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Abortion

Abortion is the medical process of ending a pregnancy so that it does not result in the birth of a child. There are many reasons as to why a women may choose not to continue with her pregnancy, from risks to her own health right through to personal.

Abortion is the medical process of ending a pregnancy so that it does not result in the birth of a child.

There are many reasons as to why a women may choose not to continue with her pregnancy, from risks to her own health right through to personal circumstances or the possibility that the baby may be affected by a medical condition.

For some women, choosing to end their pregnancy may be a relativily simple and easy decision to reach, for others it will be one of the most difficult choices they ever make.

The complex range of emotions that surround an unplanned pregnancy are often what make the choice so difficult. It is these psychological factors coupled with social and economic influences and pressures that can sometimes lead to women feeling pressured into making a decision that is not entirely their own.

This fact-sheet intends to provide information and advice about abortion, as well as details of additional services available to help women to make the most well informed and appropriate choice.

Abortion facts1

According to the British Pregnancy Advisory Service (BPAS) - a charity who provide support for women affected by unplanned pregnancy - one in three women over 45 has had an abortion, making it a more common experience than often expected.

An abortion is the medical or surgical ending of a pregnancy (although an early natural termination is sometimes still called a 'spontaneous abortion'). There were 189,574 abortions performed in Britain in 2010, an 8% increase since 2000. These figures do not include the ‘morning after’ pill, of which 250,000 doses were issued last year in England. These have been sold by Chemists, without a prescription, to over 16’s since 2001.  Many women find themselves in the position of considering the impact of an unwanted pregnancy but the decision can be a difficult one for the majority.

Abortion has been practised for decades now and has been legal in England, Wales and Scotland since 1967. It is still illegal in Southern and Northern Ireland. 

In some cultures it is an acceptable form of birth control whereas in others it is considered morally unacceptable, which can make a decision about pregnancy a very lonely experience.Time, too, presents another pressure as it is generally accepted that earlier interventions are better and safer both emotionally and physically.

Making the right decision

A woman might need support or counselling to make a decision about whether or not to proceed with a pregnancy. An unwanted pregnancy may result in an adoption, fostering, an abortion or the decision to struggle to care for a baby.

Some of the organisations which offer pregnancy testing and advice are not impartial and cannot offer objective help by providing all the information needed to make the right decision. Their information may be biased or limited and may involve incorrect or untrue evidence and claims. For impartial pregnancy counselling and advice we recommend that you use an organisation from the Department of Health Register of Pregnancy Advice Bureaux. 

Post-abortion help and counselling is widely available to those who may need help afterwards. A decision might be practical and rational and be ‘the right one’ but still leave a feeling of sadness or guilt. Others may seek help later in life following feelings of loss or regret about an earlier termination.

Making a decision to end a pregnancy can be simple for some, and more complex for others, depending on their temperament, their relationship and the pressures of the community they live in. Often the decision is made under extreme pressure, without consulting family or friends. In situations like this counselling can be useful. The most vulnerable women are those who are not in stable relationships, those suffering abuse and those under 16.

Abortion laws

The 1967 Abortion Act covers the UK mainland but not Northern Ireland. The law states that abortions must be carried out in a hospital or licensed clinic and that two doctors must agree that an abortion would cause less damage to a woman’s physical or mental health than continuing with the pregnancy. An abortion must be performed within the first 24 weeks of pregnancy, although there are some circumstances which allow it to be done later.

If you are seeking an abortion you can ask your GP or go to the local family planning clinic or genitor-urinary medicine clinic. A doctor can refuse to issue certificates if he or she has a moral or religious objection, but should recommend another doctor who would be willing to do so.

Abortions are available on the National Health Service and through private clinics. The cost at private clinics depends on each organisation and the stage of pregnancy, with earlier abortions usually costing less.

Therapeutic reasons for women to consider an abortion include:

  • To save her life.
  • If congenital disorders are diagnosed in the foetus.
  • Preserving the physical or mental health of the woman.
  • Reducing the health risks in multiple pregnancies by reducing the number of embryos.

Good, impartial medical advice should be sought at the earliest possible opportunity, as the choice of procedures can differ according to time and circumstance

Common elective reasons for considering an abortion include:

  • If the woman is a victim of rape or incest.
  • If there is no stable relationship.
  • If there is a financial inability to support a child.
  • If the mother is too immature to support to child.
  • If there are work or study pressures.

When is the right time to seek help?

When considering a termination the earlier help is sought the better. Termination is a simpler procedure when performed earlier, when medical or surgical procedures are both still options.  Medical procedures involve taking a pill, accompanied by injection for later terminations. Surgical procedures include Vacuum Aspiration for pregnancies up to 15 weeks and Dilation and Evacuation for pregnancies of 15-24 weeks. 

The decision to terminate a pregnancy for some may be a complex one and may require the help of an experienced, unbiased counsellor who may explore the wider implications of the decision, consider all available options and support the woman in her choice.

The immediate and long-term implications of the decision for the woman and her partner should also be considered, although often the immediate family is not informed to simplify the initial decision. If a girl is underage, specialist help will be needed.

Abortion procedure

There are a number of different abortion methods. The most suitable option for you and your personal circumstances will be determined by how many weeks pregnant you are, usually calculated by counting the number of weeks since the start of your last period.

Whether you are visiting a private clinic or an NHS setting, your first appointment should give you the opportunity to discuss your circumstances if you feel comfortable doing so. You will then be told about the different abortion methods, the most suitable option for you and the possible risks and complications.

During your first appointment, the doctor or nurse will take your full medical history to ensure that you are not offered an abortion which could put your health at risk. Other tests which may be carried out include a blood test to check for anaemia, a test for Sexually Transmitted Infections (STIs), an ultrasound scan to confirm how far gone you are, a vaginal examination and possibly a cervical smear test.

Before the abortion itself is carried out you will also need to sign a consent form, allowing the procedure to be carried out.

Below is a summary of the abortion methods currently used by the NHS2:

- Early medical abortion - the abortion pill

(Can be carried out up to 9 weeks of pregnancy)

This is a non surgical procedure which involves taking two different forms of medication which result in a miscarriage.

The first drug - mifepristone - blocks the hormone which is required to make the fertilised egg stick to the lining of the womb.

48 hours later you will be given the second medicine - prostaglandin. The prostaglandin breaks down the lining of the womb within approximately four to six hours of ingestion, and the embryo is then lost through bleeding from the vagina.

Some women may prefer this option because they feel it is a more natural method than undergoing surgery.

- Vacuum aspiration or suction termination

(Can be carried out from between 7 to 15 weeks of pregnancy)

A surgical procedure in which a tube is gently inserted into the womb to remove the foetus.

- Late medical abortion

(Can be carried out from 13 weeks of pregnancy)

This is a similar method to that of an early medical abortion, whereby the same two drugs - mifepristone and prostaglandid - are used at a later stage. Because the pregnancy is further along the medication will take longer to have an effect and a second dose of prostaglandin may be needed.

- Surgical dilation and evacuation

(Can be carried out from 15 weeks of pregnancy)

Carried out under general anaesthetic this procedure involves gently stretching the cervix with tools known as dialators. Once the canal is large enough the womb is emptied using a suction tube.

- Late abortion

(Can be carried out from between 20 to 24 weeks of pregnancy)

There are two different abortion procedures for women in the latter stages of pregnancy, both of which require a short stay in hospital.

            - Surgical two-stage abortion

  • Carried out under general anesthetic, the first stage stops the heartbeat of the foetus and softens the cervix.
  • The day after the foetus and surrounding tissue are then removed.

            -Medically induced abortion

Prostaglandin is injected directly into the womb inducing strong contractions. You remain awake throughout the procedure, but if you are in discomfort you may be given medication to lessen the pain.

Once the contractions have run their course dilation and evacuation may then be used to ensure the womb is completely empty.

What are the risks?

Of course, it goes without saying that no surgical procedure or medication are entirely risk free, so what are the potential risks of terminating an unplanned pregnancy?

The risk of abortion is very low, especially when carried out during the first 12 weeks of a womens pregnancy.

It does also not usually have an effect on a womens future chances of conception.

According to the NHS Choices fact-sheet on abortion3, there are three very low risk complications that could happen at the time of termination:

  1. Haemorrhage - excessive bleeding occurs very rarely, in approximately 1 in every 1,000 abortions.
  2. Cervical damage - damage to the cervix occurs in around 10 in every 1,000 abortions.
  3. Womb damage - damage to the womb occurs in approximately 4 in every 1,000 abortions and 1 in 1,000 medical abortions carried out between weeks 12 and 24.

Post abortion risk

Once the abortion has been carried out the main concern is the possible risk of infection to the womb. This is rare but does sometimes happen if some of the foetus and associated tissue remain.

Side effects can include heavy bleeding and pains similar to menstruation pains, both of which can be eased and treated with the use of antibiotics.

If the infection goes untreated for a period of time, it can develop into something more serious like an infection of the reproductive organs such as pelvic imflammatory disease. Diseases such as this can lead to infertility or ectopic pregnancy and for this reason it is important that advice is sought from a medical professional as soon as any symptoms are spotted so that treatment can be started promptly.

Despite abortions not being particularly dangerous procedures, the more stress the cervix undergoes the more likely it is to become weak and/or damaged. Repeated abortions are not recommended, they can lead to higher chances of endometiosis and infertility - or if you do fall pregnant in the future can increase the risk of miscarriage, premature delivery or an ectopic pregnancy.

In terms of the emotional after effects, there is currently no evidence that having an abortion has a lasting psychological impact. However, many women experience strong feelings of guilt and sadness after having an abortion for which post-abortion counselling can be hugely beneficial.

How can Counselling help?

The practicalities of proceeding with or terminating a pregnancy need to be balanced with the emotional factors to ensure the right decision is made. It can be a stressful time, reinforced by feelings of isolation, if the woman is under pressure to conform to wider expectations without addressing her own needs.

Counselling at the earliest stages can help an individual reach the best informed choice. Family planning clinics often have trained counsellors who are non judgemental and able to help. Where a couple are both involved in making the decision, it may be appropriate for them to attend couple counselling to explore the more complex needs of each and what these might represent.  Each partner might hold different points of view which can swing and move – it is rarely a simple clear-cut decision.

  • Sunday, 29 July 2012

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Website is very informative :)

Super User Super User 29. July, 2012 |