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Abortion





 /conditions/articles/abortion/how-is-it-performed

Abortion

How an abortion is carried out

In the UK, under The Abortion Act 1967, abortions can only be carried out in a hospital or a specialist licensed clinic.

In most cases, an abortion in hospital will be carried out as a day procedure and you won’t need to stay overnight.

However, in some regions, the second part of early medical abortion (tablet) can be arranged to happen at home (see below).

Before the abortion

When you go for your first appointment, you should be given the opportunity to talk about your situation. You’ll be informed about the different methods of abortion, and which method is suitable for your stage of pregnancy. You will also be advised about any related risks and complications.

The doctor or nurse will take your medical history to make sure the type of abortion you are offered is suitable for you.

You’ll have a blood test to find out your blood group to see if you’re anaemic.

You should also be tested for sexually transmitted infections (STIs), and may be given antibiotics to stop an infection developing after the abortion.

Before having an abortion, you may also need to have:

If you have never had a vaginal examination before, the healthcare professional examining you will be aware you are anxious and will be as careful as possible. You should let them know if you are anxious and have not been examined internally before.

You may also be given information and advice about which method of contraception to use after the abortion. Finally, before having the abortion, you will be given a consent form to sign.

Methods of abortion

There are a number of different methods of abortion. The method recommended for you will depend on how many weeks pregnant you are. This is usually calculated by counting the number of weeks from the first day of your last period.

Broadly speaking there are two types of abortion – medical and surgical. A medical abortion is carried out using medication while a surgical abortion involves a minor operation. 

The methods of abortion are described below.

Early medical abortion (up to nine weeks of pregnancy)

An early medical abortion involves taking two different medicines 36-48 hours apart. The effect of the medication will be similar to having an early natural miscarriage – this means you will have some bleeding and some pain when the abortion happens.

After your initial visit to see the doctor, you will have two more appointments on different days.

On your first visit you will be given an abortion pill called mifepristone, which blocks the hormone that makes the lining of the womb suitable for the fertilised egg. After taking the first tablet, you will be able to go home and continue your normal everyday activities.

Very little will happen while you are waiting for the second part of the treatment. A few women will have mild cramps and a little bleeding, but most will not. If you have heavier bleeding or significant pain, you should contact the hospital or clinic.

If it is out-of-hours, you should go to your nearest walk-in centre or local hospital’s accident and emergency (A&E) department.

Two days later, on your second visit to the hospital or clinic, you will be given the second medicine, prostaglandin. Within four to six hours of taking prostaglandin, your womb lining will break down and be lost, along with the embryo, through bleeding from your vagina. This part of the process can be painful, but you can take a painkiller.

Medicines used during an early medical abortion may make you feel sick and you may have diarrhoea.

In some areas of the UK, the second dose of medication is administered on an outpatient basis and the abortion can be managed at home. This will be discussed with you if that is offered by the clinic or hospital.

Vacuum aspiration or suction termination (from seven 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 five to 10 minutes and can be carried out under a local anaesthetic or general anaesthetic.

Your cervix (womb entrance) will be dilated (widened) to make accessing your womb easier. A tablet may be placed inside your vagina a few hours before the abortion to soften your cervix and make it easier to open. Sometimes, an alternative ‘preparing’ tablet is given by mouth.

A small, plastic suction tube connected to a pump will then be inserted into your womb and used to remove the foetus and surrounding tissue.

After having a vacuum aspiration abortion, you will usually be able to go home the same day. However, following the procedure, you will usually experience some bleeding which can last for up to 21 days. The average length of bleeding is about nine to 10 days.

In most cases, the bleeding will be quite heavy for two to three days before settling down. Some women only bleed for three to four days in total. You may experience mild or moderate cramps for which you can take simple painkillers.

Late medical abortion (from nine to 20 weeks of pregnancy)

As well as being used for early abortion, mifepristone and prostaglandin can also 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 having a late medical abortion, you will usually be able to return home on the same day. However, sometimes an overnight stay in hospital may be required.

In rare cases, a second course of prostaglandin tablets may be required. This will be discussed with you. In a small number of cases (less than one in 20), the placenta or afterbirth does not pass. In this case, you may need to have a small operation under a general anaesthetic to remove the placenta.

Surgical dilation and evacuation (from 15 weeks of pregnancy)

Surgical dilation and evacuation (D&E) is a procedure carried out under general anaesthetic. Your cervix will be gently stretched and dilated and forceps and a suction tube will be used to remove the foetus and tissue within the womb.

Surgical D&E 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. The clinic or hospital will advise if you need to stay in hospital overnight. As with vacuum aspiration, you may experience some bleeding for up to 21 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 and are described below.

  • Surgical two-stage abortion - stage one stops the heartbeat of the foetus and softens the cervix. Stage two is carried out the following day and involves removing the foetus and surrounding tissue. Both stages are carried out under general anaesthetic.
  • Medically induced abortion - this is similar to a late natural miscarriage and involves the medicine, prostaglandin, being injected into your womb, making it contract strongly (as in labour). Contractions can last six to 12 hours. You will remain awake during the procedure and will be given medicines to help control the pain if needed. D&E may then be used to ensure the womb is completely empty.

Published Date
2014-08-19 11:22:13Z
Last Review Date
2014-07-17 00:00:00Z
Next Review Date
2016-07-17 00:00:00Z
Classification
Abortion






Abortion

Introduction

An abortion is the medical process of ending a pregnancy so it does not result in the birth of a baby.

It is also sometimes known as a ‘termination’ or a ‘termination of pregnancy’.

Depending on how many weeks you have been pregnant, the pregnancy is ended either by taking medication or by having a surgical procedure.

Read more about how an abortion is performed.

An abortion is not the same as a miscarriage, which is where the pregnancy is lost or ends naturally. The loss starts without medical intervention, although medical or surgical treatment may be needed after a miscarriage has started to help empty the womb.

Why an abortion may be needed

There are many reasons why a woman might decide to have an abortion, including:

  • personal circumstances – including risk to the wellbeing of existing children
  • a health risk to the mother
  • a high chance the baby will have a serious abnormality – either genetic or physical

Read more about why an abortion may be necessary.

When an abortion can be carried out

Under UK law, an abortion can usually only be carried out during the first 24 weeks of pregnancy as long as certain criteria are met (see below).

The Abortion Act 1967 covers England, Scotland and Wales but not Northern Ireland, and states:

  • abortions must be carried out in a hospital or a specialist licensed clinic
  • two doctors must agree that an abortion would cause less damage to a woman’s physical or mental health than continuing with the pregnancy

There are also a number of rarer situations when the law states an abortion may be carried out after 24 weeks. These include:

  • if it’s necessary to save the woman’s life
  • to prevent grave permanent injury to the physical or mental health of the pregnant woman
  • if there is substantial risk that the child would be born with serious physical or mental disabilities

Generally, an abortion should be carried out as early in the pregnancy as possible, usually before 12 weeks and ideally before 9 weeks where possible.

Read more about when an abortion is carried out.

NHS abortions

If you want to have an abortion through the NHS, you’ll usually need to be referred to a specialist service that deals with abortion.

You can ask your GP to refer you or you can go to your local family planning clinic or genito-urinary medicine (GUM) clinic. Use the post code search facility to find your nearest sexual health clinic.

The law states that any doctor with a moral objection doesn’t have to certify a woman for an abortion. But they must recommend another doctor who is willing to help.

Before an abortion can proceed, two doctors must ensure that the requirements of the Abortion Act are fulfilled, and they must both sign the relevant certificate.

This will often – but not always – be your GP and the doctor at the clinic where the abortion will take place.

Although it’s often very helpful to talk through the options with your GP or a family planning nurse before being referred, it’s possible to refer yourself for an NHS abortion in some parts of the country.

You can self-refer for an NHS-funded abortion by contacting:

Funding of NHS abortion services differs in various parts of the country. The level of NHS provision ranges from more than 90% of local demand to less than 60%.

In some areas, the NHS will pay for abortions at private clinics, but in other areas you may need to pay to have an abortion at a private clinic.

Private abortions

You can contact a private abortion clinic without being referred by a doctor. However, the NHS will not usually pay for this, and the agreement of two doctors is still required. The clinic will make the arrangements.

Costs for abortions in private clinics vary and will depend on:

  • the stage of pregnancy (earlier abortions are usually less expensive)
  • whether an overnight stay is needed
  • the method of abortion used

If you are considering having an abortion, it is important to talk to somebody about it as soon as possible.

Risks

No clinical procedure is entirely risk free, but abortion poses few risks to a woman’s physical health, particularly when carried out as early as possible in the pregnancy (preferably during the first 12 weeks).

Having an abortion will not usually affect your chances of becoming pregnant and having normal pregnancies in future.

The risk of problems occurring during an abortion is low. However, there are more likely to be problems if an abortion is carried out later in a pregnancy.

The risks associated with abortions are:

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

Read more about the risks of abortion.

Published Date
2014-08-19 11:21:25Z
Last Review Date
2014-07-17 00:00:00Z
Next Review Date
2016-07-17 00:00:00Z
Classification
Abortion






Abortion

Risks of an abortion

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

Having an abortion will not usually affect your chances of becoming pregnant and having normal pregnancies in future.

Risks at the time of an abortion

There is a low risk of problems occurring during an abortion. However, there are more likely to be problems if an abortion is carried out later in a pregnancy.

The risks associated with abortions are:

  • haemorrhage (excessive bleeding) - occurs in about one in every 1,000 abortions
  • damage to the cervix (the entrance of the womb) - occurs in no more than 10 in every 1,000 abortions
  • damage to the womb - occurs in up to four in every 1,000 abortions during surgical abortion, and less than one 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, which is usually caused by failing to completely remove all of the foetus and associated tissue.

You can reduce the risks of infection by using sanitary pads until the bleeding stops. It is best to avoid using tampons until your next period. You should also avoid having sex until the bleeding has stopped.

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 lead to a more severe infection of your reproductive organs, such as pelvic inflammatory disease (PID), which can cause infertility or ectopic pregnancy (where a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes). However, the risk of an infection can be reduced by taking antibiotics at the time of the abortion.

Repeated abortions can cause damage to your cervix and increase the risk of late miscarriages.

After having an abortion, you may experience some period-type pains and some vaginal bleeding, which should gradually improve after a few days. Most women are able to return to their usual activities within a day or so. However, you should seek medical attention if:

  • you have severe pain
  • the bleeding becomes very heavy
  • the bleeding has not stopped after 14 days

You will usually be advised not to have sex for up to two weeks, or until the bleeding has stopped. Seek advice from your GP, a family planning clinic or a pregnancy advisory service if you experience physical or emotional problems after having an abortion.

Post-abortion counselling

Women vary greatly in their emotional response to having an abortion. You may experience a number of different feelings and emotions.

However, research suggests that having an abortion does not lead to long-term emotional or psychological problems.

If you need to discuss how you are feeling after having an abortion, you can contact a post-abortion counselling service.

It is recommended you seek advice and counselling from a recognised counselling provider, such as CareConfidential or the British Pregnancy Advisory Service (bpas).

Find NHS counselling services near you.

Published Date
2014-08-19 11:22:33Z
Last Review Date
2014-07-17 00:00:00Z
Next Review Date
2016-07-17 00:00:00Z
Classification
Abortion,Cervix,Womb






 /conditions/articles/abortion/mapofmedicinepage

Abortion

See what the doctor sees with Map of Medicine

The Map of Medicine is used by doctors throughout the NHS to determine the best treatment options for their patients. NHS Choices offers everyone in England exclusive and free access to this cutting-edge internet resource, which lets you see exactly what your doctor sees.

The information in the Map has been approved by the UK’s leading clinical experts, is based on the best available clinical evidence, and is continually updated. To take advantage of this unique resource go to:

Map of Medicine: termination of pregnancy

Published Date
2011-11-25 11:31:06Z
Last Review Date
2010-06-03 00:00:00Z
Next Review Date
2012-06-03 00:00:00Z
Classification
Abortion






 /conditions/articles/abortion/when-should-it-be-done

Abortion

When an abortion can be carried out

In England, Wales and Scotland abortion is legal up until 24 weeks of pregnancy, although most abortions are carried out much earlier than this.

In rare circumstances, an abortion can sometimes be carried out legally after 24 weeks (see below).

The Abortion Act 1967

In accordance with The Abortion Act 1967, an abortion must usually be carried out before 24 weeks of pregnancy. The law states that:

  • abortions must be carried out in a hospital or a specialist licensed clinic
  • two doctors must agree that an abortion would cause less damage to a woman’s physical or mental health than continuing with the pregnancy

The few situations when the law states an abortion may be carried out after 24 weeks are:

  • if it’s necessary to save the woman’s life
  • to prevent grave permanent injury to the physical or mental health of the pregnant woman 
  • if there is substantial risk that the child would be born with physical or mental abnormalities and be seriously handicapped

Generally, an abortion should be carried out as early in the pregnancy as possible, usually before 12 weeks and ideally before nine weeks where possible. It’s rare for an abortion to be performed after 24 weeks.

Most abortions (around 90%) are carried out before a pregnancy reaches 13 weeks, and virtually all abortions (around 98%) are performed before 20 weeks.

The earlier an abortion is carried out, the easier and safer the procedure is to perform. However, you must be given enough time to consider all your options so you’re as comfortable as possible with your decision.

To work out how many weeks pregnant you are, the calculation is usually made from the first day of your last period. If the exact stage of pregnancy is unclear, you may need an ultrasound scan.

Personal decision

Making a decision about whether to have an abortion isn’t easy. Before deciding, you should discuss your situation with healthcare professionals, family members and, if applicable, your partner. You should consider all options and these can include:

  • abortion
  • possibly keeping the baby
  • more rarely, considering adoption for the baby

Always remember the final decision about whether or not to have an abortion is yours, and you should not be pressured into making a decision you might later regret.

If you are under 16 years of age, you can have an abortion without telling your parents, as long as two doctors believe it’s in your best interests and you fully understand what is involved.

However, the doctors will encourage you to involve your parents or another adult in your decision-making process. This increases the amount of support you have available. If you choose to have an abortion, you have the right for it to remain confidential, regardless of your age.

Published Date
2014-08-19 11:21:39Z
Last Review Date
2014-07-17 00:00:00Z
Next Review Date
2016-07-17 00:00:00Z
Classification
Abortion






 /conditions/articles/abortion/why-is-it-necessary

Abortion

Why an abortion may be necessary

A woman may decide to have an abortion due to her personal circumstances. But there are also medical reasons why an abortion may be necessary.

The Abortion Act 1967 states that provided a pregnancy has not exceeded its 24th week, an abortion may be carried out if:

  • continuing with the pregnancy would involve a greater risk to the woman’s life than ending the pregnancy
  • continuing with the pregnancy would involve a greater risk of injury to the woman’s physical or mental health than ending the pregnancy
  • continuing with the pregnancy would involve a greater risk to the physical or mental health of any of the woman’s existing children
  • there is a significant risk that the baby would be born with a serious physical or mental disability – read more about termination for foetal abnormality

The Act also makes it clear that two registered medical practitioners must both agree about the above points. In practice, this gives doctors a great degree of flexibility in referring women for abortions and supporting their request to proceed.

Read more about the Abortion Act 1967.

Deciding to have an abortion

Deciding to have an abortion can be difficult and a number of factors – social, economic, emotional – may be involved. But there is a wide range of information and advice services available to help you make your decision.

Your GP is one of the best people you can ask for advice about having an abortion. As well as being able to give you information about the procedure itself, they will also be able to discuss all your available options. Any discussion you have with your GP will be completely confidential.

If you don’t feel comfortable talking to your GP, you may prefer to contact an organisation such as:

  • Marie Stopes International - one of the UK’s leading providers of sexual and reproductive healthcare services; you can call their 24 hour helpline on 0845 300 8090
  • Brook - a national voluntary organisation that provides free and confidential sexual health advice and services aimed specifically at people under 25 years of age; Brook currently provide a text and webchat service 9am-3pm Monday to Friday 
  • the Family Planning Association (FPA) - a UK charity that provides sexual health information; you can contact the FPA’s confidential helpline on 0845 122 8687 if you live in Northern Ireland

Published Date
2014-08-19 11:21:53Z
Last Review Date
2014-07-17 00:00:00Z
Next Review Date
2016-07-17 00:00:00Z
Classification
Abortion