Surgical Abortion

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 6 hours before the procedure. Normally a partner or support person can accompany you into the clinic 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. Your partner or support person will be contacted after the procedure, to let them know when they should collect you from the clinic.

Registration

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. Contact details for your support person will be also be required so the clinic can call them when you are ready to leave the clinic. While they will not be able to remain with you throughout the consultations, procedure and recovery, it is not possible for patients to leave any clinic after anaesthetic without a support person.

Payment (for private clinics only)

You will have to pay for the cost of the termination before continuing through to surgery. Prices at private abortion clinics vary, for information about pricing call the clinic directly. Some clinics 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 may be considerably more than you have been quoted, possibly around double the Medicare rate.

Pre-operative blood tests (blood group and haemoglobin level)

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.

Identification

You are required to have some form of legal identification, and a photo ID is usually requested by clinics. 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 and take your medical history. 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/or 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. It can be helpful to bring headphones or something to read during the waiting periods.

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. It is okay to ask questions.

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. You are not required to see the scan. The scan 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 sometimes a different surgery or treatment.

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

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, and it is not commonly used in Queensland abortion clinics. 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.

General 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:

• General health. For example, having a cold, being a smoker or being anaemic would affect the type of anaesthetic choices that are available.
• It is important that your asthma is controlled if you wish to have a general anaesthetic.
• The doctor will need to know what medications you are taking and when the last seizure occurred.
• Food, drink or smoke. Whether you have consumed anything orally for a certain time before the procedure.
• How many weeks along the pregnancy is.
• The doctor will advise which anaesthetic is appropriate depending on the client’s weight.
• Stress level. The doctor will advise which anaesthetic is appropriate for clients who are emotional or stressed.
• Previous experience with surgery and gynaecological procedures.

Some questions and issues we encourage you to discuss with the anaesthetist are:

• General health and previous experience with anaesthetic (if any).
• Whether a choice of anaesthetic will be offered? If yes, what are the choices? If no, what are the reasons for not being offered a choice of anaesthetic?
• What are the risks and benefits of each of the options?
• Feelings during the procedure?
• What is the effect of the anaesthetic?
• What are the possible complications?
• Any fears regarding having an anaesthetic, for example fear of needles, fear of losing control?

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, and that you do not use any recreational drugs or take medication you haven’t mentioned to the clinic. Anything injected or taken orally before the abortion could have an adverse effect on you after the anaesthetic has been administered, and the doctor may decide not to proceed with the abortion.

A first trimester abortion is a simple surgical procedure. It is a very safe procedure when performed by a trained medical practitioner. The procedure itself takes less than 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 twelve weeks.

Vacuum curettage: up to 14 weeks gestation

In a first trimester abortion procedure, the contents of the uterus are removed using gentle suction, after the cervix has been dilated (widened). For procedures between 12 and 14 weeks gestation, the doctor may give you medication to soften and dilate the cervix some time before the anaesthetic is administered (sometimes this medication is also used in pregnancies at less than 12 weeks, depending on the individual woman’s cervix). For most procedures at less than 12 weeks gestation, after the anaesthetic is administered the medical practitioner widens the cervix a few centimeters using dilator rods. A small, soft tipped instrument called a cannula is then inserted through the cervix to the uterus and 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 but may 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. All clinics listed on our map of Queensland abortion and contraception services have been licensed by Queensland Health. 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.

The entire process for a first trimester abortion requires a woman or pregnant person to be at the clinic for around four or five hours, although the abortion itself only takes a few minutes.

Dilation and evacuation (D&E): after around 14 weeks gestation

In a dilation and evacuation procedure, the contents of the uterus are removed using instruments rather than gentle suction, and the cervix needs to be dilated more widely than in a vacuum curettage termination. In procedures from around 16-17 weeks upwards, the dilation process can be performed using a combination of medications and dilator rods, and the entire abortion procedure can involve medical appointments over two consecutive days from this gestation upward. Issues to be aware of when considering a termination at 16-17 weeks or later include the need to have somewhere fairly close to the clinic to stay (if you will need to attend the clinic on two consecutive days instead of one), and to be very sure about your decision; changing your mind after the doctor has started the dilation has serious implications for the pregnancy.

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 not allowed to drive for 24 hours or sign any legal documents e.g rental agreements, purchase agreements or employment contracts.

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 and people with the ability to become pregnant will experience this. Some people experience spotting while others bleed for up to two weeks. 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. Most clinics will provide you with a prescription for antibiotics to use after your abortion. Some clinics provide the antibiotic through your drip while you are in the theatre, while others require you to take oral antibiotics for around a week after your surgery.

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:

• Sexual intercourse
• Using 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.

Before going to the clinic, check the following items off this list

• Did you make sure not to eat, drink, smoke or use drugs or medications other than what you have told the clinic about for the specified time before the abortion?
• Do you have your Medicare card?
• Do you have your Health Care Card or Pension Card (if you have one)?
• Do you have your blood group, haemoglobin level and hepatitis status (or is this done at the clinic)?
• Do you have your ID?
• 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 that you are taking?
• Do you have payment for any antibiotics (around $10)?
• Did you call the clinic the day before to confirm your appointment?