Abortion
An abortion is the medical process of ending a pregnancy so that it does not result in the birth of a baby.
It is also sometimes known as a termination.
One in three women will have an abortion in their lifetime.
This page covers:
•How to get an abortion
•When it can be done
•Making a decision
•What happens
•Risks of an abortion
How to get an abortion
Under the Abortion Act 1967, women may only have treatment for an abortion at an approved premises, usually a clinic. This includes having both parts of the medication needed for an Early Medical Abortion (EMA) (before 10 weeks) – mifepristone and misoprostol.
Under the Act, the Secretary of State for Health has the power to classify a class of place as acceptable for treatment for abortion to take place. In June 2018, the Minister for Health and Social Services in Wales approved a woman’s usual place of residence (home) in Wales as a suitable place to take the second part of the EMA (misoprostol).
The Welsh Guideline for early medical abortion with self-administration of misoprostol in the home setting allows women up to 9 weeks and 6 days gestation without any complicating factors to take misoprostol home with them. There are three main ways to get an abortion on the NHS:
•contact an abortion provider directly – the British Pregnancy Advisory Service (BPAS),
•speak to your GP and ask for a referral to an abortion service – your GP should refer you to another doctor if he or she has any objections to abortion
•visit a contraception clinic, family planning clinic, sexual health clinic or genitourinary medicine (GUM) clinic and ask for a referral to an abortion service. Find nearby clinics here.
Waiting times can vary, but you shouldn't have to wait more than 5 working days from your initial appointment to having an abortion.
Abortions can also be paid for privately if you prefer. Costs for private abortions vary depending on the stage of pregnancy and the method used to carry out the procedure.
When an abortion can be carried out
Most abortions in Wales, England and Scotland are carried out before 24 weeks of pregnancy.
They can be carried out after 24 weeks in certain circumstances – for example, if the mother's life is at risk or the child would be born with a severe disability.
The length of your pregnancy is calculated from the first day of your last period. If you're not sure how long you've been pregnant, you may need an ultrasound scan to check.
Abortions are simpler and safer the earlier they're carried out. Getting advice early on will give you more time to make a decision if you're unsure.
Deciding to have an abortion
Some women may be certain they want to have an abortion, while others may find it more difficult to make a decision.
All women requesting an abortion should be offered the opportunity to discuss their options and choices with, and receive support from, a trained pregnancy counsellor.
Impartial information and support is available from:
•your GP or another doctor at your GP practice
•a counselling service at the abortion clinic
•organisations such as BPAS – but beware of so-called "crisis pregnancy centres" that claim to provide impartial advice but often do not
You may also want to speak to your partner, friends or family, but they don't have a say in the final decision.
If you don't want to tell anyone, your details will be kept confidential. If you're under 16, your parents don't usually need to be told.
What happens during an abortion
Before having an abortion, you'll attend an appointment to talk about your decision and what happens next.
Whenever possible, you should be given a choice of how you would like the abortion to be carried out.
There are two options:
•medical abortion (the "abortion pill") – you take two medications, usually 24 to 48 hours apart, to induce a miscarriage
•surgical abortion – you have a minor procedure to remove the pregnancy and normally go home soon afterwards
After an abortion, you'll probably need to take things easy for a few days. It's likely you'll experience some discomfort and vaginal bleeding for up to two weeks.
Risks
Most women won't experience any problems, but there is a small risk of complications, such as:
•infection of the womb – occurs in up to 1 in every 10 abortions
•some of the pregnancy remaining in the womb – occurs in up to 1 in every 20 abortions
•excessive bleeding - occurs in about one in every 1,000 abortions
•damage to the cervix (the entrance of the womb) – occurs in up to more than 1 in every 100 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
If complications do occur, further treatment – including surgery – may be required.
Having an abortion will not usually affect your chances of becoming pregnant and having normal pregnancies in future.
In fact, you may be able to get pregnant immediately afterwards and should use contraception if you want to avoid this.
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How is it performed?
Abortions can only be carried out in hospital or licensed clinics or, for a medical abortion, you can be given the second part of the medication to use at home.
You won't usually need to stay in the clinic or hospital overnight, but you may need to attend several appointments on different days.
This page covers:
•Before an abortion
•Methods of abortion
•Afterwards
Before the abortion
Before having an abortion, you'll need to attend an assessment appointment at the hospital or clinic.
During this assessment, you may:
•discuss your reasons for considering an abortion and whether you're sure about your decision
•be offered the chance to talk things over with a trained counsellor if you think it might help
•talk to a nurse or doctor about the abortion methods available, including any associated risks and complications
•do a pregnancy test to confirm you're pregnant – an ultrasound scan may be done to check how many weeks pregnant you are
•be tested for sexually transmitted infections (STIs), your blood type and low iron levels (anaemia)
•be given antibiotics to reduce the risk of an infection developing after the abortion
When you're sure you want to go ahead with the abortion, you'll be asked to sign a consent form and a date for the abortion will be arranged. You can change your mind at any point up to the start of the procedure.
Methods of abortion
There are two main types of abortion:
•medical abortion (the "abortion pill") - taking medication to end the pregnancy
•surgical abortion - a minor procedure to remove the pregnancy.
Medical and surgical abortions can generally only be carried out up to 24 weeks of pregnancy.
But in exceptional circumstances an abortion can take place after 24 weeks – for example, if there's a risk to life or there are problems with the baby's development.
You will be offered a choice of which method you would prefer whenever possible.
Medical abortion
A medical abortion involves taking medication to end the pregnancy. It doesn't require surgery or an anaesthetic, and can be used at any stage of pregnancy.
It involves the following steps:
•you first take a medicine called mifepristone – this stops the hormone that allows the pregnancy to continue working; you'll be able to go home afterwards and continue your normal activities
•usually 24 to 48 hours later, you take a second medicine called misoprostol – this will either be a tablet that you may swallow, let dissolve under your tongue or between your cheek and gum, or put inside your vagina
•within about four to six hours, the lining of the womb breaks down, causing bleeding and loss of the pregnancy If a medical abortion is carried out after nine weeks, you may need more doses of misoprostol and you're more likely to need to stay in the clinic or hospital. Occasionally, the pregnancy doesn't pass and a small operation is needed to remove it.
Surgical abortion
Surgical abortion involves having a procedure with local anaesthetic (where the area is numbed), conscious sedation (where you're relaxed but awake), or general anaesthetic (where you're asleep).
There are two methods.
Vacuum or suction aspiration
Can be used up to 15 weeks of pregnancy. It involves inserting a tube through the entrance to the womb (the cervix) and into your womb. The pregnancy is then removed using suction.
Your cervix will be gently widened (dilated) first. A tablet may be placed inside your vagina or taken by mouth a few hours beforehand to soften your cervix and make it easier to open.
Pain relief is usually given using medicines that you take by mouth, and local anaesthetic, which is numbing medicine injected into the cervix. You may also be offered some sedation, which is given by injection. A general anaesthetic isn't usually needed.
Vacuum aspiration takes about 5 to 10 minutes and most women go home a few hours later.
Dilation and evacuation (D&E)
Used from around 15 weeks of pregnancy. It involves inserting special instruments called forceps through the cervix and into the womb to remove the pregnancy.
The cervix is gently dilated for several hours or up to a day before the surgery to allow the forceps to be inserted.
D&E is carried out with conscious sedation or general anaesthetic. It normally takes between 10-20 minutes and you may be able to return home the same day.
Afterwards
If you have a medical abortion, you may experience shortlived side effects from the medications, such as nausea and diarrhoea. General anaesthetic and conscious sedation medication can also have side effects.
For all types of abortion, it's likely you will experience some stomach cramps and vaginal bleeding, too. These usually last a week or two. Sometimes light vaginal bleeding after a medical abortion can last up to a month.
After an abortion, you can:
•take ibuprofen to help with any pain or discomfort
•use sanitary towels or pads rather than tampons until the bleeding has stopped
•have sex as soon as you feel ready, but use contraception if you want to avoid getting pregnant again as you'll usually be fertile immediately after an abortion
Get advice if you experience heavy bleeding, severe pain, smelly vaginal discharge, a fever or ongoing signs of pregnancy, such as nausea and sore breasts. The clinic will give you the number of a 24-hour helpline to call if you have concerns.
You may experience a range of emotions after an abortion. If you need to discuss how you're feeling, contact the abortion service or ask your GP about post-abortion counselling.
Buying abortion pills online
It's against the law to try to cause your own abortion. It is possible to buy abortion pills online, but you will not know if these are genuine and they could be harmful.
Before doing anything, contact an abortion advice service such as the British Pregnancy Advisory Service (BPAS), who can help you find appropriate care for free and in confidence.
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Risks
Abortions are generally very safe and most women won't experience any problems.
But like any medical treatment, there is a small risk that something could go wrong. The risk of complications increases the later in pregnancy an abortion is carried out.
This page covers:
•Possible complications
•When to get medical advice
•Effect on fertility and future pregnancies
Possible complications
The main risks associated with abortions are:
•infection of the womb – occurs in up to 1 in every 10 abortions; it can usually be treated with antibiotics
•some of the pregnancy remaining in the womb – occurs in up to 1 in every 20 abortions; further treatment may be required if this happens
•continuation of the pregnancy – occurs in less than 1 in every 100 abortions; further treatment will be needed if this happens
•excessive bleeding - occurs in about 1 in every 100 surgical abortions
•damage to the entrance to the womb(cervix) - occurs in up to 1 in every 100 surgical abortions
•damage to the womb - occurs in up to 4 in every 1,000 surgical abortions, and less than one in 1,000 medical abortions carried out at 12-24 weeks
Women who have an abortion are no more likely to experience mental health problems than those who continue with their pregnancy.
There is also no link between having an abortion and an increased risk of breast cancer.
When to get medical advice
After having an abortion, you'll probably experience some period-type pains and some vaginal bleeding, which should gradually improve after a few days, but can last for one to two weeks. It's normal and is usually nothing to worry about.
But you should get advice if you experience any signs of a possible problem, such as:
•excessive bleeding – for example, if you pass large clots or go through two or more sanitary pads an hour for more than two hours in a row
•severe pain that can't be controlled with painkillers such as ibuprofen
•a high temperature (fever)
•smelly vaginal discharge
•continuing pregnancy symptoms, such as nausea and sore breasts
The clinic will provide you with the number of a 24-hour helpline to call if you experience any problems after an abortion.
Effect on fertility and future pregnancies
Many women are able to get pregnant immediately afterwards, so you should start using contraception right away if you don't want this to happen. You should be advised about this at the time you have the abortion.
Having an abortion won't affect your chances of becoming pregnant and having normal pregnancies in the future if there are no problems with the abortion, such as injury to the uterus or cervix, or serious infection. These problems are not common. .
There's a very small risk to your fertility and future pregnancies if you develop a womb infection that isn't treated promptly. The infection could spread to your fallopian tubes and ovaries – known as pelvic inflammatory disease (PID).
PID can increase the risk of infertility or ectopic pregnancy, where an egg implants itself outside of the womb.
But most infections are treated before they reach this stage and you'll often be given antibiotics before an abortion to reduce the risk of infection.
Having several abortions is associated with a slightly increased risk of giving birth prematurely, before the 37th week of pregnancy, in future pregnancies.
Talk to your doctor or an abortion advice service for more information if you're concerned about the possible risks of an abortion.