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 Abortions

An 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.
On the second visit to the clinic you will be given more medicine 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. At this stage you will be observed for an hour and then may be allowed home. The pregnancy will be expelled over a period of 1 to 6 hours. In some regions the woman is required to stay at the hospital or clinic until the procedure is complete.
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.

Due to the medicines used in this type of abortion, a medical abortion is not suitable if you:

Are over 35 and smoke more than 10 cigarettes a day.
Have a suspected ectopic pregnancy.
Have a history of heart disease or high blood pressure.
Have liver or kidney disease.
Are taking long term steroids.
Have adrenal failure.
Are taking anti coagulants.
Have any hemorrhagic disease or porphyria.

Vacuum aspiration or suction termination (from 7 to 15 weeks of pregnancy)

Vacuum aspiration, or suction termination, is a procedure that uses gentle suction to remove the foetus from the womb. The procedure usually takes 5-10 minutes and can be carried out under a local anaesthetic (where the area is numbed) or general anaesthetic (where you are put to sleep).

The entrance to the womb (cervix) is dilated (opened) to allow access to the contents. To soften the cervix and make it easier to open, a tablet may be placed in the vagina a few hours before the abortion. A small, plastic suction tube connected to a pump is then inserted into the womb and used to remove the foetus and surrounding tissue.

After a vacuum aspiration abortion, you will usually be able to go home the same day. However, following the procedure you may bleed a little for up to 14 days.

Late medical abortion (from 13 weeks of pregnancy)

As well as being used for early abortion, mifepristone and prostaglandin can be used for abortion later in pregnancy. However, the abortion will take longer, and more than one dose of prostaglandin may be needed. This type of abortion is similar to having a late natural miscarriage.

After the procedure, you can return home the same day, but sometimes an overnight stay in hospital is required.

Surgical dilation and evacuation (from 15 weeks of pregnancy)

Surgical dilation and evacuation (D&E) is a procedure that is carried out under general anaesthetic. The cervix is gently stretched and dilated and forceps and a suction tube are used to remove the foetus.

The procedure usually takes 10-20 minutes to perform and, if you are healthy and there are no complications, you may be able to return home the same day. You may have some bleeding for up to 14 days.

Late abortion (20-24 weeks)

There are two options for a late abortion carried out at 20-24 weeks. Both require an overnight stay in hospital.

Surgical two-stage abortion:
- stage one stops the heartbeat of the foetus and softens the cervix
- stage two (carried out the following day) removes the foetus and surrounding tissue
- each stage requires a general anaesthetic
Medically induced abortion:
- similar to a late natural miscarriage
- the medicine prostaglandin is injected into the womb, making it contract strongly (as in labour)
- contractions can last 6-12 hours
- you will remain awake during the procedure and may be given medicines to control the pain
- D&E may then be used to ensure that the womb is completely empty

If you bleed heavily, have a lot of pain or a high temperature after an abortion, seek medical help immediately.

Risks of an abortion

No clinical procedure is entirely free from risk, but abortion poses few risks to a woman's physical health, particularly when carried out during the first 12 weeks of pregnancy.

Risks at the time of an abortion

The risk of problems occuring during an abortion is low. However, there are more likely to be problems if an abortion is carried out later in a pregnancy. The low risks associated with abortions are:

haemorrhage (excessive bleeding) — occurs in about 1 in every 1,000 abortions
damage to the cervix — occurs in no more than 10 in every 1,000 abortions
damage to the womb — occurs in up to 4 in every 1,000 abortions during surgical abortion, and less than 1 in 1,000 medical abortions carried out at 12-24 weeks

Risks after an abortion

After an abortion, the main risk is infection in the womb, usually caused by a failure to completely remove all of the foetus and associated tissue.

If you have an infection after an abortion, you may bleed heavily from your vagina and have some period-like pain. Antibiotics are usually used to treat the infection.

If an infection is not treated, it could result in a more severe infection of your reproductive organs, such as pelvic inflammatory disease, which can cause infertility or ectopic pregnancy. However, the risk of an infection can be reduced by taking antibiotics at the time of the abortion.

Repeated abortions can cause damage to the entrance of the womb (cervix), and increase the risk of late miscarriages.

After an abortion, you may have some period-type pains, and some vaginal bleeding, which should gradually lessen after a few days. Most women can return to their usual activities within a day or so.

However, seek medical attention if you have severe pain or if bleeding has not stopped after 14 days.

Women vary greatly in their emotional response to having an abortion.

Following an abortion many women will have a mixture of positive and negative reactions.

Positive Reactions:

Relief
Happiness

Negative Reactions:

Sorrow
Sadness
Guilt
Regret
Grief
Loss

In some women these negative reactions can lead to:

Depression
Anxiety
Low self-worth.

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.

You can read about adoption or keeping the baby using the following links: 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 telephone advisor is available on our national helpline 0300 4000 999

or

use our free CareConfidential Online Advisor service.