Abortion (sometimes called termination) is the surgical or medical ending of a pregnancy. It has been legal since 1967 and is legally available up to 24 weeks of pregnancy (or up to the due date if a disability is diagnosed).
Abortions can take place in NHS hospitals or in private clinics. In England, around 75% are under the NHS, whereas in Scotland, 98% are performed under the NHS.
Most abortions take place around 10-12 weeks of pregnancy. About 190 000 abortions are done each year in England and Wales, and about 13 000 in Scotland. It is illegal in Northern Ireland.
There is a variety of ways abortion is done:
Medical abortion:
Early Medical Abortions
An early medical abortion (EMA) is one that takes place in the first trimester, usually between 5-7 and 14 weeks of pregnancy. How is an early medical abortion done?
On your first visit to the hospital or clinic, you will be given a drug called Mifegyne. This makes the lining of the womb unsuitable for the pregnancy to continue. This drug can make some women feel sick. If vomiting occurs, a second pill has to be given. After this, you can go home.
During the next 48 hours, you may start to bleed and experience stomach cramps. Some women expel the pregnancy at home.You will be expected to go back to the clinic or hospital at a pre-arranged time and four tablets will be placed in your vagina. The drug (called prostaglandin) causes the womb to contract and expel the foetus. You will be given painkillers for stomach cramps. Most women expel the foetus within 1-6 hours whilst at the clinic or hospital.Late medical abortions
Late medical abortions are those that take place after 12-14 weeks of pregnancy. Some clinics and hospitals now prefer a medical termination as an alternative to surgical abortion if you are over 14 weeks of pregnancy.
The upper limit for this procedure 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.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?
Late medical abortions up to 16/17 weeks use the same medication as an early medical abortion, but will probably involve taking prostaglandin vaginally and by mouth. Stomach cramps can be quite strong, but again you will be given painkillers.
After 16/17 weeks, the uterus may also injected with prostaglandin to induce contractions and a substance to ensure that the foetus is not delivered alive.
A late medical termination can take longer to complete because the cervix has to dilate much more than with an early medical abortion. There is a possibility you will see the foetus.What are the health risks of medical abortions?
- Medical abortions are generally safer than surgical ones because you don’t have to have a general anaesthetic and no instruments are introduced into the womb. The risk of infection or physical damage to the cervix or womb is therefore reduced.
- There is a risk of the pregnancy not being terminated but this is rare.
- The termination might not be ‘complete’ i.e. some tissue may be retained which can cause infection and abnormal bleeding.
- Excessive bleeding can occur and may need to be treated.
- Late medical terminations may result in the placenta being retained. An operation may be required to remove it.
- The risk of heavy bleeding is also greater with late medical terminations.
Surgical abortion:
Surgical abortion can be offered as an alternative to a medical abortion, but in some places it is not now the preferred method. Local information about procedures needs to be sought from your nearest pregnancy crisis centre, GP or family planning clinic.Early Surgical Abortion
How is an early surgical abortion done?
Up to 14 weeks of pregnancy, a suction method (called vacuum aspiration) can be used. The woman is usually given a general (but sometimes a local) anaesthetic. A suction tube is inserted into the womb and the developing baby (foetus) is removed. After this, a woman usually bleeds for up to 14 days.
Late surgical abortion
How is a late surgical abortion done?
Up to 19 weeks of pregnancy, the developing baby is larger so surgical dilatation and evacuation (D&E) is used. This means that, under general anaesthetic, the opening of the woman's womb is stretched open and forceps (a metal tool) are used to remove the developing baby. Again, bleeding may occur afterwards for up to 14 days.After 20 weeks of pregnancy, surgical abortion involves injecting the developing baby to stop its heart or cutting the umbilical cord to ensure that it is dead. The next day, a dilatation and evacuation procedure (D&E, as described above) is done to remove it from the womb. The woman is under general anaesthetic for both parts of this abortion and usually has to stay in for at least one night.
In Scotland, the dilatation and evacuation (D&E) procedure is not used (see note above).
What are the health risks?
The risks to physical health include infection (up to 10% of cases); haemorrhage (bleeding) (in 1.5 per 1000 abortions); perforation of the womb (about 1-4 per 1000 abortions); damage to the cervix (up to 1% of abortions). If complications ensue, especially infection, relative infertility is not rare. Total infertility is rarer but does occur. Other problems include a higher risk of ectopic pregnancy, miscarriage and premature labour in later pregnancies.How will I feel about it afterwards?
Many women initially feel relieved after an abortion because they feel that the problems are solved. Some naturally feel sadness about the abortion but, over time, cope with it in a way that’s acceptable to them. However, there are many who do not cope and who experience various symptoms of what is now known as post-abortion stress.
You may experience these symptoms if you are unsure or ambivalent about having an abortion. For example, you may
- be pressurised by someone into the decision;
- feel as if you have no choice because circumstances feel overwhelming;
- be pregnant with a wanted baby but feel you have to abort because a disability has been diagnosed;
- have strong motherly feelings or maternal instinct;
- have been depressed before or
- do not feel very comfortable with the idea of abortion.
You may feel a combination of any of the above. Symptoms of post-abortion stress can include:
- Emotions such as guilt, grief, sense of loss and anger.
- Feeling the need to ‘replace’ the baby.
- A feeling of distance from existing children.
- Inability to maintain normal routine
- Depressed feelings that are stronger than ‘a little sadness’
- Sleeping problems
- Flashbacks
- Tearfulness
- Disturbing dreams or nightmares
- Inability to be near babies or pregnant women
In severe cases, a woman can become suicidal, self-harming, indulge in risk-taking behaviours, become dependent on drugs or alcohol or suffer anxiety or panic attacks.
These symptoms can occur at any stage after an abortion, sometimes triggered by another loss later on.
What do I need to think about as I make a decision about having an abortion?
Abortion is not always the easy quick-fix decision that it can appear to be. It can feel like: 'If I end the pregnancy, I end the problem'. But abortion can create problems – emotional and physical - of its own.
In the urgency of a crisis pregnancy, abortion often feels like the only way out of difficult circumstances, but not many people know very much about it.
It is hard to face the fact that abortion results in the death of a developing baby, but this needs to be taken into account in your decision making process. This may be painful for you to realise but it is better to consider it now rather than later.
It is so important to understand fully what's involved - in abortion itself as well as baby development - so that you can make a decision based on accurate information and not feelings of panic or fear. Know Your Options
We have all been given the ability to make choices with dignity and self-respect. It is wise to pay attention to your own deeper feelings - your conscience, instinct and beliefs, not just the difficult circumstances - before you make a decision.
The options to keep the baby or make an adoption plan for your baby are very positive choices and ones that may bring you greater health and well-being in the long run. It is important that you take time to consider these as well. Click for What about Adoption? and What about having a baby?
Talk to someone about it who can give you accurate information and help you talk through the issues affecting you.
A CAREconfidential advisor is available on 0800 028 2228
A CAREconfidential advisor is also available online, click here.