Episode 10 Abortion

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This page contains information transcribed directly from the MOGCAST podcast. You can listen to the episode on Spotify.

“Hi, everyone. My name is Dr. Aekta Neel, and I am a consultant obstetrician and gynaecologist who works primarily at Western Health in the Joan Kirner Women's and Children's, and I also work at the Royal Women's Hospital in the Abortion and Contraception Service.

Today, we'll be talking about termination of pregnancy or abortion. To start with, a little bit of background. The terminology. Already, I've used two different terms, and they are used synonymously. I use both terms, termination or abortion, depending on the consult and what the patient prefers the language to be.

The word abortion has some stigma associated with it, and by using it more we aid in making it a more normal and common medical term. Abortion law in Australia varies state to state. In Victoria, the law states that termination of pregnancy can be performed for any woman up to 24 weeks pregnant.

After 24 weeks, an abortion may be performed if two medical practitioners are in agreement and that they believe that it is in the woman's best interest considering all circumstances, including her medical, physical, psychological, and social circumstances. The law in Victoria also covers for conscientious objection. If a health practitioner has a conscientious objection to an abortion, they must refer the woman on to another practitioner that they know does not have a conscientious objection.

In my work, I see women from all different walks of life who are requesting an abortion. Some of them are people who have had an abnormality detected on aneuploidy screening, or a structural abnormality on an ultrasound.

Some are those who are just not ready to be a mother or parent and some are those who come from a significant psychosocial disadvantage, whether that is substance use, mental health, or significant family violence issues. The point I'm trying to make here is that people who come to you to request an abortion can come from a complete variety of backgrounds, but that doesn't make their request any less valid.

Another key aspect of the abortion consultation is to also discuss contraception. This is a time when women are seeking healthcare and are often motivated to seek better forms of contraception if the pregnancy was initially unplanned. There are two different types of abortions available. A medical abortion, which involves pills, or a surgical abortion.

To help me demonstrate this and also the basic consult I would take with a patient seeking an abortion, I have asked Dr. Althea Askern to assist as being a patient.

“Hi Althea, and thanks for coming in today. What can I help you with?”

“Yes, well hopefully I can be a good patient for you, Aekta. Uh, so I've just found out that I'm pregnant.”

“Okay, and how are you feeling about that?”

"Not great, actually. It's completely unplanned, and not something that I'm ready for. I was hoping you'd be able to help me organize an abortion.”

“Of course! Do you mind if I ask you some background questions first?”

“Sure.”

“So, do you mind just telling me how old you are, if you've ever been pregnant before, and when your last period was?”

“Yes, so I'm 26 years old. I've never been pregnant before and I have regular periods with my last one being exactly six weeks ago.”

“And do you have any medical or surgical issues?”

“No, no medical issues and I've never had surgery before. I don't take any regular medications and I’m not allergic to anything”

“And what about your social circumstances? Who do you live with and are you working?”

“I live with two housemates and I'm currently studying nursing, and I work part-time in hospitality.”

“And what about the circumstances that led to this pregnancy?”

“Well, I've got a boyfriend. Um, we've been together for a year. He knows about the pregnancy and while he doesn't feel ready to be a father yet he’s going to support me either way.”

“Well, that’s really great to hear. One of the things I always like to check when I'm seeing someone requesting an abortion is that they are safe, and that the decision is theirs and they're not being pushed or coerced into anything.”

“Oh, sure. That makes sense. Well, I'm definitely safe.”

“Well, I'm here to support you in whatever decision you make. Some women seek counselling to further discuss options for the pregnancy, which I'm happy to organize if you want. Can you tell me what has led to your decision to have an abortion?”

“Well, it's obviously not something I ever thought I would be doing. I'm still studying and I'm not ready financially or emotionally to have a child. I’ve discussed it with my partner, and he agrees too. And my mom's really been supportive through this as well. Um, thanks for the offer, but I don't really need any counseling. I’m happy just to organise an abortion.”

“Okay, well, the first thing we need to do is organize a blood test to check your blood group, your beta hCG level, and your full blood count. We'll also organize for you to have an ultrasound to confirm that the pregnancy is correctly located in the uterus, and to confirm your dates.

Provided all of that comes back okay, you have two options for an abortion. One is a medical abortion, where I prescribe tablets that end the pregnancy and essentially cause you to miscarry. And the second option is where I refer you to have a surgical abortion.”

“Oh, I didn't actually realize there were options. Um, can you tell me a bit more about them?”

“Sure, so a medical abortion involves giving you a tablet called Mifepristone, which is an antiprogesterone tablet and blocks progesterone from supporting the developing pregnancy. Okay. 36 to 48 hours later, after you have that tablet, you then take four Misoprostol tablets buccally, or in the side of your cheeks. These are prostaglandin analogs that cause the smooth muscle of the uterus to contract, and the cervix to soften and open, and makes you pass the pregnancy, similar to having a miscarriage. It's important that you have a support person available during this time.

A medical abortion is approved in Australia up to 9 weeks of the pregnancy, or 63 days and works about 95 percent of the time. Most women have pain and bleeding similar to a very heavy or bad period and that usually starts within four to six hours of the Misoprostol tablets. 90 percent of women will pass the pregnancy within 24 hours. But you can also have bleeding for 2 to 3 weeks after a medical abortion.

We make sure we prescribe tablets for pain relief and nausea at the same time. There is a small risk of an incomplete abortion with retained pregnancy tissue, and about 1 percent risk that the abortion doesn't work, and the pregnancy actually just continues. So, we call you in a couple of days to check on how you're doing, and then follow you up with a blood test in 14 days to make sure the beta hCG level has dropped appropriately.

Some people choose a medical abortion because they feel it's more natural, that they can do it in the comfort of their own home, and that it avoids the risks of surgery. Others don't want to do this, as it does involve significant cramping, bleeding, and is a bit more unpredictable.”

“Hmm, ok and so what about surgery?”

“A surgical abortion is a day procedure where you will be in a hospital or private facility. You usually have a general anesthetic, although some procedures can be done with a local anesthetic. While asleep or anesthetized, the surgeon will slightly dilate your cervix and then use a suction curette to remove the pregnancy.

The procedure only takes about 5 to 10 minutes, and you'll be able to leave about 1 to 2 hours later. You will have some pain and bleeding after the procedure, but by the next day, its usually only light bleeding, and that usually settles within a week.”

“Well, that sounds much easier. What are the risks?”

“It is more definitive than a medical abortion, and that's why some people prefer this.

But it does carry some risks as well.

There are general risks of bleeding and infection, and in about 2 percent of cases there may be retained pregnancy tissue. There are also more serious but very rare risks of uterine rupture or cervical damage.”

“OK, well that was very informative, but I think I’m leaning towards a surgical abortion, but I might have a think about it while I wait for my blood tests and ultrasound.”

“Absolutely. I'll organize those investigations for you, and then I'll see you later this week and you can let me know what you've decided, or if you have any further questions. Thank you so much for coming in today.”

So that demonstrates a consult and explains the two common methods of abortion that we use, early medical abortion or surgical abortion.

There are some other great resources about abortions, including the following website, 1 800 MY OPTION, MS2STEP, which gives you more information on the early medical abortion tablets, Mifepristone and Misoprostol, and Children by Choice, which is a Queensland based organization.

I hope you found this talk useful, and thanks for listening.”