Abortion – surgical and medical options

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What is abortion?
An abortion (also known as termination) is the medical process of ending a pregnancy, so it does not result in the birth of a baby.
I think I am pregnant with an unplanned pregnancy. What should I do?
If you think you are pregnant, the first thing to do is take a pregnancy test. You can do this by visiting your doctor or buying a test from a pharmacy or supermarket. The sooner you do this the better.
If you are pregnant, you can work out the stage of your pregnancy by calculating the number of days since the first day of your last period. The clinic you attend will need to know this information. If you aren’t sure about your due date, don’t worry. You healthcare team can help you figure this information out. You will also need to have an ultrasound to ‘date’ the pregnancy prior to any treatment starting.
If you decide to have an abortion, it’s best to have it as early as possible. The procedure needed for an abortion later in pregnancy (after 9 weeks) is more complex.
What methods of abortion are available?
There are 2 ways to have an abortion — with surgery or by taking medicine. Both ways are very safe and effective in Australia.
Your chosen health care professional will discuss which options are available to you, depending on your stage of pregnancy and circumstances.
What is a medical abortion?
A medical abortion is used for ending pregnancies earlier than week 9 (depending on the clinic). You will need to be prescribed and take medicine called MS-2 Step. It is sometimes called ‘the abortion pill’.
MS-2 Step can be prescribed by any healthcare practitioner with appropriate qualifications and training — this may include doctors, nurses and midwives.
All pharmacies can stock this medication. However, depending on where you live, you may need to go to a dedicated clinic or a hospital.
Medical abortion is a 2-stage process.
The first stage involves taking a tablet that blocks the hormone necessary for the pregnancy to continue called Mifepristone.
This is followed 36 to 48 hours later by a second medicine called Misoprostol, that causes the contents to flow out of the uterus.
A medical abortion is very safe. It is effective in about 99 out of 100 people who have it. If it doesn’t work, you may be able to try another dose of the medicine, or you might need a surgical abortion.
However, a medical abortion is not suitable for everyone. People with some medical conditions, who take certain medicines or who are more than 9 weeks pregnant should not have a medical abortion.
If you have an intrauterine contraceptive device (IUD), you will need to have it removed before you have a medical abortion.
Some clinics can offer medical abortion consultations via telehealth video call. Speak to your chosen health professional or clinic to find out if this option is available to you.
Before a medical abortion
Before a medical abortion you will usually have a urine or blood test and an ultrasound to confirm you are pregnant and check the stage of your pregnancy.
You will also be given information about other options, counselling and support services.
During a medical abortion
The procedure for a medical abortion happens in 2 stages. First you will be given a pill called mifepristone (RU486) to take straight away. Then you go home and have 4 more pills called misoprostol. You take these 36 hours to 48 hours after taking the mifepristone. It’s important you take these pills as instructed.
Between one and 24 hours after taking the second medicine, you will usually experience bleeding and cramping. Make sure you rest at home and take pain-relief medicines, such as paracetamol or ibuprofen, if you need to.
You might also experience a short period of:

vomiting
diarrhoea
dizziness
tiredness
mild fever

Within 6 hours, most people will have passed the pregnancy tissue out through their vagina. You might pass some large blood clots.
After a medical abortion
Most women will experience bleeding and cramping after a medical abortion for about 2 weeks, although bleeding can continue for 6 weeks after a medical abortion.
You should get your first menstrual period 4 to 8 weeks after your treatment; however some contraceptive methods may change this.
What are the risks associated with a medical abortion?
Medical abortion is a very safe way to end a pregnancy.
Complications can include the following:

You can have a reaction to the abortion medicines.
There may be a small amount of pregnancy tissue left in the uterus — you will need a surgical procedure to remove this. This happens in about 1 in 25 cases of medical abortion.
The procedure may be unsuccessful at ending the pregnancy, and you may need more medicine or surgery to complete the abortion. This happens in less than 1 in 100 cases of medical abortion.
You may have heavy bleeding.
You may get an infection, and will need different medicines to treat this.

Medical abortion does not affect your future fertility.
What is a surgical abortion?
A surgical abortion uses suction to remove the pregnancy tissue. It is performed by a trained doctor. It is very effective — only about 1 in 1000 surgical abortions don’t work and may need an additional procedure.
There are 2 types of surgical abortion:

Suction abortion: This is the most common method of abortion. This method involves gentle suction to empty the contents of your uterus. This procedure can be done until about 14 weeks after the first day of your last period.
Dilation and evacuation (D & E): Suction and medical tools are used to empty the contents of your uterus. This is normally done for pregnancies that are further along (more than 14 weeks after the first day of your last period).

Before the procedure
Before a surgical abortion you will usually have a blood test and an ultrasound to confirm you are pregnant and determine the stage of your pregnancy.
You will also be given information about other options, counselling and support services.
If you choose to have a D & E, you will need medicine to open your cervix a day or so before the procedure.
During the procedure
You should not eat or drink for 4 to 6 hours (or as instructed by your health professional) before a surgical abortion. You will usually have a light general anaesthetic. Another option is a local anaesthetic with sedation to make you feel drowsy.
During the procedure, the doctor will put a small plastic tube through your vagina into your uterus. This will use suction to empty your uterus. It usually takes about 10 to 15 minutes. You won’t feel any pain during the procedure.
After the procedure
The clinic staff will monitor you to ensure you have recovered. You will usually spend about 3 to 5 hours in total at the clinic.
You will usually need someone else to drive you home afterwards, as you will feel drowsy from the anaesthetic.
You should get your first menstrual period 4 to 6 weeks after your procedure. Some contraceptive methods may affect this.
What are the risks associated with a surgical abortion?
Surgical abortion is a safe and effective way to end a pregnancy, so long as it is done by a qualified doctor in a reputable clinic.
Rarely, complications can occur, including:

reactions to the anaesthetic
damage to the uterus or cervix caused by surgical instruments
small pieces of pregnancy tissue being left in the uterus, which will need a surgical procedure to remove them (this happens in about 1 in 1000 cases of surgical abortion)
the procedure being unsuccessful at ending the pregnancy, so that another surgical procedure is required (this happens in about 1 in 1000 cases of surgical abortion)
heavy bleeding
infection

An uncomplicated abortion will not affect your chance of becoming pregnant in the future.
What should I expect after having a medical or surgical abortion?
Vaginal bleeding
It is normal to experience some vaginal bleeding and cramping after a surgical or medical abortion. The amount of bleeding varies from person to person.
Following a medical abortion, you may have up to 6 weeks of bleeding. After a surgical termination, it usually stops sooner, after about 2 weeks. It is normal for bleeding to stop and start. Some people have very little bleeding.
If you have continuous, heavy bleeding (more than 2 soaked maxi pads within 2 hours), seek urgent medical attention. See your doctor, or call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.
Pain and discomfort
Many people experience mild abdominal pain, similar to period pain. Here are some tips to help ease pain and discomfort after a medical or surgical abortion:

Take over-the-counter pain-relief medicines, such as paracetamol or ibuprofen.
Use a heat pack or hot water bottle.
Gently massage your lower abdomen while you sit on the toilet. You may find that this also helps you pass any blood clots.

Return to regular activities
Most people find that they can return to their normal activities the day after an abortion. It’s still a good idea to take it easy and avoid heavy lifting and/or strenuous exercise for at least a week after the procedure.
Preventing infection
Here are some tips for reducing your chance of infection:

Use sanitary pads instead of tampons.
Do not put anything in your vagina for at least 2 weeks — this includes avoiding vaginal sex and douching.
Avoid baths or swimming — showering as usual is fine.

Emotional effects
Everyone has different feelings about their own procedure. There is no right or wrong way to feel after your abortion. If at any time you would like to talk to someone, its important that you seek help early. There are many services available to support you.
Follow up with your healthcare provider
Call your healthcare provider if:

you bleed very heavily (you soak 2 pads every hour for 2 hours or more)
you have cramps that don’t get better with medicine
you have a fever

After about 1 to 2 weeks, you will usually have a follow-up appointment with your doctor. If you have had a medical abortion, you may also have a referral for an ultrasound or a blood test to confirm that you are no longer pregnant.
Remember that you can get pregnant again right away, so make sure to discuss contraception options with your chosen healthcare provider.
How much does an abortion cost?
The cost of an abortion will depend on:

if it is a medical or surgical abortion
how far you are into your pregnancy (how many weeks pregnant)
if you are using a public service or a private clinic

MS-2 Step is listed on the Pharmaceuticals Benefits Scheme (PBS). This means that the Federal Government pays for part of this medicine. For the latest information on how much this medication may cost you, visit the PBS website.
Some clinics may offer bulk billing, or they may be partially covered by Medicare. Abortion in a private clinic can cost several hundred dollars.
As well as the cost of the procedure, consider that you may need to travel to get an abortion. Abortion services may not be easily accessible in rural and remote areas. Depending on the law in your state or territory, and your stage of pregnancy you may need to travel interstate to have an abortion.
Resources and support
Australia has safe and supportive abortion and family planning clinics that can provide reliable advice.
To find these clinics, and for reliable, unbiased information about abortion in your state or territory, contact: