Abortion Services Information

Abortion Services Information

First steps: who to speak to, where to go and the law.

What should I do if I think I may be pregnant?

You should take a pregnancy test. You can buy a test in any pharmacy or supermarket, and carry out your own test at home. Many of the discount shops also sell pregnancy tests.

A pregnancy test involves using a urine sample, and an early morning sample is more accurate. Modern pregnancy tests can tell if you are pregnant by the time your period is one week late. You don't need to buy the more expensive digital one, a simple one is fine.

Who can I speak to about my pregnancy?

Many people with an unplanned pregnancy choose to speak to friends, family or a partner about the pregnancy and what to do next. You may know straightaway that you do not wish to continue the pregnancy, but often people feel uncertain or confused initially. It can be helpful to speak through your feelings with someone else not directly connected to your situation.

You can speak to your own GP or to a member of staff at Sandyford Sexual Health Services. You can make an appointment to talk to a nurse about options on 0141 211 8620. We will explain your choices, and will ensure you have the information and time you need to make a decision.

If you decide to continue with the pregnancy, you can call 01412324005 to book a midwife appointment. If you need to speak to someone about adoption, the midwife will be able to help.

What is the law around abortion?

Abortion in the UK is available up to 24 weeks of pregnancy, provided certain criteria are met. Abortion is available in Greater Glasgow and Clyde up to 20 weeks of pregnancy. If you are 20 weeks pregnant or above, we will need to refer you to the British Pregnancy Advisory Service (BPAS).

Abortions are carried out under The Abortion Act (Scotland). Two doctors must agree in writing that going ahead with abortion would cause less harm to a person’s (or their existing children’s) physical or mental health than continuing with the pregnancy. Most doctors will view the distress of continuing with an unwanted pregnancy as likely to be harmful. However, some doctors may choose not to be involved in abortion services and referrals, in which case they must refer you to another doctor or service, who will be able to help you.
The doctors who work in our service will understand your situation and support your decision. We will arrange for another team member to review your case, and provide the second opinion, as required by law.

How do I go about getting an abortion?

If you wish to have an abortion, or to talk about your options for the pregnancy in more detail, you will need an appointment with the abortion assessment clinic.
You can make your own appointment for the abortion assessment clinic. You do this by calling the Termination of Pregnancy Assessment and Referral Service (TOPAR) on 0141 211 8620. You can leave a voicemail and we will call you back. Your own doctor, nurse or support worker can also refer you to TOPAR.

Your first consultation will be a telephone assessment, when we will call you on your preferred number. This will usually be within 5 working days of contacting us. If you cannot talk safely on the phone, and prefer to talk to us in person, we can arrange for you to come into the clinic instead.

Will I have to pay for the abortion?

No, you will not have to pay for either the abortion assessment clinic or the abortion procedure, provided you are entitled to receive NHS care in Scotland.

What happens at the assessment appointment?

You will have a detailed consultation with one of our doctors or nurses. It is important that you have somewhere safe and private to talk to us. If you are not somewhere private, we can call you back at a more suitable time. If you need an interpreter to be on the call, we will arrange this.

Our staff are specially trained to work in the abortion service, and will be understanding of your situation and needs. You will be able to discuss your own circumstances and how you feel about the pregnancy. 

We will explain your pregnancy choices and give you detailed information about abortion. If you decide to proceed to an abortion, we will arrange the
abortion for you. If you feel uncertain how to proceed, you will be able to take time to consider your decision, and we will offer you a follow-up appointment. You can also have an appointment to speak with a specialist counsellor if you wish. 

What will happen at the clinic?

Ultrasound

An assessment will be made and if appropriate, you will have an ultrasound scan. This will confirm how many weeks pregnant you are, and will check that the pregnancy is not going to be a miscarriage (pregnancy failure) or a tubal (ectopic) pregnancy. Not everyone will need an ultrasound scan.

We will ask you to attend with a comfortably full bladder to help with the scan. Most scans are abdominal (tummy) scans, but if you are very early in the pregnancy you will require a transvaginal (internal) scan. The person carrying out the scan will not routinely show you the scan image. If you wish to see the scan, please tell the staff member.

Sexual health screen

We will offer everyone attending the abortion assessment clinic a sexual health screen. This is to check that there are no infections which may lead to complications after the abortion.

We will ask you to take a cotton bud sample from the lower vagina which we will test for Chlamydia and Gonorrhoea. A full sexual health screen also includes a blood test for HIV and syphilis, and you can also have these tests taken.
If you do not need to see us in person, we will include a sexual health testing kit in your treatment pack. It is really important for you to post the test kit back, so that we can ensure you are not at higher risk of infection after your abortion treatment.

Blood test

You may need to have a blood test taken when you attend the clinic. This is to check your blood count to make sure that you are not anaemic, and a check of your blood group. This is required if you are above 10 weeks pregnant, or are having a surgical abortion.

If you are a Rhesus negative blood type you may need to have an injection called anti-D on the day of your abortion, or within 72 hours afterwards. This is to prevent you having any blood group complications in future pregnancies. You only need this injection if you are above 10 weeks pregnant or having a surgical abortion.

If you decide to have a full sexual health screen, your HIV and syphilis test can be taken from the same blood sample.

Consent

If you decide you wish to proceed to an abortion, we will ask you for your consent. This can be done verbally or via a consent form. This confirms that you wish to have the abortion, and that you have been given information about your options and about risks of the procedure.

It is important that you ask us if you are unclear about any of the information you have been given.

Abortion choices

In Greater Glasgow and Clyde, you can have an abortion up to 20 weeks of pregnancy. The type of abortion will depend on how many weeks pregnant you are.

The different types of medical abortion

Medical abortion (tablets) - up to 20 weeks pregnant

Medical abortion involves 2 sets of tablets, which are designed to cause you to start bleeding and pass the pregnancy, similar to someone having a miscarriage of a pregnancy.

Medical abortion can be self-managed at home in early pregnancy, or can be managed in the hospital setting, either because the pregnancy is further on, you prefer hospital treatment, or there are medical reasons for you to be in hospital.

Early Medical Abortion at Home (EMAH)

During your first consultation, we will assess if you are suitable to undergo EMAH. If you are suitable for this option, and wish to do the treatment at home, we will explain the medication to you, and make sure you know what to expect. We will prepare a treatment pack for you, which will contain both medicines needed for the treatment, painkillers and anti-sickness tablets. The pack will also contain full medication instructions, and contact phone numbers for advice. You will have heavy bleeding and pass the pregnancy at home, usually a few hours after the second part of the treatment. We usually advise that you have someone with you for support on the day of the second medication.
More detailed information is available on our leaflet ‘Early Medical Abortion at Home’.

To be suitable for early medical abortion at home, you will need to meet certain criteria:

• Be under 12 weeks pregnant at the time of treatment
• Be 16 years of age or over
• Be in good general health, with no significant previous pregnancy problems
• Have a phone so you can call for advice if needed
• Have access to transport so that you can go to clinic/hospital if you are concerned
• Agree to do a follow-up test after 3 weeks.

Medical Abortion in Hospital

Medical abortion in the hospital setting involves 2 appointments, usually 2 days apart. Before a medical abortion in hospital, we will need to see you in the clinic, to carry out an ultrasound scan, complete consent and permission forms, and give you the details for your hospital admission.

We will give you the 1st medication (Mifepristone) on the 1st abortion treatment appointment. This is a tablet that you swallow. This blocks the hormones going to the pregnancy. We will try to co-ordinate appointments so that you can take the first tablet on the day you attend for the scan and completion of forms.

You will have the 2nd medication (Misoprostol) on the day you attend hospital for admission. This is a set of 4 tablets which you put into the vagina. These tablets will cause you to start bleeding and pass the pregnancy.

Make sure you have something to eat before you attend for your appointments. You are welcome to bring 1 person of your choice with you.

You cannot bring children to your treatment appointments, so if you have children you will need to make childcare arrangements.

What will happen with the first abortion medication?

• The doctor or nurse will check your medical details.
• We will give you 1 Mifepristone tablet to swallow with some water. You may feel a little sick.
• If you vomit within 1 hour of taking the tablet, you will need to return to the ward or clinic to take another tablet.

What will happen between my visits?

• Before attending for your second medication, you may have light bleeding and experience period type pains. In most cases these symptoms are only slight and nothing to worry about.
• Please do not use tampons.
• There is a small chance that your bleeding may become heavier and you may have more severe pain. It is possible that you could pass the pregnancy at this stage but this is very unlikely. If you are worried at any time, please contact the ward or clinic for support and advice. We will give you a direct contact number for the gynaecology ward and clinic. If you or the staff are concerned, you will be able to return for assessment.
• You can use simple pain killers such as paracetamol if you experience cramps or pain
• It is very important that you keep the second appointment, even if you have experienced bleeding after the first medication.

What will happen with my second medication?

• You will be admitted to the gynaecology ward. You should expect to stay in hospital between 6 and 8 hours. Occasionally you may require to stay in longer (rarely overnight), especially if you are over 10 weeks pregnant, or have complications.
• 
  To make your stay more comfortable, please feel free to bring something to read, something to eat and drink, and music to listen to. You should also bring pyjamas or a nightdress to change into.
• 
  The nurse will ask you about any pain or bleeding that you may have had over the last 2 days. If you have had other symptoms, please mention these.
• 
  We will give you 4 small tablets to put in into the vagina (if you prefer, a member of staff can do this for you). You will start to bleed and experience period type pains, usually within a few hours of using this medication. If there is no bleeding after a few hours, the nurse will give a further dose of the medication orally.
• 
  People vary in their reaction to this treatment. Some have significant bleeding and pain, while others have minimal bleeding and pain. Most people are somewhere in between.
• 
  If you are over 10 weeks pregnant, the abortion is likely to be more painful, and you will have more bleeding. Some people will need to have several doses of the medication every 3 hours until the pregnancy is passed. Once the pregnancy has been passed, we will give you an injection to make the womb contract and reduce the risk of heavy bleeding.
• 
  The pregnancy is likely to be passed along with clots of blood. The pregnancy is likely to be recognisable, especially if you are over 7 weeks pregnant. If you do not want to see this it is important not to look at what you pass.
• 
  You may also have diarrhoea, sickness, headache, dizziness, and hot flushes or chills. There is usually no need to worry about these, but please mention them to the nurse caring for you who assess if you need medication to help your symptoms.
• 
  We will ask you to use a bedpan every time you use the toilet so that the nurse can check to see if you have passed the pregnancy whilst using the toilet. If you are uncomfortable going to the toilet on your own, please ask a nurse who will support you.
• 
  Please use sanitary pads. The nurse will check these for signs of the pregnancy, before they are disposed of.
• 
  Before you go home, you will usually have a vaginal examination to check that the abortion is complete. Occasionally it may be necessary to arrange an ultrasound scan to check this.
• 
  We will prescribe you a choice of painkillers for the day of the abortion. Most people find tablet painkillers adequate, but occasionally stronger painkillers are needed. You will also be prescribed an anti-sickness medication.

How long will I bleed for after the procedure?

Most people bleed for 7 – 10 days after the abortion, with the first few days being quite heavy, and getting lighter after that. Some people do bleed for longer, with bleeding lasting until the first period after the abortion.

You should not use tampons after the abortion. This helps prevent infection. You can use tampons again when your next period comes.

Placenta (Afterbirth)

The placental (afterbirth) tissue usually passes at the same time as the pregnancy, or shortly afterwards. Sometimes (less than 1 in 20) the afterbirth does not come away, and you will need to go to theatre for a small operation to remove the afterbirth. This is more common if you are over 10 weeks pregnant.

Surgical Abortions

Surgical abortions are currently not available in Greater Glasgow and Clyde, due to Covid related pressures.

Surgical abortion is an operation usually carried out under a general anaesthetic (you will be asleep). It is carried out between 7 to 12 weeks of pregnancy.
If you choose a surgical abortion, we will need to see you in clinic to do an ultrasound scan, an infection screen, and to complete consent and permission forms.

Pre-assessment visit
If you choose a surgical abortion, you will need to have a pre-assessment appointment, which we will organise for you. This is a routine check-up to make sure you are fit enough to have your operation in day surgery.
At this appointment, you will have your height, weight and blood pressure checked. Occasionally you will need other tests such as an ECG or x-ray. The nurse will confirm the date and time of your day surgery admission, and will tell you what time to fast from before your operation. This is the time after which you should not eat or drink anything.

Day Surgery Admission
We will tell the date, time and location of your surgery when you attend the clinic. It is important that you arrive at the day surgery ward at the correct time. If you are late, your operation may be cancelled. Someone can take you to the ward, but cannot stay with you.
It is important that you arrive fasted from the time you were advised.
You will be admitted a few hours before your operation.
A nurse will confirm that you still wish to have the abortion. You will be given 2 small tablets called misoprostol to put into your mouth under your tongue. These tablets are to soften the neck of the womb, and are given 2-3 hours before your operation. The tablets reduce the risk of any damage to the womb or cervix during your operation. You may notice some cramps after taking these tablets.

What happens during the operation?
You will have the anaesthetic before your operation. You will be given an injection to make you sleep, and you will not feel anything during the operation.
Once you are asleep, an instrument (speculum) is placed into the vagina and the neck of the womb (cervix) is gently opened with dilators. A thin plastic tube is inserted into the womb, and the pregnancy is removed by suction. The operation usually takes 10-15 minutes, although you may be asleep longer than this. The operation is carried out through the vagina, so you will not require and cuts or stitches unless there was a serious complication.

What happens after the operation?
Once the operation is over, you will wake up in the recovery area, and will then be taken back to the ward.
Once you are fully awake, you will be offered something to eat and drink. If you feel nauseated or are sick, you can have treatment for this.
You may have period type pain for a few hours after the operation and the nurses can give you painkillers for this. Sometimes the pain can continue for a few days, so make sure you have some painkillers like paracetamol or ibuprofen at home.
Most people bleed for 7 – 10 days after the abortion, with the first few days being quite heavy, and getting lighter after that. Some women do bleed for longer, with bleeding lasting until the first period after the abortion.
Going home after the abortion
You will usually be able to go home around 3 hours after your operation, as long as you have not experienced any complications. Occasionally some people need to stay in hospital overnight, so make sure you make any necessary arrangements, such as childcare, before your admission.
As you have had a general anaesthetic, a responsible adult will need to accompany you home and stay with you overnight. For 24 hours after a general anaesthetic you must not:

• Drive a car
• Operate machinery
• Drink alcohol
• Sign any important documents

What are the risks of Abortion?

Abortion at any time in pregnancy is a safe procedure for which serious complications are uncommon. The earlier in the pregnancy you have an abortion, the safer it is. Your doctor or nurse will tell you about the risks and potential complications that relate to the specific abortion procedure being offered to you.

If you have concerns about the risks, let your doctor or nurse know so that they can tell you more.

Risks at the time of abortion include:

• Excessive vaginal bleeding, so that you may need a blood transfusion. This only happens in around 1 in every 1000 abortions under 20 weeks of pregnancy but increases to 4 in 1000 abortions performed after 20 weeks of pregnancy.
• Damage to the cervix happens in no more than 1 in every 100 surgical abortions.
• Damage to the uterus happens in between 1 and 4 in every 1000 surgical abortions.
• Damage to the uterus happens in less than 1 in every 1000 medical abortions done between 12 and 24 weeks of pregnancy.

Should complications occur, treatment, including surgery, may be required. If there are concerns about damage to the uterus or other structures, a laparoscopy (telescope) procedure may be required. If there is excessive bleeding from the womb, which does not respond to medication or a suction procedure, it may be necessary to insert a pressure balloon into the womb. In a very rare scenario, a hysterectomy could be required in there was life-threatening bleeding.

Risks after the abortion include:

• You are more likely to get problems in the 2 weeks after the abortion than at the time of the procedure itself.
  
  Up to 1 in 10 people can get an infection after an abortion. You will be advised to have a sexual health screen before the abortion, to make sure there is no pre-existing infection. A negative sexual health screen reduces the risk of infection complications. If infection is identified, you will be given antibiotics to treat this.
• You may not pass all the pregnancy tissue at the time of abortion and further treatment may be needed. This happens in fewer than 6 in 100 people having a medical abortion and 1-2 in 100 people having a surgical abortion. This can be usually be managed with antibiotics, but sometimes an operation may be needed to remove the pregnancy tissue from the womb.

What happens after the Abortion?

You may bleed for 2 to 3 weeks following the termination. However, some people bleed less than this, while others may bleed up until their next period. You should not use tampons after the abortion, to reduce the introduction of infection. You should use sanitary pads. You can use tampons again when your next period comes.

Will abortion affect my fertility in the future?

If there were no problems with your abortion, it will not affect your future chances of becoming pregnant again in future. Abortion does not increase the risk of a miscarriage, ectopic pregnancy or a low placenta, if you do have another pregnancy. However, you may have a slightly higher risk of premature birth.

Contraception after abortion

It is very important that you make a plan for contraception after your abortion, so that you reduce the chance of having another unplanned pregnancy. Your fertility will return very quickly after the abortion, so it is vital that you start contraception right away. Your doctor or nurse will discuss your contraceptive choices, and help you to make the right choice of method for you.

Longer acting methods of contraception, like the implant and the intrauterine methods (‘coil’) help to reduce the chance of another abortion, so it would be worth thinking about these options carefully.

You will usually be provided with your chosen method on the day of abortion.

Do I need a follow-up appointment?

You will have been given a contact number for the unit you attended for your abortion. If you develop excessive bleeding or pain within 48 hours of leaving the unit, you should contact the nurses there for advice. After that, if you are concerned, you should contact TOPAR at Sandyford, or your GP.

Symptoms to be concerned about include:

• Ongoing pain, which is not responding to simple pain killers
• Bleeding which becomes much heavier again
• Ongoing bleeding beyond 3 weeks
• A high temperature or fever
• A bad smelling vaginal discharge
• Ongoing symptoms of pregnancy, such as nausea or sore breasts

We should have given you a supply of your chosen method of contraception on the day of abortion. However, if you do not have a contraceptive method, it is essential that you contact Sandyford or your GP to discuss your options, before you start having sex again.

A few people may need an ultrasound scan 2 weeks after the abortion. This is to confirm that all the pregnancy tissue was passed, and to check that you are no longer pregnant.

If you are advised that you need to have a scan, it is very important you attend.

People who have chosen the early medical abortion at home will need to do a special type of pregnancy test, 3 weeks after the abortion. It is very important to remember to do this test, to confirm that the abortion has worked.

Support after abortion

For most people the decision to have an abortion is not easy. How you react will depend on the circumstances of your abortion, the reasons for having it and how comfortable you feel about your decision. You may feel relieved or sad, or a mixture of both. Most people will experience a range of emotions around the time of the decision and the abortion procedure.

The majority of people who have abortions do not have long-term emotional problems.

An abortion will not cause you to suffer emotional or mental health problems in itself, but if you have had mental health problems in the past you may experience further problems after an unplanned pregnancy. These problems are likely to be a continuation of problems experienced before and can recur whether you choose to have an abortion or to continue with the pregnancy.

Specialist post abortion counselling is available through Sandyford.

You can make an appointment by calling the Sandyford counselling and support service on 0141 211 6700 and asking for a POTC appointment.

If you are worried how you will cope with this abortion, your doctor or nurse can arrange for you to see the counsellor soon after the abortion.

If you feel you have ongoing issues from a past abortion, you can make an appointment to speak to a counsellor, however long ago you had the abortion.

What happens to the pregnancy tissue after abortion?

If you choose EMAH, the pregnancy tissue will either be passed with bleeding when you go to the toilet, or with bleeding onto a sanitary towel. You will dispose of the sanitary towel as usual.
If you undergo abortion in the hospital setting, we will deal respectfully with your pregnancy tissue, in keeping with national guidelines for sensitive disposal of pregnancy tissue.
Pregnancy tissue will be placed in an individual box, and will be sent to the hospital mortuary. It will then be sent to a local crematorium for cremation. There will be no cremated remains (ashes) available from the pregnancy.

We will ask you to sign a consent form, giving your permission for cremation of the pregnancy tissue. If you wish to make your own arrangements for disposal of the pregnancy, speak to the doctor or nurse at the clinic about options.

 

Additional Information

Confidentiality and information sharing

We will treat your information confidentially at all times, and only staff who are involved in your care are allowed to access your records. Your attendance at the abortion assessment clinic and any subsequent attendance for treatment and tests will be documented in your records. The records used are Sandyford and hospital records.

We will write a letter to your GP, providing information about your attendance for abortion. It is important that your GP knows about your treatment, in case you have any problems afterwards.

Data protection and privacy assurance

Information regarding your treatment is used to prepare statistics on patients undergoing abortions in Scotland. These statistics are necessary to monitor service delivery and help to improve services available to patients in the future.
To do this, data is provided in strictest confidence to Public Health Scotland. This data does not identify you by name, and is never shared with other organisations.
This information is shared in accordance with the requirements of the Abortion Act 1967 and the Abortion (Scotland) Regulations 1991. All personal data is processed and stored securely in accordance with the General Data Protection Regulation and all other relevant data protection laws..

What if I am under 16 years old?

Any young person, regardless of age, can give valid consent to medical treatment providing they are considered to be legally competent; that is, able to understand a health professional’s advice and the risks and benefits of what is being offered. Your doctor or nurse will work with you to assess your understanding of the situation.

All those under 16 years of age are encouraged to involve their parent or guardians or another supportive adult. If you choose not to do this, doctors can still offer you an abortion if they are confident that you can give valid consent and this is in your best interests.

You have a right to confidentiality like everyone else. However, if your doctor or nurse suspects that you are at risk of abuse or harm, they are obliged to involve social services. They would always try to discuss their concerns with you, before involving other services.

Gender Based Violence

Between 1 in 3 and 1 in 5 people will experience emotional, physical and/or sexual abuse from a current or ex-partner. Research suggests that 1 in 3 people seeking an abortion may have experienced abuse from a current or ex-partner.
We are here to support you, and will confidentially ask you if you are, or have, experienced gender based violence.
It is very important that you are able to make your own decision about the pregnancy, and are not under pressure from a partner, family or others. We will check with you that you are able to make your own decision.

If you are currently in an abusive relationship, or you have experienced abuse in the past, contact the National Domestic Abuse Helpline on 0800 027 1234 (24 hours) for information on support services in your area. Calls to this number are free and are not traceable on your phone bill.

Abortion at 20-24 weeks

Abortion is not currently available in NHS Greater Glasgow and Clyde at 20 weeks and above. If you are 20 weeks pregnant or more you will need to be referred to British Pregnancy Advisory Service (BPAS).You will usually have a consultation with an adviser in Glasgow, who will then arrange for you to attend a specialist abortion service in England. This may mean being away from home for up to 2 days.

Provided you are eligible for NHS care, NHS Greater Glasgow and Clyde will meet the cost of your treatment, travel and necessary accommodation.

What will happen if I can’t speak English well?

It is very important that you are able to understand all the information you receive. It is equally important that you are able to clearly explain to the doctor or nurse your situation and feelings about your decision. If you cannot speak English well enough, we will arrange for you to have a trained interpreter for your consultation and treatment. This interpreter will treat all your information confidentially.

It is not acceptable for you to use a friend or family member to translate for you. However, you can bring someone with you for support if you wish.

What if I am not happy with the service I have received?

If you feel unhappy about any aspect of your care, please tell the staff member looking after you. This means we can try and resolve any concerns directly and quickly for you. If you do not feel able or comfortable to do this, you can ask to speak to another member of staff. If you feel your concerns are not being dealt with, you may wish to make a formal complaint.

What if I wish to make a complaint?

If we have been unable to resolve your concerns, or you wish to make a formal complaint, you can get further information from NHSGGC complaints department. They will usually ask you to put your complaint in writing, and we will respond within an agreed timescale.

Telephone: 0141 201 4500 (for complaints only) Email: complaints@ggc.scot.nhs.uk

Useful Contact Details and Further Information

TOPAR Appointments and Advice 0141 211 8620

Sandyford Counselling and Support Services 0141 211 6700

Sandyford Sexual Health Services and Information 0141 211 8130 If you wish to cancel your abortion appointment please call TOPAR on 0141 211 8620

Monday - Friday 8.30am – 7.00pm

Outside of these hours, or if the line is busy, you can leave a voicemail and we will call you back