Abortion - surgical and medical options

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. Your healthcare team can help you figure this information out.

If there is uncertainty about your last period dates and the stage of your pregnancy, you may need to have an ultrasound to accurately 'date' the pregnancy prior to any treatment starting. Having an ultrasound is also recommended if your pregnancy is more than 14 weeks or if there are other concerns, such as signs of an ectopic pregnancy.

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 your individual circumstances and preferences.

You may find a decision aid tool useful to help you make an informed decision about which method of abortion may be right for you. This can be done at home or with your healthcare provider.

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'.

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 might need a surgical abortion.

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.

Before a medical abortion

Before a medical abortion you may have a urine or blood test and an ultrasound to confirm you are pregnant and check the stage of your pregnancy.

Although these tests are not always required, particularly if you are confident with your period dates and if the pregnancy stage is earlier than 10 weeks. Your healthcare provider will advise which tests are right for you based on your individual circumstance.

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.

A blood test to detect ongoing pregnancy is usually recommended 14-21 days after taking the medication to make sure the abortion has worked.

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 may have a urine or blood test and an ultrasound to confirm you are pregnant and check the stage of your pregnancy.

However, if you are confident with your period dates and the pregnancy stage is earlier than 10 weeks, you may not be required to have these tests. Your healthcare provider will advise which tests are right for you based on your individual circumstance.

Depending on the stage of your pregnancy, you may be offered medication to help soften your cervix prior to the surgery. This is usually required if your pregnancy is 14 weeks of more.

You will also be given information about other options, counselling and support services.

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 abortion, it usually stops sooner, after about 2 weeks. It is normal for bleeding to stop and start. Some people have very little bleeding.

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 30 minutes for 2 hours or more)
• you have cramps that don't get better with medicine
• you have a fever

After about 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.

What can you expect from your healthcare team?

As a patient in Australia, you can expect your treating team to respect your healthcare rights. The healthcare rights of all Australians are set out in the Australian Charter of Healthcare Rights. These rights apply to any healthcare you get, anywhere in Australia, including in public hospitals, private hospitals, general practice and in the community. You have a right to:

• be treated with respect
• be involved in making decisions about your health and include anyone you want
• be informed about your health conditions and any tests or treatments you are offered
• receive help understanding this information, if you need it
• ask your healthcare team any questions you may have

Your health care team might give you a decision aid. This is a paper or online resource that can help explain your options and get you to think about what’s important to you. If a decision aid is available for the choice you’re considering, it can be very helpful.

Learn more about shared decision making and understanding consent and your rights.

Resources and support

Australia has safe and supportive abortion and family planning clinics that provide reliable advice and care.

To find these clinics, and for reliable, unbiased information about abortion in your state or territory, contact:

• Family Planning Alliance Australia
• MSI Australia
• Sexual Health and Family Planning ACT
• NSW Pregnancy Choices Helpline (1800 008 463)
• Family Planning NT
• Children by Choice (Queensland)
• Unplanned pregnancy services (SA)
• Family Planning Tasmania
• 1800MyOptions (Victoria)
• Sexual Health Quarters (WA)

The Victorian Government's Health Translations website has information about abortion in other languages.