Abortion, Your Questions Answered Leaflet

abortion your questions answered

Marie Stopes International is a specialist reproductive healthcare organisation and a registered charity working in both the UK and overseas. Our nine main UK centres help over 80,000 women and men each year with abortion, sterilisation, contraception and health screening… but the good work does not stop there. Any financial surplus generated in the UK helps us provide reproductive healthcare services to women and their families in some of the poorest communities in the world. The organisation campaigns for better awareness of sexual health issues and open access to services for everyone. Our aim is to provide a high quality service, tailored to individual need. Whichever service you require we offer convenient appointments and experienced teams who are supportive and professional. For information & appointments:

Telephone 0845 300 8090 – 24 hours www.abortion-help.co.uk

Contents 1 What happens now? 1 What will happen at my consultation? 4 How is an abortion performed? 6 Do I have to have an anaesthetic? 6 Will it hurt? 7 Who will perform the procedure? 7 Are there any risks? 9 What are the centres like? 10 How long will I have to stay at the centre? 10 How will I feel afterwards? 10 Can someone stay with me? 11 How long will I need to take off work? 11 Does anyone have to know? 12 What next?

This booklet is designed to answer some of the most common questions we are asked about abortion, and to help you reach an informed decision about the treatment options open to you. Our team is trained to offer whatever support you feel you need, so please feel free to ask as many questions as you like.

What happens now? The first step is your consultation with a doctor or a specialist nurse.

What will happen at my consultation? You will be seen by a doctor or nurse who will discuss the different methods of abortion and help you choose the treatment that is best for you, which will depend on the stage your pregnancy has reached and your personal choice. You will be asked about your medical history and any medication you may be taking. In order to fulfil legal requirements your reason for seeking abortion will also be explored by a doctor.

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Discussing your decision & your options… While most women are very sure about their decision to have an abortion, others may be undecided. If you feel you need to discuss your situation or if you are at all unsure about what is best for you, we can arrange for a separate appointment with a specialist counsellor prior to consultation. Ultrasound scan… We will need to assess how many weeks pregnant you are using ultrasound scanning. If there are concerns an internal (vaginal) examination may be necessary. Ectopic pregnancy… If there is any chance that your pregnancy is ectopic, that is situated outside the uterus in the fallopian tube, you will be referred to a hospital for further scanning by an experienced radiographer. Unfortunately ectopic pregnancy can be very difficult to detect with an ultrasound scan, often giving the appearance of a normal pregnancy. This can be a life-threatening condition, therefore it is very important to report any unusual symptoms to us, such as one-sided pain, tenderness or bouts of dizziness. Blood test…. We will test for anaemia and the Rhesus factor of your blood by a quick finger prick. If your pregnancy has progressed beyond 13 weeks, a full blood sample will be taken.

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Testing for chlamydia… As part of your consultation and treatment we will perform a simple urine test for chlamydia, which is a common infection that many women and men have without symptoms. If left untreated, chlamydia can cause infertility. Please read the information leaflet provided. Future contraception… Your consultation is a good opportunity to discuss your future contraceptive needs. It is very important to understand that you can conceive as early as two weeks after an abortion. We are happy to discuss all the different contraceptive methods available, to find which one suits you.

Our teams are very experienced and are trained to offer whatever support you feel you need. If you have any concerns at any time, however small they may seem, please ask.

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How is an abortion performed? The kind of treatment you have will depend on how many weeks pregnant you are. The different options will be discussed in full at your consultation so you can make an informed choice.

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Early Surgical Abortion (Before 12 weeks pregnancy) At this stage gentle suction is used to remove the pregnancy from the uterus This is a very quick and simple procedure, taking less than five minutes to perform A general anaesthetic is not necessary and safer options are available – we will explain in a little more detail later.

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Early Medical Abortion: The Abortion Pill Three or four visits are necessary to complete this treatment. The ‘abortion pill’ (also called RU486) is available before 9 weeks of pregnancy and provides an alternative to surgery. Two different drugs are used to cause a miscarriage. Not all women are suitable for medical abortion and you will not be able to choose this method if: – You are over 35 and smoke more than 10 cigarettes a day – You have a suspected ectopic pregnancy – You have a history of heart disease, high blood pressure, liver or kidney disease – You are taking long-term corticosteroids – You have an IUD in place which will not be removed – You have adrenal failure – You are taking anti-coagulants or have any haemorrhagic disease or porphyria – You have poorly controlled inflammatory bowel disease.

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Some women feel that the abortion pill is more ‘natural’ than a surgical abortion, while others feel that the process takes too long. It really depends on what you prefer.

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Surgical Abortion

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Later Surgical Abortion

(13–19 weeks pregnancy) This procedure will take around 10-15 minutes, as we will need to dilate the cervix (opening of the uterus). If your pregnancy has progressed beyond 15 weeks, you may be given some medication to prepare your cervix for the procedure.

(19–24 weeks pregnancy) At this stage of pregnancy, the procedure is performed in two separate stages. You will be asked to arrive at the centre early in the morning for the first stage, which involves preparation of your cervix to cause it to gently dilate over a few hours. There is no need to have an anaesthetic for this part of the procedure. The second stage, to complete the abortion, will take place later that day and you will be given a general anaesthetic.

Should you have any questions about what happens regarding your pregnancy following treatment, please ask a nurse for information.

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Do I have to have an anaesthetic? No – in the early stages of pregnancy it is safer not to have an anaesthetic. There are health risks associated with general anaesthetic, particularly if you are overweight, suffer from any heart condition or have asthma. If you choose not to have a general anaesthetic you will recover and be able to go home much more quickly. When you have a general anaesthetic, the drugs can make you feel quite drowsy and sick. You will not be able to eat for six hours or drink for three hours before your treatment and you should not drive for 48 hours after having the anaesthetic – check with your motor insurance company. You might wish to consider conscious sedation. This will make you drowsy and relaxed and you may not remember much about the procedure. You will recover more quickly than after a general anaesthetic, without the after effects and will be able to go home a lot earlier.

The safest possible option in the early stages is to choose no anaesthetic drugs and remain fully awake and alert. This allows the quickest possible recovery and discharge.

Will it hurt? The simple answer is yes – although the discomfort associated with abortion is often likened to a strong period pain. As everyone experiences pain differently, it is impossible to tell exactly how you will feel. Most women who choose not to have an anaesthetic report that any pain is bearable, only lasts a very short time and very quickly subsides once the procedure is over. If you choose general anaesthetic there will be some cramping and discomfort following the procedure.

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Who will perform the procedure? Although you may see either a nurse or doctor for your consultation, a very experienced, specialist doctor will carry out the procedure. A nurse will stay with you throughout to offer you support and make sure you are comfortable and relaxed.

Are there any risks? There is little risk associated with early abortion, particularly in early pregnancy and no evidence at all that a straightforward abortion has any effect on future fertility or any other aspect of general health. However, any surgical procedure or medical treatment carries some risks, and you need to be aware of these: Infection: This can be reduced by following our aftercare advice. If an infection is not treated, it can lead to further serious problems and future infertility. Missed abortion: There is a risk, in early pregnancy, of the pregnancy being missed. At Marie Stopes Centres the risk is less than 1 in 10,000 ( 0.01%). If this happens a repeat procedure will be necessary. We may recommend that you come back two to three weeks after the treatment for a pregnancy test to ensure that all is well – a test done less than two weeks after your treatment is not reliable. Please do not hesitate to contact us if you are concerned that you are still pregnant. Incomplete abortion: At any stage there is a possibility of a tiny piece of tissue being left in the uterus. This can cause pain and bleeding and may lead to infection. The risk of this is less than 1% ( 1in 100 ). If you experience pain or prolonged bleeding please contact us for advice. In some cases a repeat procedure is indicated.

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Because women ask for fast appointments with the minimum of fuss, Marie Stopes International has pioneered the most modern and simple procedures. We ensure that you have as much choice about your treatment as possible. Our centres are fairly small and informal – not at all like visiting a hospital. We aim to make women feel comfortable and relaxed from the moment they arrive.

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Damage to uterus: There is a very small risk of your uterus being damaged during the course of the procedure. In some cases other internal organs may be affected. The risk is extremely small ( but greater in later pregnancy), occurring in less than 1 in 10,000 women ( 0.01% ). Your treatment will be carried out by an experienced doctor and we may need to transfer you to hospital if this should happen

What are the centres like? We aim to make the centres as welcoming and friendly as possible. The largest centre has a mix of 26 beds and reclining chairs and the smallest has 6 reclining chairs. You will usually share a small ward or lounge with other women who are having the same treatment (most centres do not have single rooms)

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How long will I have to stay at the centre? This will depend on the type of treatment you are having; the following is an approximate guide:

Consultation and treatment on one day With no anaesthetic With conscious sedation With general anaesthetic

2–4 hours 2–5 hours 3–8 hours

Treatment on a separate day With no anaesthetic With conscious sedation With general anaesthetic

1–3 hours 1–4 hours 3–6 hours

You also need to bear in mind that if you have to have a blood test, a scan or cervical preparation before your treatment, your stay at the centre will be longer. If you choose medical abortion your first appointment will be very quick, just to take the first pill. Your second visit to complete the treatment could involve a stay of a few hours at the centre or you may decide to go home straight away. We ask that you have somebody to accompany you home following treatment with general anaesthetic or conscious sedation.

How will I feel afterwards? It is quite normal to feel a bit low for a few days. Most women feel a sense of relief, but others may feel difficult emotions. At Marie Stopes Centres specialist counsellors are available, if anyone needs to talk through their feelings.

Can someone stay with me? Because our centres are small we do not have much space for people to wait with you. We have to respect the feelings and privacy of everyone, so it is not possible to allow companions onto the wards and into the treatment areas, particularly male partners.

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We would ask you to try and limit the number of people who come with you to the centre and to understand that they may be asked to leave to collect you later if the centre is busy.

Women often tell us how relieved they were to speak to people that were We are unable to look after young children or babies so you need to arrange childcare. Bringing babies to the centre may upset other women. completely non-judgmental. You certainly have notoneed towork? worry about How long will I need take off Many women return to work the next day after an abortion, but this is that when you visit a Marie Stopes entirely up to you. If you have a physically demanding job you may want to take a few days off. International centre. Does anyone have to know?

And it also might reassure you to know that an estimated one in three British Marie Stopes International promises to keep details of all clients’ womencompletely will have an Everyone abortion some appointments confidential. is given at a special personal identification number (PIN) so that only you can access details about your time during their life. appointment or treatment.

It is completely your decision who you tell about your treatment – this includes your partner, parents and GP. We will only contact your GP with your permission.

What next?

This means that abortion is an experience shared by a lot of women – women of all ages, cultures and what You will be given further information explaining your next appointment, to bring and what to expect, which you will need to read carefully to ensure circumstances. that everything goes as smoothly as possible. Once you have made your decision about your treatment, an appointment will be made for you, either at the same centre where you have your consultation, or another Marie Stopes Centre.

We hope that this booklet has helped to answer your questions. If there is anything at all that you are unsure about or that is worrying you, please ask.

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Notes

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Marie Stopes International aims to provide the best possible service and your feedback is important to us. Happily the vast majority of our clients express a high level of satisfaction with our services. However if you have any comments or suggestions for improvements we can make, please use the questionnaire that will be provided. If you are not satisfied with any aspect of the service provided and wish to make a complaint please ask at the Centre for a copy of our written procedure ‘Complaints – Information for Clients.’ This offers advice on how to go about this and outlines our standards when dealing with complaints. The Centre Manager will give your complaint their urgent attention, carry out an investigation and respond to you, but should you be dissatisfied with the handling of your complaint, it will be referred to the Director of UK Operations. If you need to contact one of our Centres to discuss anything, please call the telephone numbers below: Marie Stopes One Call: Termination of pregnancy information and appointments line:

0845 300 8090 Male and female sterilisation services:

0845 300 0212 Health screening for men and women:

0845 300 0460 You can also contact the Healthcare Commission

0845 601 3012 The address of the local office is outlined in ‘Complaints – Information for clients’ located at the Centre.

Marie Stopes International 1 Conway St Fitzroy Square London W1T 6LP United Kingdom Telephone +44 (0)20 7636 6200 Facsimile +44 (0) 20 7034 2369 Email [email protected]

Registered charity no. 265543 Company no. 1102208

TOP1/rev3/JD/09.07

Website www.mariestopes.org.uk