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Abortion

NHS Direct Online Health Encyclopaedia

Introduction
Abortion is the common name for the medical process of Ending pregnancy. Healthcare professionals may use the term termination of pregnancy or just termination to describe an abortion.

An abortion is different from a miscarriage (see miscarriage) where the pregnancy ends without any medical intervention (although medical treatment may be needed after a miscarriage). Confusingly, healthcare professionals sometimes refer to miscarriage as spontaneous abortion.

Many people have very strong views and opinions about abortion (both for and against), often based on deeply held religious, cultural or philosophical beliefs. Whilst all of these views should be respected, the law in the UK (1) makes it legal to have an abortion in the first 24 weeks of pregnancy providing certain criteria are met (see next section).

The law on abortion (called the Abortion Act 1967) only covers the UK mainland (England, Scotland and Wales) and excludes Northern Ireland.

The law also states that:

Abortions must be carried out in a hospital or licensed clinic.
Two doctors must agree that the requirements of the Abortion Act 1967 have been met.
NHS Abortions

In order to have an abortion on the NHS you need a referral of two doctors who have to agree that the requirements of the Abortion Act have been met. Usually, the first doctor is the womans GP and the second is a doctor working at the hospital or clinic where the abortion takes place.

Sometimes women do not feel happy about approaching their own GP to ask to be referred for an abortion. If this is the case, doctors at some family planning clinics, young peoples clinics and some genito-urinary medicine (GUM) clinics will also refer women for an NHS abortion.

Doctors can refuse to certify a woman for an abortion because of their personal beliefs. If this is the case, they should recommend another doctor who can help.

Funding of NHS abortion services differs in various parts of the country; the level of NHS provision ranges from more than 90% of local demand to less than 60% in some areas. In some areas the NHS will pay for abortions to be provided by private clinics, but in other areas it may be necessary to pay for an abortion in a private clinic.

Private Abortions

You can also refer yourself for an abortion at a private clinic, although the NHS will not pay for this. The agreement of two doctors is still required before the abortion can take place, but the clinic will make the arrangements.

Costs for abortions in private clinics vary. The costs will depend on:

which organisation or company carries out the abortion,
the stage of pregnancy (earlier abortions are usually less expensive), and
whether an overnight stay is needed.
If you are considering an abortion, it is important to talk to somebody about it as soon as possible.

When should it be done?
Abortion is legal up to the 24th week of pregnancy and the majority of abortions are carried out before the 12th week of pregnancy.

If the woman's life is in danger or if there is a real risk that the child, if born, would have a severe physical or mental disability, then there is no legal time limit.

Generally, an abortion should be carried out as early in the pregnancy as possible (ideally, before 12 weeks) when it is easier and safer. However, you must be given enough time to consider all your options so you are as comfortable as possible with your decision.

If you are considering an abortion, it is important to speak to somebody as soon as possible.

Why is it necessary?
The reasons that an abortion may be necessary are set out in the Abortion Act 1967 (1). These are:

continuing with the pregnancy would be a greater risk to the womans life than would ending the pregnancy,
continuing with the pregnancy would involve a greater risk of injury to the womans physical or mental health than would ending the pregnancy,
continuing with the pregnancy would be more of a risk to the physical or mental health of any of the womans existing children, or
there is a real risk that the child, if born, would have a serious physical or mental disability.
In practice, this gives doctors a great degree of flexibility in referring women for abortions.

However, making the decision to have an abortion is a personal choice for the woman concerned. Sometimes this may be a very difficult choice, influenced by social, economic and emotional factors. Because of this, a wide variety of counseling, information and advice services are available to help women to make the most appropriate decision for them.

How is it performed?
In the UK, abortions can only be carried out in a hospital or licensed clinic.

How an abortion is carried out will depend on how long after conception it takes place. This is usually estimated by counting the number of weeks from the first day of the womans last period.

The following is a summary of the most usual methods of providing an abortion and local practices may vary:

Up to 9 weeks
In the first nine weeks of pregnancy the abortion pill may be used. This is also called an early medical abortion. This actually involves taking two drugs 48 hours apart.

The first drug (mifepristone, also known as RU486) blocks the action of the hormone that makes the lining of the womb suitable for the fertilised egg. After this part of the process, women normally go home, returning 48 hours later for stage 2 of the process.

The second drug (prostaglandin) is given 48 hours later and causes the womb to cramp and contract. The lining of the womb breaks down and is lost along with the embryo through bleeding from the vagina. This part of the process can be painful although pain-killing medication can be given.

The drugs used in this process can make some women feel sick and in some cases they may vomit or have diarrhoea.

9-14 weeks
From 9 to 12 weeks of pregnancy, a process called vacuum aspiration (which means gentle suction) can be used to remove the foetus from the womb. During a vacuum aspiration abortion, a narrow plastic suction tube is inserted into the womb through the neck of the womb (the cervix). A pump is then connected to the tube and this sucks out the foetus along with other tissue associated with the pregnancy.

After a vacuum aspiration abortion there can be a little bleeding for up to 14 days.

Vacuum aspiration abortions can be carried out under a local or general anaesthetic. It is not normally necessary to stay in the hospital or clinic overnight after a vacuum aspiration abortion.

14-19 weeks
Between 14 and 19 weeks of pregnancy, a process known as surgical dilatation and evacuation (often referred to as D&E) may be used. This is carried out under a general anaesthetic. The process involves stretching the neck of the womb (the cervix) just wide enough for forceps to be used to remove the foetus.

Vacuum aspiration (see above) may be used afterwards to ensure that no tissue is left inside the womb. There may be some bleeding after the abortion for up to 14 days.

This type of abortion does not usually require an overnight stay in hospital.

20-24 weeks
Between 20 and 24 weeks, there are two alternative methods of abortion.

The first is known as a surgical two-stage abortion as there are two stages to it, each of which requires a general anaesthetic.

Stage 1 involves stopping the heart beat of the foetus and softening the neck of the womb (cervix). Stage 2 is carried out the following day and involves removing the foetus and other tissue associated with the pregnancy using the D&E method explained above.

Surgical two-stage abortions usually require an overnight stay in hospital.

The second option is known as a medically induced abortion (or medical induction abortion) and is similar to a late miscarriage. The drug prostaglandin is injected into the womb and this causes it to contract strongly as in labour. This can last for around 6-12 hours. During the process the woman remains awake and may be given drugs to control the pain.

Afterwards the D&E process explained above may be necessary to ensure that the womb is completely empty.

Medically induced abortions usually require an overnight stay in hospital.

As with all abortions, if when you leave the hospital or clinic you experience heavy bleeding, a lot of pain, or a high temperature, you should seek medical help.


Recovery
No clinical procedure is entirely free from risk, but abortion poses few risks to a woman's physical health, particularly when provided in the first 12 weeks of pregnancy. Some women may experience some period-type pains and there may be a few days of gradually lessening bleeding. Most women are able to return to their usual activities within a day or so of their abortion.

The main risk after an abortion is infection in the womb caused by a failure to empty it completely. This will show itself by heavy bleeding from the vagina and sometimes some period-like pain. This is usually treated with antibiotics.

Women are usually advised to avoid sexual intercourse for two weeks after treatment.

Women vary greatly in their emotional response to having an abortion. Research evidence suggests that abortion does not lead to long-term emotional or psychological problems. However, some women can experience feelings of sadness or guilt after an abortion, and post-abortion counseling services are widely available.

If you are experiencing either physical or emotional problems after an abortion, always seek advice from your GP, a family planning clinic or pregnancy advisory service.

References
1.Queen Elizabeth II. The Abortion Act 1967. London: HMSO, 1967.

© Queen's Printer and Controller of HMSO, 2005

Crown copyright material is reproduced with the permission of the controller of HMSO and the Queens Printer for Scotland.

 

 

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