or a procedure room, but is not always available. A local anaesthetic is injected into the cervix and, once numb, a small tube is inserted into the womb. A syringe fitted to the end of the tube is used to remove the pregnancy by suction. You should expect to experience very strong cramps. The procedure takes 10-15mins. This can be done up to 12 weeks and is available at some private abortion clinics.Late surgical abortionHow is a late surgical abortion done?Surgical dilation and evacuation abortion:15 weeks+This is usually NHS funded but carried out in private abortion clinics. Prior to the operation Misoprostol tablets are inserted vaginally to soften the cervix.During the operation the pregnancy is removed using forceps and vacuum aspiration. After 22 weeks, and sometimes earlier, this is a two-day procedure. On the first day, usually under general anaesthetic, a surgeon will inject medication into the foetal heart to stop it. In addition, dilators are put in the cervix to stretch it open in preparation for the next day’s surgery. The later the pregnancy the longer the expected admission time at the clinic / hospital will be. You should expect to stay overnight. In Scotland, the dilatation and evacuation (D&E) procedure is not used (see note above). What are the health risks? - Infection (up to 1 in 10)
- Excessive bleeding (approximately 6 in 1000)
- Perforation of the womb (up to 4 per 1000)
- Damage to the cervix (up to 1 in 100)
- Further surgical intervention when abortion in ‘incomplete’ (1 in 100)
- Infection following the procedure / untreated STI may pose the greatest risk to future fertility, including ectopic pregnancies
- There is likely to be a higher risk of miscarriage and preterm labour in subsequent pregnancies.
Many women initially feel relieved after an abortion. Some feel sadness about the abortion, but over time cope with it in a way that’s acceptable to them. However, there are some who do not cope well and who experience various symptoms, which are sometimes called post-abortion stress. These can include: - Emotions such as guilt, grief, sense of loss and anger.
- Feeling the need to ‘replace’ the pregnancy.
- A feeling of distance from existing children.
- Inability to maintain normal routine.
- Depressed feelings, which are stronger than ‘a little sadness’.
- Sleeping problems.
- Flashbacks.
- Tearfulness.
- Disturbing dreams or nightmares.
- Difficulty being near babies or pregnant women.
- In severe cases a woman can become suicidal, self-harming, indulge in risk-taking behaviours, become dependant on drugs or alcohol, or suffer anxiety or panic attacks.
These symptoms can occur at any stage after an abortion and are sometimes triggered by another loss later on. Some women are more susceptible to these symptoms particularly if there was uncertainty or ambivalence surrounding the decision.
Such women may have experienced: - Feeling uncomfortable about the idea of abortion.
- Strong motherly feelings or maternal instinct.
- Feeling she had no choice because circumstances were overwhelming.
- Having an abortion after a disability had been diagnosed in wanted pregnancy.
- Previous depression or mental ill health.
- Feeling pressurised by someone close.
What do I need to think about as I make a decision about having an abortion?In the urgency of a crisis pregnancy, abortion often feels like the only solution. To make a fully informed decision it may well be helpful for you to have the opportunity to look at all the options and possible outcomes, even if you ultimately choose abortion.We all have the freedom to make choices with dignity and self-respect. It is wise to pay attention to your own deeper feelings, your conscience, instinct and beliefs, whilst you are considering your personal circumstances. Click for What about Adoption? and What about having a baby? CareConfidential offers a safe place to consider and discuss all your options, and make your own decision. A CareConfidential advisor is available on 0800 028 2228
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