Before the abortion
When you are referred for abortion and go for your first appointment (sometimes referred to as the ‘assessment’ appointment), you should be given the opportunity to talk about your situation. You will be informed about the different methods of abortion, and which methods are suitable for your stage of pregnancy. You should also be advised about any related risks..
The doctor or nurse will take your medical history to make sure that the type of abortion you are offered is suitable for you. At the assessment appointment, a number of other things usually happen, including:
Finally, before starting treatment, you will be given a consent form to sign.
In Scotland, England and Wales, under The Abortion Act 1967, abortion treatment can only be carried out in a hospital or specialised licensed clinic. In most cases, an abortion is carried out in an out-patient clinic or ward or as a day procedure, and an overnight stay in hospital is not usually required.
There are a number of different methods of abortion. The type recommended for you will depend on how many weeks pregnant you are.
Early medical abortion (up to 9 weeks of pregnancy)
Early medical abortion involves taking two different medications, usually around 48 hours apart. The effect of the medication will be similar to an early miscarriage.
Following your initial assessment appointment at the abortion service, you will usually have two more appointments on different days. On your first visit you will be given a medication called mifepristone, which blocks the hormone that makes the lining of the uterus (womb) suitable for the fertilised egg. After taking the first pill, you will be able to go home and continue your normal everyday activities. In some instances (where appropriate) the first medication may be given at the assessment appointment.
On your next visit to the abortion service, you will be given the second medication, which is called misoprostol. This medication is usually inserted vaginally or taken orally. This medication causes the lining of the uterus (womb) to break down, and to be passed along with the embryo and bleeding, through the vagina. This usually happens within four to six hours of the medication being taken. This part of the process can be a bit like a very heavy period. It can be painful, but painkillers can be taken, and are usually provided by the abortion service.
The medicines that are used during an early medical abortion may make you feel quite sick and you may have diarrhoea.
In some cases, depending whether you live close enough to the abortion service, you may be able to return home after taking the second medication. This will be discussed with you if that is offered by the clinic or hospital. Otherwise you would remain in hospital as a day patient until the pregnancy is passed.
Following the procedure you will bleed, usually for 7-10 days.
Surgical abortion (from 7 to 13 weeks of pregnancy)
Vacuum aspiration, or suction termination, is a procedure that uses gentle suction to remove the pregnancy tissue from the uterus (womb). The procedure usually takes 5-10 minutes and can be carried out under a local anaesthetic (where the area is numbed) or general anaesthetic (where you are put to sleep). Most women receive a general anaesthetic for the procedure.
The entrance to the womb (cervix) is dilated (opened). To soften the cervix and make it easier to open, a tablet may be placed in the vagina or mouth a few hours before the abortion. A small, plastic suction tube connected to a pump is then inserted into the womb and used to remove the pregnancy tissue.
After a vacuum aspiration abortion, you will usually be able to go home the same day. Following the procedure you will bleed, usually for around 7 days
Later medical abortion (from 9 to 18/20 weeks of pregnancy)
As well as being used for early abortion, mifepristone and misoprostol can be used for abortion later in pregnancy. At this time, the abortion will take longer (usually between six and twelve hours, depending on how many weeks pregnant you are), and more than one dose of misoprostol may be needed. This type of abortion is similar to having a later miscarriage. You will be awake during this procedure, and medication will be given to manage the pain.
After the procedure, you can usually return home the same day. Sometimes the pregnancy can take longer to pass and an overnight stay in hospital is required.
Following the procedure you will bleed, usually for 7-10 days. Depending on how many weeks pregnant you were, you may notice some other symptoms such as a small amount of fluid leaking from the breasts.
Later surgical abortion
The following procedures are not currently available in Scotland. If you are over 18/20 weeks pregnant you may need to travel to a specialist clinic in England for one of these treatments, funded by your local NHS service.
Dilation and evacuation (from 18 weeks of pregnancy)
Surgical dilation and evacuation (D&E) is a procedure that is carried out under general anaesthetic. The cervix is gently stretched and dilated and forceps and a suction tube are used to remove the fetus and surrounding pregnancy tissue.
The procedure 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. You will have bleeding for up to 14 days.
Two-stage later surgical abortion (from 20 to 24 weeks of pregnancy)
If you are more than 22 weeks pregnant, the abortion usually requires a two-stage process, carried out under general anaesthetic.
In stage one, an injection stops the heartbeat of the fetus and medication is used to soften the cervix. Stage two is carried out the following day, and involves removal of the fetus and surrounding tissue
Following the procedure you will bleed, usually for up to 14 days. You may notice some other symptoms such as a small amount of fluid leaking from your breasts.