How is termination of pregnancy performed

Abortions can only be carried out in hospitals or licensed clinics.

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 an 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 Counselling 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 ofabortion

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 should 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 firsttake 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 have another appointment where 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 four to six hours, the lining of the womb breaks down, causing bleeding and loss of the pregnancy you may have to stay at the clinic while this happens or you may be able to go home

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 (thecervix) 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.

Dilatation 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 about 10 to 20 minutes and you might be able togo home the same day.

After an abortion

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.

You can also find NHS counselling services near you .