This information has been developed to provide women with an outline of each stage involved in accessing a surgical termination of pregnancy at a private clinic. It is intended as a guide only; it should be noted that the procedure may vary at individual clinics, depending on the management and health care practices adopted by the medical director/s. If you have any questions or want more detail, call the clinic you are considering attending.
A few clinics in Queensland do offer medication termination of pregnancy. This option is only available until nine weeks gestation.
In preparing for minor surgery it is essential that you have a shower and remove all jewellery and makeup. You will probably be told to not eat anything up to about 8 hours before the procedure. A partner or support person can accompany you into the clinic and attend the initial consultation with the counsellor if you'd like. However, it isn't usually possible for your partner or support person to stay with you throughout the medical examination and the other medical procedures, like the ultrasound. They will then be contacted to pick you up when the procedure is complete.
When you first arrive at the clinic you will be asked to fill out a registration card with details such as your name, address and a contact phone number.
You will have to pay for the cost of the termination before continuing through to surgery. Expect to pay between $300 and $800 within the first trimester of pregnancy (up to the first twelve weeks of the pregnancy) as prices vary from clinic to clinic. Some clinics also provide concessions for Pension or Healthcare Card holders. It is important to have your Medicare card at the time you pay because part of the cost of the abortion is billed to Medicare. If a Medicare card or Medicare number is not available full payment will be requested. This will be considerably more than you would have been quoted. Cairns clinic is a bit different from the other clinics because it requires full payment up front. Where full payment is made, Medicare card holders can claim a rebate for part of the cost by lodging a Medicare form.
Pre operative blood tests (blood group and haemoglobin level):
When a termination of pregnancy is a surgical procedure it is important that the clinic is aware of your blood group and Rhesus status (positive or negative). The haemoglobin level affects the choice of anaesthetic offered. Pathology tests are usually taken at the clinic. The clinic is required to contact you if there is concern over your pathology test results. If requested this contact can be made by letter.
You are required to have some form of legal identification. A driver's license or a birth certificate are examples of acceptable legal identification.
Some clinics provide counselling or intake sessions with a fully qualified counsellor, however at most clinics the person you speak to before the procedure could be an administration worker, a health worker or a nurse.
Regardless of whether or not you see a counsellor, the day of the appointment is not the best time or place to seek decision-making counselling. If you want to talk about your decision with a counsellor, it’s best to do this before the day of the procedure.
The clinic worker you speak to before the procedure is there to make sure it is your decision, that you are consenting to the procedure, answer any questions you have, take your medical history and document your reasons for the procedure. If you are unsure about your decision and you want decision making counselling, you can ask the clinic if they have counsellors and if they provide decision making counselling. Alternatively, you may wish to contact Children by Choice as we specialise in non-judgmental, pro-choice, decision making counselling, which is provided by trained Social Workers, Counsellors and Psychologists, by telephone throughout Queensland, and face-to-face in Brisbane, free of charge.
You'll be asked to change into a surgical gown (the sort that open at the back and are commonly worn during an operation). Your clothes are stored safely. Socks and a cardigan or shawl can be brought with you to wear while waiting for surgery, as it can be quite cool in the clinic due to the air conditioning.
The next stage in the process involves a consultation with the clinic doctor. The doctor will discuss your medical history and answer any questions regarding the procedure.
The doctor must get your informed consent before the procedure happens. To obtain informed consent the doctor must be satisfied that you clearly understand the surgical abortion procedure and the associated risks. It is important to ask questions if the instructions and explanations given by the doctor are unclear or the information is difficult to understand.
To give informed consent you will be requested to sign a consent form. The consent form states that you are aware of the procedure, risks and complications and that you request the operation to take place.
The doctor needs to confirm the pregnancy and gestation. This is done by either an internal examination or more often a transvaginal or abdominal ultrasound scan. This also enables the doctor to become familiar with your individual cervix and uterus before the abortion. The doctor also confirms that there is not an ectopic pregnancy (a pregnancy where the fertilised egg has implanted outside of the uterus). Ectopic pregnancies are rare but do require hospitalisation and a different surgery.
An anaesthetic is required during the abortion procedure. An anaesthetic is standard to all surgical operations. At most clinics, there are three types of anaesthetic available, which will be discussed with the Anaesthetist:
Local anaesthetic given to the cervical area makes the cervix and the lower part of the uterus numb so women don't feel anything during the operation. Few women will be offered local anaesthetic solely due to health reasons or personal choice. If you think you would prefer a local anaesthetic you should be aware that the process of administering the local anaesthetic to the cervix can be quite painful to experience while conscious. However, there are very few health risks associated with local anaesthetic.
Twilight anaesthetic (intravenous sedation) with Local anaesthetic
This combination is the most commonly used for surgical abortion. When Twilight anaesthetic is given you will experience a feeling of floating and will be quite drowsy. The local anaesthetic is given afterwards. You will be in a dream-like consciousness during the procedure and may have only vague memories of the operation. There are few health risks associated with this anaesthetic.
This anaesthetic makes you unconscious within a few seconds. There are some health risks associated with general anaesthetic including impairment of gag reflex (ability to vomit), problems with the airway and increased bleeding.
For all Twilight and General anaesthetics a drip will be inserted into your arm. This is used to deliver any drugs and to manage complications that could occur.
The choice of anaesthetic offered to you is determined by a number of factors including:
Some questions and issues we encourage you to discuss with the anaesthetist are:
You will be required to spend the same amount of time in recovery regardless of the anaethetic administered. You can expect to be more alert after the local anaesthetic and the Twilight anaesthetic. It is important that you have nothing to eat, drink or smoke for a certain period of time before the abortion. Anything taken orally before the abortion could have an adverse affect on you after the anaesthetic has been administered.
An abortion is a simple surgical procedure. It is a very safe procedure when performed by a trained medial practitioner. The procedure itself takes between three and ten minutes however, the average length of time spent at the clinic is between three and four hours because this includes pre and post operative care.
An abortion later in the pregnancy remains a safe procedure when performed by a trained medical practitioner. However a different procedure technique and timeframe applies for abortions after about fourteen weeks. Some clinics emphasise that it is up to the doctor’s discretion whether they will provide a second trimester abortion. Costs also increase steeply after twelve weeks.
After the anaesthetic is administered the medical practitioner dilates (widens) the cervix a few centimeters. This is done using graduated dilator rods (similar in appearance to the ring measure used by a jeweller). A small, soft tipped instrument (cannula) is then inserted through the cervix to the uterus. The cannula is attached to a small suction pump which gently suctions away the contents of the uterus. A curette (spoon shaped instrument) is then used to check that the uterus is empty. The instruments are then withdrawn and the woman proceeds to the recovery room.
Complications are rare and happen in only 0.5% of all cases. They include perforation of the uterus, tearing of the cervix and heavy blood loss. However, any complications are minimised by attending a clinic with well trained doctors and nurses. Identification and treatment of any complications will occur in theatre or recovery. You'll be closely monitored in the recovery area by registered nurses for between approximately forty-five and ninety minutes. During this time you will be given something to eat and drink.
At the end of the recovery period you are able to leave the clinic as long as you have someone to pick you up and take you home.
After the anaesthetic it is usual to feel drowsy or 'not quite with it' and you are advised not to drive yourself home. For your safety it is important that at least one other person knows that you have had a surgical procedure that day. Before you leave the clinic will give you an after-hours contact number just in case you have any concerns about your health.
It is normal to have some bleeding and cramping following an abortion but not all women will experience this. Some women experience spotting while others bleed for a few days. Pain can be managed with regular pain relief (not aspirin) and bleeding is managed with sanitary pads. If you follow all of the advice given complications are rare. Infections are possible, due to the fact that the cervix has been dilated. Infections occur in approximately 2% of cases.
To reduce the risk of infection it is recommended that you have nothing inside your vagina for two weeks after the abortion and that you refrain from:
Insertion of tampons
Being submerged in water (swimming or taking baths) and/or
Excessive or strenuous exercise.
If you do get an infection your temperature will go up and you may experience vaginal discharge; a foul smelling odour from the vagina; heavy blood loss or cramping in the abdominal region. If an infection is detected early, it can be treated with a course of antibiotics. If left untreated an infection can be dangerous. To reduce the risks of an infection it is advised that the post-operative instructions are followed carefully. If you have concerns seek medical assistance.
Clinics recommend that you have a post operative check-up one or two weeks after your procedure. Most clinics will provide a post-operative check-up but may advise you to go to your regular doctor instead. Therefore, you may choose which option is more appropriate for you.