Having an abortion is a personal choice and there can be many medical and social reasons for having one.
In Great Britain (England, Scotland and Wales), it's legal for an abortion to be carried out up to 24 weeks into a pregnancy. However, in exceptional circumstances, there isn't a strict upper limit. For example, you may be able to have an abortion after 24 weeks if your life is under serious threat or if your baby will be born with a severe disability. Most women, however, have abortions before 13 weeks of pregnancy.
In Northern Ireland, abortion is only legal in exceptional circumstances.
There are two main types of abortion – medical and surgical.
Medical abortion is often carried out in the early stages of pregnancy (up to nine weeks). It involves taking medicines to end the pregnancy. However, you can have a medical abortion up to 24 weeks into your pregnancy.
Two different procedures can be used to perform a surgical abortion.
Both procedures use suction to empty your womb (uterus).
Making a decision about having an abortion is often difficult. You may find that talking to someone you trust can help – for example, your partner, a family member or a close friend. Alternatively, you may prefer to speak to your GP or a professional counsellor.
To have an abortion, you must get consent from two doctors. Usually, the first is your GP and the second is a doctor from the clinic or hospital where your abortion will take place. The two doctors must decide that, on balance, having an abortion will decrease any risks to you (or your child's) physical or mental health.
Where possible, you will be offered a choice of procedure, but this will depend on how many weeks pregnant you are and whether you have any pre-existing medical conditions.
At your first appointment, your doctor or nurse will ask you to take a pregnancy test to confirm your pregnancy. You may also need to have an ultrasound scan to check your pregnancy dates. You don't have to see any pictures during the scan unless you would like to.
You may have urine and blood tests, and swabs taken from your vagina to check for sexually transmitted infections (STIs). You may also be offered a cervical screening test if you haven't had one within the last three to five years.
Your doctor or nurse will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.
Your doctor may prescribe antibiotics before, during or after your abortion to prevent or treat infection.
If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your doctor or anaesthetist's advice.
In a medical abortion, you will need to attend the clinic or hospital on two separate days. On your first visit, you will be given a medicine to take by mouth called mifepristone. This blocks the hormone progesterone that is needed for a pregnancy to continue. After you have taken mifepristone, you may have some vaginal bleeding. At your second visit, one to two days later, you will be given a medicine called prostaglandin, either taken as tablets or placed into your vagina (a pessary). This makes your womb contract.
Within four to six hours of receiving the prostaglandin, you will have some vaginal bleeding and cramping (similar to period pains), as the lining of your womb starts to break down, ending the pregnancy.
If you’re between nine and 13 weeks pregnant, and the abortion doesn’t happen within four hours of receiving the prostaglandin, you may need another dose. This will be given either as a tablet or as a pessary. You may need to stay at the clinic or hospital over night.
If you're over 13 weeks pregnant, you will usually need to stay in hospital to be cared for by a nurse or midwife.
You will be offered pain relief for medical abortion. Over-the-counter painkillers, such as paracetamol and ibuprofen may be enough, or your doctor may prescribe stronger tablets such as codeine or an injection if you need it.
Before the operation, you may be given a prostaglandin as a pessary. This will make it easier for your doctor to open your cervix and will reduce the risk of damage occurring during the operation.
This procedure is usually carried out under local anaesthesia. Your doctor will inject a local anaesthetic into the entrance to your womb (cervix) to reduce any discomfort or pain. You may also have a sedative for this procedure, which will help you to relax and feel less anxious. Your doctor will then insert a tube into your womb and apply gentle suction, ending the pregnancy. This procedure takes about five to 10 minutes and you will usually be able to go home a few hours after.
Alternatively, the procedure may be carried out under general anaesthesia, which means you will be asleep during the procedure. Talk to your doctor about the best option for you.
D&E is carried out if you're more than 15 weeks pregnant. You will usually have a general anaesthetic for this procedure. Your surgeon will open your cervix and end the pregnancy with a suction tube and forceps. If there is any tissue left in your womb, it will be removed by suction with vacuum aspiration. This procedure takes between 10 and 20 minutes and you will usually be able to go home on the same day.
If you're more than 20 weeks pregnant and have a D&E procedure you will need to stay in the clinic or hospital over night.
You will be offered pain relief throughout a surgical abortion. This may be given to you through a drip in your arm and you may also be given tablets to take home to ease any further discomfort.
If you have had a general anaesthetic, you will need to rest until the effects of the anaesthetic have passed.
Before you leave the clinic or hospital, your doctor or nurse will check how you are feeling and talk you through any aftercare you may need. You may also be given some information to take with you and advice about how to contact a counsellor if you need more help.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol and ibuprofen. Paracetamol alone may not be strong enough after an abortion so your doctor may prescribe stronger painkillers. Your doctor may also prescribe antibiotics to prevent or treat infection. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
You will be invited to have a check-up in the first two weeks after your abortion. You may be able to go to the clinic or hospital where the abortion took place, or you may go to your GP's surgery or a sexual health clinic.
After your abortion, you may go through a number of different emotions. Some women feel relieved; some feel sadness and grief, whereas others may have mixed feelings. There is no right or wrong way to feel, but if you’re finding things particularly difficult, try talking to someone close to you such as a friend or relative. Alternatively, you may wish to speak to a health professional for further advice.
Abortions are commonly performed and generally safe. However, you need to be aware of the possible side-effects and the risk of complications of this procedure.
Side-effects are the unwanted, but mostly temporary effects you may get after having the procedure.
You will have some pain in your abdomen and some vaginal bleeding after your abortion, which may feel like strong period pains. This is normal and to be expected.
Bleeding can last for several weeks after a medical abortion, and about two weeks after a surgical abortion. Occasionally, light bleeding, spotting or discharge can continue for up to a month. However, if your bleeding is very heavy, you should seek medical advice immediately.
Complications are when problems occur during or after the procedure.
In a small number of women (less than one in 100 women), some tissue is left in the womb after a medical abortion. This is called an incomplete abortion. You may therefore need to have the remaining tissue removed surgically under general anaesthesia.
Other specific complications of surgical abortion are uncommon but can include:
You may develop an infection after your abortion – around one in 10 women develop an infection afterwards. Contact your GP if you have any of the following symptoms.
If you have an infection, you may need further treatment, which may include a course of antibiotics, or you may need to be admitted to hospital and given antibiotics through a drip in your arm.
Produced by Natalie Heaton, Bupa Health Information Team, July 2012.
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