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Women's Health

Everything you need to know when considering an abortion

Wed 6th May, 2020

Reviewed by: Dr. Vamsee Thalluri

Throughout the world, abortions are becoming a more routine procedure as part of delivering quality health care. The World Health Organization states that globally there are roughly 56 million abortions performed each year. However, no matter how commonplace abortions are around the world, it is still a confusing and often scary time for those deciding if having an abortion is right for them.

This guide outlines important information about what it’s like to get an abortion, and hopefully it provides you with reassurance to make the best decision for your life. As someone who chose to have an abortion and has now dedicated her career to advocating for women’s health, I felt it was important to share my research and experience. I know I would have benefited from a resource like this when I was enduring the experience myself.

Am I pregnant?

First and foremost, confirm you are pregnant before anything else. If possible, you can start by tracking your last menstrual period. If you have a regular cycle and track it via a calendar or app, then great! However, do be advised that this alone does not confirm if you are pregnant or not, but rather if your period is experiencing an abnormal schedule. If you are like me, and have an irregular period, tracking your period can be more difficult than expected. Therefore, confirming with a pregnancy test is crucial.

There are many at-home pregnancy urine tests that can be bought at your local chemist or pharmacy and conducted in the comfort of your own home. These tests track the levels of human chorionic gonadotropin (hCG), a hormone released in the body that may confirm pregnancy.

However, be aware that at-home pregnancy tests, at best, only work six days before your missed period, which could leave some time for uncertainty.

At-home urine tests are also not as reliable as blood tests as they sometimes can give false negatives. According to pregnancy test maker Clearblue, “if you are testing early, you should be aware that even if your result is not pregnant, you may still be pregnant. This is because levels of hCG vary from woman to woman and there may not yet be enough hormone for the test to give a positive result.”

The most effective way to find out if you’re pregnant is through a blood hCG test. The blood test is much more sensitive than a urine test and can be conducted from around one week after conception, providing a bit more certainty. Your GP, specialist, sexual health provider, or local clinic can provide a blood test to confirm you are pregnant and can also help provide resources and options for your next steps.

Ok I’m pregnant. But how pregnant?

Because regulations of abortions in most countries are determined by the weeks of a pregnancy, not only knowing if you are pregnant, but also how far along into the pregnancy you are, will help determine what your options are.

One option is to consult your calendar or cycle tracking app to estimate the first day of your last period, in order to determine how many weeks pregnant you might be. This estimation can be highly unreliable if you have irregular periods, but making an educated guess is better than having no information at all.

There are also high-end pregnancy urine tests that have a weeks indicator, however the results are very vague and only provide a weak range (i.e. 2-3 weeks, 3+ weeks) that could prove to be problematic. In any case, most people who become pregnant will not know how far along they are until they visit their doctor to receive a dating ultrasound, a scan done early in the pregnancy to calculate the stage of pregnancy.

In my case, I did not know the exact weeks until the day of my procedure in which they did an ultrasound. Because my period was irregular, this was the only option I had, but it also meant I had to decide on the spot how I wanted to proceed. It is best to be as prepared as possible and to not hesitate before making an appointment with your GP, specialist, or local clinic.

Your options are often purely based on how many weeks pregnant you are – the wrong estimation, or waiting too far into the pregnancy, could restrict how doctors are able to proceed.

What are my options?

Abortion is still a highly divisive debate and the laws concerning its access vary by country and state. If you are able to access abortion services in your country, it is important to understand your rights in order to make the best decision for you and your life.

As most restrictions are determined by weeks of pregnancy, it’s important to educate yourself early and thoroughly.

Medical vs. Surgical

Once you have determined your rights to access abortion, it is best to distinguish between the type of procedures: Medical and Surgical.

According to Marie Stopes, an international sexual and reproductive health care service, “Medical abortion is a safe and effective method of terminating an early pregnancy, up to 9 weeks gestation, using medication rather than surgery.”

A medical abortion is a two-step process in which first a tablet is ingested to block the hCG hormones, then 1-2 days later a second tablet is taken to start the individual’s menstrual cycle, or to expel the inner lining of the uterus. This type of abortion is low-risk and, according to Marie Stopes, has a success rate up to 98%.

In some states in Australia, there is a Telehealth option for medical abortions performed up to 8 weeks of pregnancy. This service, also known as a “tele-abortion”, allows patients to perform a medical abortion in the comfort of their home with the supervision of a medical professional via telephone. Tele-abortion is a fairly new service that may be a preferred method for some individuals. Please be sure to check ahead of time if you are eligible for this method.

Another service for terminating pregnancy is surgical abortion.

Kin Fertility Medical Director, Dr Vamsee Thalluri, says a surgical termination pregnancy is done by a procedure known as a "dilatation and curettage."

"This procedure involves dilating the cervix and then passing a suction like tube through the cervix, into the uterus and removing the pregnancy tissue with gentle suction," said Dr.Thalluri.

"The procedure typically only takes around five minutes to perform and is done under a light anaesthetic while you are asleep. Women are then discharged the same day".

What’s next?

Next, you’ll have to decide if an abortion is the best option for you. Unfortunately, this is the stage of the process in which a “how to” guide will fail to offer you a clear answer for your situation.

Ultimately, only you will know if having an abortion at this time is right for you, however, here are some basic points to consider that might guide the decision-making process.

Not all of these are suitable factors for everyone, but they might be for some, so pick and choose what’s best for your reality:

Mental health: Is having an abortion or not having an abortion right now better for my long-term mental health?

Support: Do my have family, friends, and/or partner support my decision to have or not have an abortion?

Finances: Do I have the finances to support my decision?

Timing: How do I believe having a baby right now will impact my life?

Appointment

If you have decided that having an abortion is the right decision, it’s important to make an appointment with your healthcare provider as soon as possible. Marie Stopes has Family Planning locations throughout Australia, but there are also smaller clinics that might be more convenient to your location. You might also prefer utilising your GP or specialist for the procedure if you are more comfortable with their practice. Be sure to ask about any state or clinic-specific requirements and if there is anything you should prepare for in advance.

Clinics can have varying processes depending on their state laws and how they are funded.

For instance, the clinic I attended made me wait two weeks for my appointment as per protocol, but this is not the standard everywhere. It is important to be aware of these requirements as waiting times could limit your options.

On the day of your appointment, although it is not required, you may want someone to accompany you. I suggest wearing comfortable clothes and to come prepared to wear a sanitary pad, as you might experience some bleeding post procedure. I recommend blocking out the day or afternoon as there could be long waiting times and it can be an emotionally draining experience for some, but not all.

If you need additional support, reach out to friends and family you feel comfortable discussing your experience with. I was very fortunate to have very empathetic healthcare providers that supported me through the procedure, however, it was a long day and it would have been comforting to have a familiar face in the waiting room with me.

Procedure

Unless your healthcare provider has already confirmed the number of weeks of pregnancy, you will have an ultrasound to verify this on the day of your abortion.

This is to ensure the provider is abiding by the government restrictions for abortion in your area and to confirm what your options are. My provider asked if I wanted to see the ultrasound or if I wanted to know if it would be multiple births. This may not be protocol for every clinic, but I personally found it a jarring question to be asked, and you might want to consider ahead of time what you would answer if put in that situation.

Once the ultrasound confirms the number of weeks, you will discuss your options and preferences with your healthcare provider.

Remember, there are two methods for abortion in Australia, medical (where typically two medications are given a day or so apart in pregnancies up until around 9 weeks gestation) that may be offered as a tele-health option, and surgical (a short procedure that is usually performed in late first trimester and second trimester terminations).

Both options have similar effectiveness rates and are medically tested to be safe procedures. Your health care provider can recommend what’s the best method for your situation, but be prepared that your options may vary if you were not certain of the number of weeks of pregnancy.

Recovery

After the procedure it’s best to rest and avoid any activities that cause increased pain. You can plan to resume your normal activities the following day, but it’s best to avoid having sex and using tampons for at least two weeks, or until your body feels ready.

According to Dr Thalluri, you may bleed up to a week or so after the procedure, but the flow should improve over time. “If the bleeding gets heavier or is associated with pain or unusual discharge, then it is important to see your doctor to exclude the possibility of any retained products of pregnancy or infection," he says.

You should expect your next menstrual period to begin four to seven weeks after your procedure, and it is recommended that you maintain your routine contraception and birth control methods. You should also schedule a follow-up appointment with your healthcare provider, as it may be a suitable time to reconsider your contraceptive options.

Making the decision to have an abortion is difficult for some, but it might be a bit easier if there was a broader understanding of the complete process. The scariest thing for me was the unknown, and I am happy to share my experience.

Everyone’s body reacts differently, so it’s important to be easy on yourself and to not push yourself before you’re ready. Deciding to have an abortion can sometimes be a lonely experience, so be sure to stay connected to those who offer you support.

Marie Stopes also offers complementary abortion counselling if you would like support from a trained professional before, during, or after the procedure. Even if you are a supporter of a woman’s rights to choose, the experience can be more intense than you realised when you are the one enduring an abortion firsthand. But hopefully, your experience can be a testament to others, and you can pay forward what you once received and needed.