What is abortion and what are the treatment options?

Abortion

Whether it be private or on the NHS, there are two types of abortion routinely carried out: surgical and medical.

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. The following is a summery of the main things that are likely to occur during the procedure.

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 two 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 four 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 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.
Late medical abortions do happen in some cases, though it is more common that after 9 weeks of pregnancy a surgical termination will be advised.

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. Sometimes, the EMA medication does not work (this is estimated at 2-3% of the time, 2-3 in every 100 people). In this case a surgical abortion would 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 one in 10 women has an infection 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 nine out of every 100 cases.

Early Surgical Abortion

How 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 10-15 minutes. 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 two 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 10-15 minutes. This can be done up to 12 weeks and is available at some private abortion clinics.

Late surgical abortion

How 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 nject medication into the foetal eart to stop it.
In addition, dilators are pt 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 of a surgical abortion?

Infection (up to 1 in 10)
Excessive bleeding (approx 6 in 1000)
Perforation of the womb (up to 4 in 1000)
Damage to the cervix (up to 1 in 100)
Further surgical intervention when abortion is ‘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, but figures on this vary.

Abortion on the NHS

Within the NHS any person facing an unplanned pregnancy can easily access an abortion through her GP or through the Family Planning Services or Sexual Health service. Counselling is also offered within the Community Gynaecological Service that deals with referrals for abortion.

This is not compulsory and most women choose not to have it. Practical help for women who do not wish to have an abortion is harder to access.

Private abortion provision

Outside the Health Service, the main abortion providers are Marie Stopes International, and BPAS. Brook is also a main referral agency, as well as NHS Direct.

Post abortion support

Post-abortion support from the abortion providers can be given but both Marie Stopes and BPAS will usually only provide one or two post-abortion counselling sessions, and not an opportunity for ongoing contact. Through internet searches, the main post-abortion links always come back to the services provided by CareConfidential, called The Journey. Brook currently offers no post-abortion support service.