When you arrive at the clinic you’ll be given a number instead of being called by your name, this is to give you some confidentiality in the waiting area. You’ll be given information to read about early medical abortion and your contraception options. It’s hard to concentrate on that information though, to be honest, so I’ll go over it again when we start the consultation.
Then I’ll call you through. I’ll say ‘Hi I’m Emily, I’m one of the nurses and I’m going to go through some paper work with you.’ I’ll smile as warmly and comfortingly as possible. I’ll explain that everything we talk about is confidential. The only reason I would ever breach your confidentiality is if you told me something that meant someone was in danger.
I’ll ask if you feel safe in your relationships, if anyone has made you do anything you didn’t want to and if you’re here today of your own free will. You feeling safe is the most important thing.
I’ll ask if you you understand your options. That you can have a medical abortion with tablets, a surgical abortion whilst asleep under general anaesthetic or you can simply have a scan today and go away and reflect on what you feel is best for you. Not what is best for your partner or your parents. For you. I’ll offer you counselling. I’ll explain that counselling isn’t just to help to make a decision about your pregnancy, that it can be accessed long after you’ve had your abortion, just to help you process what’s happened.
Then I’ll go through your medical and gynaecological history in detail. I’m checking to make sure that you can safely meet all the criteria to take the medication that will end your pregnancy without causing you any harm. There are some people who it isn’t safe to give the medication to. Again. We’re thinking about safety.
I’ll ask you what contraception you were using when you fell pregnant and what you’d like to try going forward. We’ll talk through the pros and cons of all the options. If you decline all the options I’ll still give you some free condoms to take away with you and remind you that you could fall pregnant again as soon as four weeks after the procedure. It is still your choice.
Even though documenting the reason that you need to end the pregnancy is the first question on the form. I always leave it until last. To give you a bit of time to adjust to telling a stranger very intimate things. It’s there for legal reasons. Our doctors can’t sign your HSA1 form without it. On this form doctors sign to “confirm that the pregnancy has not exceeded the 24th week and that the continuance of the pregnancy would cause risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman”. Or in English; Continuing the pregnancy would cause you more harm than ending it, either mentally, physically or emotionally.
Then I’ll ask if you if you’re sure of your decision. If you’re not, we will still offer you a scan and a copy of it too, if you’d like, then we’ll ask that you take more time to reflect. If you’re sure, I’ll proceed. I’ll take consent from you, ask you to sign documents and explain all the risks of the procedure. If at any point, you start to wobble, or start to cry, I’ll stop. I’ll give you some tissues and a glass of water and sometimes a hug if you want it and I’ll explain for every person who walks through my door, this is a significant life event and that it is not only ok to feel emotional but that pregnancy hormones are no joke. That this is a safe place to cry. That there is nothing to apologise for.
If you’ve opted to take the tablets, met all the criteria, are less than 9 weeks pregnant and are ready, you can often take the first stage of the medication on the same day of your scan. Once you’ve taken the first tablet there are considerable risks to continuing the pregnancy so I will ask you again if you are one hundred percent certain of your decision and if you’re not, we’ll stop. The tablet you take at the first stage blocks progesterone and stops the pregnancy from growing any further. We’ll give you a dose of antibiotics as well as an anti sickness injection if you’ve been vomiting a lot. It’s important to keep the first tablet down for at least two hours otherwise the treatment can fail.
24 hours later you’ll return for the second stage of the treatment. This is more antibiotics, pain relief and four tablets either inserted into your vagina or placed between your teeth and your gums and left to dissolve. They don’t taste great and the treatment is often more painful, coming on more quickly if you place them in your mouth. I always give the option though because some people are absolutely done with having anything go near their vaginas and honestly, that’s fair enough.
Within half an hour to two hours after you’ve had the second stage of the medication you’ll have a heavy bleed, more than a normal period, you’ll pass some clots, the cramps will be worse that those of a normal period. You’ll feel a bit shivery and like you’ve got the flu. I strongly encourage everyone I see to take all the pain relief available, to go straight home by car (with someone else at the wheel) and go to bed. After that initial four hours the bleeding and cramping should calm down until it’s more like a normal period. That bleed can go on for up to a month. You’ll complete a pregnancy test at home 4 weeks later to confirm the treatment has worked and I’ll call you to check you’re feeling ok. There’s also a 24 hour on call telephone number that you can use if you’ve got any concerns.
When you leave my clinic room for the last time, you’ll probably say thank you but you hope to never see me again and I’ll say, you’re welcome and I completely understand.
At the end of the day it’s all about safe choices. I can’t imagine the women I see, having to buy this medication online without the support of healthcare staff or a rigorous medical assessment to ensure it’s safe to take. Without a 24 hour on call line to call when they’re worried they might have bled too much or they’re developing an infection. Having this vital aspect of healthcare be illegal, with the risk of life imprisonment doesn’t stop it happening. It just stops it from happening safely. If you’d like to add your voice to those crying out for reform in Northern Ireland where abortion remains illegal you can email your MP. In Her Shoes North, Alliance for Choice, BPAS and Amnesty International are organisations you can become involved with too. If you’re worried about the legislation changing in America you can donate to The Yellow Fund.