CHILDREN BY CHOICE ASSOCIATION INCORPORATED

Abortion Clinic Surgical Termination Procedure

This information has been developed to provide clients with an outline of each stage that they will go through in accessing a surgical termination of pregnancy at a private clinic. It should be noted that individual clinics may vary from the clinic procedure outlined in this information, depending on the management and health care practices adopted by the medical director/s.

Before arriving at the clinic:

In preparing for minor surgery, it is essential that you have a shower, and remove all jewellery and makeup. A partner or support person may accompany you into the clinic, and possibly attend the initial consultation with the counsellor (at your request) and will be contacted to pick you up when the procedure is complete. It is not usually possible for partners or support persons to accompany you throughout the medical examination and other medical procedures.

Administration

Counselling

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 and Psychologists, by telephone throughout Queensland, and face-to-face in Brisbane, free of charge. 

Preparation for surgery

You'll be requested to change into a surgical gown. These gowns can be 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 rear while waiting for surgery, as it can be quite cool in the clinic due to the air conditioning.

Consultation with the doctor

The next stage in the process involves a consultation with the clinic doctor. The doctor will discuss your medical history and answer any queries regarding the procedure.

The doctor must obtain informed consent before the procedure occurs. To obtain informed consent, the doctor must be satisfied that you clearly understand the surgical abortion procedure and 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.
 

Anaesthetic choice

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 Anaesthetst:

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:

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.

Surgery - termination of pregnancy up to 14 weeks gestation

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. 

Surgery - termination of pregnancy after 14 weeks gestation

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 14 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 12 weeks.

The abortion procedure : Vacuum aspiration technique (up to 14 weeks gestation)

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 client proceeds to the recovery room.

Complications during the operation include perforation of the uterus, tearing of the cervix and heavy blood loss. Complications are rare, occurring in less than 0.5% of all cases and are minimised by attending a clinic with well trained doctors and registered 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 45 and 90 minutes. During this time you will be given something to eat and drink.

Leaving the clinic

At the end of the recovery period you are able to leave the clinic. You're required to have someone to pick you up from the clinic.

After the anaesthetic it is usual to feel drowsy or vague. After twilight or general anaesthetic you are advised not to drive a certain period of time. For your safety, it is important that at least one other person knows that you have had a surgical procedure that day. The clinic will give you an after-hours contact number should you have any concerns about your health.

Post operative care

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 (except asprin) and bleeding is managed with sanitary pads.  Using the procedure outlined above, the rate of complications is minimal. 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 the vagina for two weeks, and for a certain period refrain from:

• Sexual intercourse

• Insertion of tampons

• Being submerged in water (swimming or taking baths)

• Excessive or strenuous exercise.

The onset of an infection can often be detected through a rise in body temperature. Other indicators of an infection include 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 quite 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.

BEFORE GOING TO THE CLINIC, CHECK OFF THE FOLLOWING ITEMS ON THIS LIST

• Did you have nothing to eat, drink and smoke for the specified time before the abortion?
• Do you have your Medicare card?
• Do you have your Health Care Card (if applicable)?
• Do you have your blood group, haemoglobin level and hepatitis status (or is this done at the clinic)?
• Do you have legal identification?
• Do you have payment for the abortion?
• Do you have a fresh pair of underpants?
• Do you have a packet of thick sanitary pads?
• Do you have contact details for your regular doctor?
• Have you arranged someone to pick you up from the clinic?
• Have you brought with you any medication you are taking?
• Do you have payment for any antibiotics (around $10)?
• Did you call the clinic the day before to confirm your appointment?
  
  Please note: It is recommended that no nail polish, jewellery or makeup be worn or taken with you to the clinic.