PREgnancy

Do you think you might be pregnant? Or has it recently been confirmed that you are pregnant? If you have had sex and missed a period it is important that you find out whether or not you are pregnant as soon as possible.

If you are pregnant, you should make an appointment to see a midwife as soon as possible. To do this, you will need to phone your GP surgery, local health centre or maternity hospital, and ask for a booking appointment with a midwife.

test is positive, but you didn't want to be pregnant

When your pregnancy test is positive but you didn't want to be pregnant

You may feel confused, upset, shocked or dismayed. However you may feel you will need to consider the options open to you. How much time you have depends on how far on in the pregnancy you are already.

These are your options:

1. continue with the pregnancy and keep the baby
2. continue with the pregnancy and have the baby adopted or
temporarily fostered
3. having the pregnancy terminated ( have an abortion)

There are a number of people who can help and advise you. You may wish to discuss things with the clinic nurse or doctor, with your GP, the staff at the Day Ward at Ayrshire Maternity Unit, Crosshouse or the dedicated counselling service at Ayrshire Central Hospital , Irvine .

If you do not wish a termination but couldn't cope with bringing up a child, then adoption might be the answer for you. You can find more about this from the Social Worker at Social Work Department, Ayrshire Central Hospital , Irvine .

It may also be helpful to discuss the options with your partner, a friend or your family before making your decision.

In the end only you can decide what is the best thing for you to do.

Many people have faced the same choice and most feel they made the right decision in difficult circumstances.

The nurses and doctors at your GP practice or sexual health clinic can talk over the options with you, at the time the test is done and at a later appointment. If you decide to continue your pregnancy, you can be referred to the antenatal clinic. There are 'pro-life' charities that can offer emotional and practical support to women who request it.

Thinking about termination?

Before you decide, you need to consider

• The reasons you want a termination:
• It is the only option?
• If you have financial problems - would talking to a social worker help
• If you feel you couldn't cope - consider what help might be available - would your family be supportive? Would talking to a medical social worker help?
• How you will feel - immediately afterwards and in the long term
• If you are going to tell anyone
• The possible complications of a termination- although these are rare

The Law

If you want an abortion, the law says two doctors need to see you to confirm that the abortion would be legal according to the criteria set out in the Abortion Act.

There are time limits to abortion, so the sooner you get advice the better. Remember that the number of weeks you are pregnant is worked out from the first day of your last normal period.

Legally in England , Wales and Scotland , you can have an abortion up to the 24th weeks of your pregnancy, with the agreement of two doctors. However it is safest if the abortion happens in the first 9 weeks of pregnancy . Most abortions are carried out before this time. Abortions are not done after 16 weeks in Ayrshire. If it is not possible to obtain a termination from the NHS or you wish to go privately, arrangements can be made locally or through the British Pregnancy Advisor service (BPAS) or private clinics. This may be expensive depending on how far advanced the pregnancy is. Some of your costs may be met by the NHS

Having an abortion in Ayrshire

In Ayrshire terminations are performed in a dedicated unit called the Day Ward at Ayrshire Maternity Unit at Crosshouse.

If you decide you want to be referred for a termination you need to speak to your GP or staff at a sexual health clinic . They will make a hospital appointment.

The termination is NOT done at the first hospital appointment. You will have a scan to check how many weeks pregnant you are. You will be given a date for the termination. This will be a few days later.

There are two types of termination:
· Surgical termination is a day-case procedure under general anaesthetic (no need to stay in overnight)
· Medical termination. You take tablets and 2 days later go back to the hospital for more tablets which leads to the womb expelling the pregnancy

The doctor you see will explain which type is most suitable for you. An important factor is how many weeks pregnant you are.

Confidentiality

You have a right to confidentiality if you are seeking an abortion. Your GP, parents or partner do not have to be informed, even if you are under 16.

If you have an abortion arranged by a sexual health clinic, you will be asked if you give permission for your GP to be informed. It is better for your GP to know what has happened, but the choice is yours.

About abortion care in Ayrshire: what you need to know. This information is for you if you are considering having an abortion.

Contents

Key points

How can I get an abortion?

What can I expect before I have an abortion?

What does an abortion involve?

How safe is abortion?

What should happen afterwards?

Is there anything else I should know?

 

Key points

•  An abortion is a way of ending an unwanted pregnancy, either through using medicines (drugs) or a surgical procedure.

•  In Great Britain , the law allows a woman to obtain an abortion up to 24 weeks of pregnancy if two doctors agree that it would cause less damage to her physical or mental health than continuing the pregnancy. There are more restrictions in Northern Ireland . In Ayrshire abortions are performed up to 16 weeks of pregnancy. If you are after this time you will be referred to another service-usually this means travelling to England .

•  The earlier in your pregnancy you have an abortion, the safer it is.

•  You will be offered a choice of different methods, depending on how long you have been pregnant.

•  You should start using contraception again immediately after your abortion. Contraception will be discussed with you and will be supplied within the Day Ward prior to discharge.

How can I get an abortion?

If you think you want an abortion you should see your GP, practice nurse or sexual health clinic as soon as possible. They can refer you to an NHS or an independent abortion service, as you wish. If you prefer, you can contact an independent service directly . In Ayrshire you can be referred for a private abortion in Glasgow, a doctor from a sexual health clinic or GP needs to refer you for this.

If your own doctor or nurse does not provide abortion referral he or she must refer you to another GP.

Abortion is free on the NHS. If you choose to have private treatment you will have to pay a fee.

If you are over 16 weeks pregnant and have to be referred to an English clinic the NHS will usually pay your costs.

Private hospitals and specialist clinics that carry out abortions are licensed and inspected by the Healthcare Commission and approved by the Department of Health.

How long will I have to wait?

Waiting times vary according to where you live, but once you have seen a doctor to ask for an abortion, you should not have to wait more than 3 weeks from your first referral to the time of your abortion.

You should be seen as soon as possible if you need an abortion for urgent medical reasons.

Can my doctor refuse to give me an abortion?

A doctor or nurse has the right to refuse to take part in abortion on the grounds of conscience, but he or she should always refer you to another doctor or nurse who will help. The General Medical Council's Duties of a Doctor says that doctors must make sure that their “personal beliefs do not prejudice patient care”. The Nursing and Midwifery Council's Code of Conduct provides similar guidance to nurses.

Will anyone else be told about my abortion?

The decision to have an abortion is a matter between you and your healthcare team. All information and treatment is confidential. This means that information about you cannot be shared with anyone else without your agreement.

In Ayrshire, the abortion service prefers to tell your GP so that the GP can provide appropriate care afterwards and in the future about this. If you do not want your GP to know, you should tell the staff in the hospital.

You do not need your partner's agreement, although many women want to discuss the pregnancy with their partner and come to a joint decision. Partners who have taken legal action to try to prevent an abortion have always been unsuccessful.

What if I am under 16?

Any young person, regardless of age, can give valid consent to medical treatment providing she is considered to be legally competent – that is, able to understand a health professional's advice and the risks and benefits of what is being offered.

All very young women are encouraged to involve their parents or another supportive adult. If you choose not to do this, doctors can offer you an abortion if they are confident that you can give valid consent and that it is in your best interests.

You have a right to confidentiality like everyone else. However, if staff in NHS hospitals suspect you are at risk of sexual abuse or harm, they are obliged, with your knowledge, to involve social services.

What can I expect before I have an abortion?

A doctor or nurse will:

· work out how many weeks pregnant you are

· talk through the decision and explore your feelings about it

· decide if you are eligible for an abortion

· explain what an abortion involves

· make sure you understand any risks

· consider your general health

· Make a note of any regular medication taken (which may cause reactions to anaesthetics).

You should get appropriate, accurate information about the abortion procedure. As well as verbal advice, you should be offered printed information that includes local details. You should be given information on the different methods of abortion that can be used at your stage of pregnancy and the possible risks associated with them.

You should be offered extra support, if you need it, to help you make your decision. You should be offered appropriate information and support if you decide not to have an abortion.

If you have special needs (if for instance, you do not speak English or if you need to be cared for by a woman doctor) healthcare staff should make special arrangements for you.

In Ayrshire these tests are done-

•  A scan to find out how many weeks pregnant you are. You do not have to watch the screen if you do not want to.

•  Blood tests to check your blood group and make sure you are not anaemic.

•  A urine test for Chlamydia. You will also be given antibiotics to help prevent problems with infection after the abortion.

What if I am RhD negative?

If you are RhD negative, you should usually be offered an anti-D injection after your abortion. You can find more information about this in Guidance on the routine use of anti-D prophylaxis for RhD negative women: information for patients , by the National Institute for Clinical Excellence (NICE), at www.nice.org.uk/pdf/Anti_d_patient_leaflet.pdf

What does an abortion involve?

An abortion is a way of ending an unwanted pregnancy using either medicines (drugs) or a surgical procedure. The types of abortion that can be used depends on the stage of pregnancy.

In Ayrshire medical and surgical abortions are available. You should ideally have a choice of methods, although this may not always be possible.

Whichever type of abortion you have, you will usually be able to go home the same day.

In Ayrshire abortions are done in a self contained ward.

Early medical abortion – up to 9 weeks of pregnancy

Medical abortion is the most effective method for women who are less than 7 weeks pregnant. It is also a possible choice at any stage of pregnancy.

You will need to attend the hospital or clinic twice, on 2 separate days. On the first visit you take tablets of mifepristone to block the hormones that help a pregnancy to continue. On the second visit you will be given prostaglandin, either as tablets or as vaginal pessaries. Prostaglandin is a hormone that makes your womb expel the pregnancy, usually within 4 to 6 hours.

The RCOG guideline recommends a number of drug combinations for medical abortion. Some of them include a drug called misoprostol (a type of prostaglandin) which is not yet licensed for use in abortion but has been shown to be safe and effective. Your doctor or nurse should tell you if you are being prescribed an unlicensed but recommended treatment.

Methods of abortion used in Ayrshire

Medical abortion - after 9 weeks of pregnancy

You take the same drugs as you would for an early medical abortion. At this stage, however, abortion takes longer and you may need to have more than one dose of prostaglandin.

Suction termination– usually from 8 to 12 weeks

In Ayrshire, suction termination is carried out under general anaesthetic.

The entrance to your womb (known as the cervix) is gently stretched and opened until it is wide enough for the contents of the womb to be removed with a suction tube. The extent to which the cervix needs to be opened depends on the size of the pregnancy. To make this safer tablets containing misoprostol (a type of prostaglandin hormone) are put into your vagina to soften the neck of the womb.

You can find more information about having an anaesthetic at: www.youranaesthetic.info

Is abortion painful?

You will probably have some pain or discomfort, whatever kind of abortion you have, during or after the procedure. It is usually like period pain. You will be offered a choice of appropriate pain relief if you need it.

How will I feel after an abortion?

How you react will depend on the circumstances of your abortion, the reasons for having it and on how comfortable you feel about your decision. You may feel relieved or sad, or a mixture of both.

Some studies suggest that women who have had an abortion may be more likely to have psychiatric illness or to self-harm than other women who give birth or are of a similar age. However, there is no evidence that these problems are actually caused by the abortion; they are often a continuation of problems a woman has experienced before.

What is the risk of the abortion failing?

There is a small risk in all methods of early abortion that the pregnancy may not be ended. Before the 7th week of pregnancy medical abortion is more successful than surgical abortion.

Overall, just over two out of every 1,000 women who have a surgical abortion continue to be pregnant.

With medical abortion (including those carried out after the 7th week), different studies have come up with different rates of failure. Some have found that only one or two out of every 1,000 medical abortions failed to end the pregnancy, while others have reported that up to 14 out of every 1,000 fail.

How safe is abortion?

For most women an abortion is safer than carrying a pregnancy and having a baby. All medical and surgical procedures have risks, but the earlier in pregnancy you have an abortion, the safer it is . Your doctor or nurse should tell you about risks and complications that relate to the specific abortion procedure(s) being offered to you. If you have special concerns about certain kinds of risk, let your healthcare team know so that they can tell you more.

Are there risks at the time of the abortion?

Problems at the time of abortion are not very common:

•  excessive bleeding (haemorrhage) happens in around one in every 1,000 abortions;

•  damage to the cervix happens in no more than ten in every 1,000 abortions;

•  damage to the womb at the time of surgical abortion happens in up to four in every 1,000 abortions;

•  damage to the womb happens in fewer than one in every 1,000 medical abortions done between 12 and 24 weeks (a time known as mid-trimester).

Are there risks after the abortion?

You are more likely to get problems in the 2 weeks after the abortion than at the time of the procedure itself. Up to one in ten women will get an infection after an abortion. In Ayrshire you are given antibiotics at the time of the abortion to reduce this risk. If you are not treated, it can lead to a more severe infection (known as pelvic inflammatory disease or PID).

In one in every 100 abortions the womb is not completely emptied of its contents and the woman may need further treatment.

Will abortion affect my future chances of having a baby?

If there are no problems with your abortion it will not affect your future chances of becoming pregnant, although you may have a slightly higher risk of miscarriage or early birth. Your fertility may be affected if you have a serious infection such as PID or if you have an injury to your womb.

Does abortion cause breast cancer?

Research evidence shows that having an abortion does not increase your risk of developing breast cancer.

What should happen afterwards?

After your abortion you should

•  ring your GP or NHS ADOC if you develop pain, bleeding or a high temperature;

•  discuss contraception and obtain supplies if you need them;

•  attend a follow-up appointment within two weeks of your abortion (this is particularly important if you have an early medical abortion). You will be told whether this appointment is at the hospital or with a GP or Family planning clinic

•  ask for further counselling if you experience continuing distress (this happens to a few women and is usually related to personal circumstances).

What happens after an abortion?

After a medical abortion or an early abortion using a local anaesthetic a woman can usually return to work, school or college the next day. She should always follow the doctor's advice. It takes time to adjust emotionally as well as physically, and medication or anaesthetics can cause disorientation for a while. Recovery takes longer after the later abortions.

Feelings after the abortion

No woman forgets that she has had an abortion, but most women who choose an abortion do not regret it.

"I just felt very relieved after the abortion. I still do!"

"Sometimes I wonder what having a baby would have been like. But, no, I don't regret it."

"I was surprised how sad I felt, but I must admit we both really relieved."

"It was a difficult time for me - not just the abortion. Counselling really helped me."

Many just feel relief. Some women feel anger, regret, guilt, or sadness. These emotions may come and go. A woman's circumstances can affect ho she feels, and emotions can also be heightened by sudden hormonal changes after an abortion.

For many women, any emotional turmoil disappears rapidly after the abortion. For others, it lingers. It can also be a stressful time for men, who may have their own feelings of regret or sadness . There is a post-abortion counseling service in Ayrshire and Arran which is based at Ayrshire Central Hospital in Irvine . You will be given information about this service after your procedure. You can also get advice and help from one of the organisations listed.

Having sex again?

Having sex may be the last thing on your mind, but a woman can become pregnant again within two weeks of having an abortion.

It's not a good idea to have sex before the cervix has closed again, as germs can get into the uterus after the treatment.

It's best to wait until after a follow-up examination, or until three weeks after the bleeding has stopped.

When she does have sex again, a woman should use a condom to reduce her risk of infection and pregnancy.

Choosing contraception

Get all the information you need to make your choice. You can get advice from your GP or a Sexual health clinic. For more information on contraception click here

If you're not sexually active, you should still plan ahead for when you will be - it only takes one sperm to fertilise an egg. It may be awkward to admit that you're "planning ahead" for sex, but it's the best way to avoid unwanted pregnancy.

Emergency contraception can prevent pregnancy by stopping a fertilised egg from implanting itself in the womb. But you have to act fast. There are two methods.

Emergency pills can be taken up to three days after sex. They are more effective the earlier they are started.

An IUD (Intrauterine device) can be fitted within five days after sex.

Emergency contraception is available from GPs, and sexual health clinics.

Is there anything else I should know?

•  Sometimes extra procedures are necessary at the time of an operation to save a person's life or prevent serious harm to their health. Your doctor or nurse will tell you about these. You have a right to say whether there are any procedures you do not want the surgeon to carry out.

•  You have the right to be fully informed about your health care and to share in making decisions about it. Your healthcare team should respect and take your wishes into account.