Programs & Services

The Women's Health Centre: Therapeutic Abortion

Medical Abortion

What is a medical abortion?

A medical abortion is an abortion, which is caused by taking a medication called methotrexate rather than by a surgical suction procedure. Methotrexate has been found to be over 90% successful in causing an abortion when it is used in combination with a second drug called misoprostol. The misoprostol is taken 5 to 7 days after the Methotrexate, either by mouth or by inserting the pills high up into the vagina. Bleeding and cramping usually begins within a few hours of taking the misoprostol. To have this type of abortion you must be very early in your pregnancy (less than 49 days confirmed by ultrasound), generally healthy, live in a large center, and be prepared to have follow-up bloodwork done possibly 2 to 3 times before the abortion can be confirmed as complete.

Who is suitable to have a medical abortion?

You must be no more than 49 days along in your pregnancy, on the date you take the methotrexate. You must be firm with your decision to terminate the pregnancy, in good general health, be able to fully understand the informed consent and be able to tolerate possible heavy bleeding, cramping and seeing the products of conception. You must be willing and able to avoid sex until the abortion is complete and must be willing to have a surgical abortion if the medical abortion is unsuccessful. You must have a telephone, be able to be contacted, and have access to transportation in case of emergency.

Advantages and Disadvantages of medical abortion

Advantages

  1. There is a greater than 85% chance of avoiding a surgical abortion.
  2. The pregnancy can be terminated as soon as there is a positive pregnancy test. This is earlier than the usual surgical abortion.
  3. Aborting the pregnancy at home provides more privacy in some cases.
  4. Medical abortion does not use instruments inside the uterus so if it is successful, there is no chance of causing damage to the uterus.

Disadvantages

  1. There is a 10-15% chance the abortion will not be effective or complete and a surgical procedure will be needed.
  2. The abortion will take at least 1 week and may (very rarely) take as long as 5 weeks to complete.
  3. Vaginal bleeding may be prolonged and heavy.
  4. Medication side effects (less than 10%) such as headaches, nausea, vomiting, sore mouth, dizziness or rash may occur.
  5. The need for several clinic visits, blood tests and possibly ultrasounds.
  6. Uncertainty about whether the abortion was a success.
  7. Medical abortion appointments can not always be accomodated at the Women's Health Center.

Surgical Abortion

A surgical abortion is provided after 8 weeks gestation due to the increased risk of missing the pregnancy were it done earlier. The procedure is done in two parts and, depending on the gestation, in one day. If the gestation period has been more than 13 weeks 6 days the procedure is done in two days.

Every client of the Women’s Health Centre seeking abortion services will have an ultrasound, as well as a nurse counsel, before the day of their abortion.

Part 1 of Procedure Day

You will meet with a nurse at the start of your appointment. She will be the one providing medications during the procedure, so that you are as comfortable as possible. She will make sure you had not eaten or drank anything since midnight, make sure you remain firm in your decision, and ask you a few other questions.

You will then meet with the physician who will discuss your decision and have you sign the consent form. The doctor will also discuss birth control options and help you get established on the birth control you choose.

Following this discussion, the doctor will take your medical history and may do a physical exam. If you decide to proceed, a laminaria (a small stick of compressed seaweed) may be inserted into your cervix. Laminaria absorbs fluid from around it, which causes it to swell. This swelling softens the cervix and begins to open it. This makes the second part of the procedure easier to perform and reduces the risk of damage to the cervix. The doctor may also choose to give you misoprostol, either orally or in the vagina, instead of laminaria. The laminaria or misoprostol may cause you to have some cramping or bleeding.

Part 2 of Procedure Day

Once the Laminaria or misoprostol has taken effect, the pregnancy is removed by suction D&C (dilitation and curettage) which means removal of the uterine lining. It is done under local anesthetic (freezing in the cervix) and medications to make you feel relaxed and comfortable through an intravenous.

The physician freezes the cervix then dilates it to the diameter of the suction curette, which is only millimeter's wide. Once the suction curette will fit through the cervix the suction is turned on. The physician will gently rotate it removing the tissue from the wall. The suction curette is removed and a metal curette is then used to ensure all tissue has been removed from the uterine wall. The uterus is then suctioned one more time. This part of the process takes 6 - 10 minutes, however you will be in the procedure room for about 15 minutes.

You will need to stay in the recovery room for one hour after the last dose of medication. As soon as you can walk unassisted, and are having no more than period like bleeding and cramping you will be discharged to go home.

Aftercare

You should experience period-like cramps and bleeding. If you are soaking a pad in an hour,2 hours in a row, you need to seek out emergency care.

Watch for signs of infection such as a foul smelling discharge from the vagina or high fever. If you experience this you need to contact your physician.

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