How to terminate 4 weeks pregnancy

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When a pregnant woman’s pregnancy ends on its own, this is called a miscarriage. It’s also known as a spontaneous abortion. When a woman chooses to end her pregnancy, it is called an induced abortion. There are two reasons why a woman would choose to end a pregnancy. One is for therapeutic reasons. This is done because the woman has a health condition in which pregnancy threatens her life. The other is called an elective abortion. This is done because a woman chooses to end a pregnancy for non-medical reasons.

There are 2 types of induced abortion:

• Medical abortion – a woman takes medicine to end the pregnancy.
• Surgical abortion – a woman has surgery to end the pregnancy.

These types of abortion are usually done in the first trimester (the first 3 months) of the pregnancy. A doctor or other health care professional performs the procedures. They are done in a hospital, doctor’s office, or health center.

Path to improved health

What is a medical abortion?

A medical abortion is an abortion caused by medicine. It is usually done in the first 10 weeks of pregnancy. The most common type of medical abortion uses a medicine called mifepristone. This is a pill that blocks progesterone, a hormone needed for pregnancy. It causes the lining of the womb (uterus) to become thin and break down. Other medicines used for this purpose include methotrexate, misoprostol, prostaglandins, or a combination of these medicines.

In general, this type of medical abortion is a 3-step process:

• A woman visits her doctor and takes the mifepristone.
• She comes back a few days later to take misoprostol. Misoprostol makes the uterus contract and empty. Many women have bleeding for about 2 weeks after taking misoprostol.
• After about 2 weeks, the woman returns to the doctor for a follow-up visit. Her doctor checks to be sure that the medicine was effective. Light bleeding or discharge (called spotting) may continue for several weeks.

The exact process will vary by state. States regulate how many times you’ll need to see the doctor and which tests he or she must perform.

What does medical abortion feel like?

For most women, medical abortion feels like a bad menstrual period. The bleeding will be much heavier than a normal period. They will probably have strong to severe cramps, diarrhea, or an upset stomach. These symptoms are normal. Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help relieve the cramps. But the doctor will want to know if any of the following occur:

• Bleeding through more than 2 sanitary pads in an hour.
• Fever above 100°F for more than 4 hours.
• Pain even after taking acetaminophen or ibuprofen.

How effective is medical abortion?

Mifepristone is about 97% effective. In rare cases when medical abortion doesn’t work, surgical abortion may be necessary.

What is surgical abortion?

Surgical abortion is when a doctor performs a procedure to remove the lining of the womb. There are 2 common procedures:

• Manual vacuum aspiration (MVA).
• Dilatation and evacuation (D&E).

Both procedures use suction to empty the womb. MVA uses a handheld tool. D&E is done with a suction machine and other tools. MVA is usually done in the first 12 weeks of pregnancy. D&E can be done after the first month of pregnancy and before the end of the 20th week. It is usually done during the second trimester.

Before the procedure, the doctor can give the woman medicine. This will help her feel calm. Then the doctor injects the area around the opening to the womb (called the cervix) with medicine. This makes the area numb. The doctor uses a tool or medicine to stretch open (dilate) the cervix. He or she then inserts a tube through the cervix and into the uterus. The tube is attached to a suction or vacuum pump. The contents of the uterus are suctioned out and emptied through the tube.

What does surgical abortion feel like?

For most women, surgical abortion feels like strong menstrual cramps. Women are often given medicine to help with the pain. They can usually go home as soon as an hour after the procedure. They are told to rest when they get home. Acetaminophen or ibuprofen can also help. Bleeding may continue off and on for a few weeks.

How effective is surgical abortion?

Surgical abortion is nearly 100% effective.

Things to consider

Are abortions safe?

When done by health care professionals during the first or second trimesters, both medical and surgical abortions are generally very safe. Serious complications are rare. Abortion generally does not reduce a woman’s ability to get pregnant in the future.

Women may feel many different emotions after an abortion, such as grief, relief, happiness, and sadness. There is no right or wrong way to feel after an abortion.  Talk to you doctor about how you are feeling.

Questions to ask your doctor

• Which type of abortion is best for me?
• What will I experience during the abortion?
• Will I be given any anesthesia for a surgical abortion?
• How heavy will my bleeding be?
• How long will bleeding last?
• What are my options if a medical abortion doesn’t work?
• Should I talk to a counselor before or after the procedure?

Resources

National Institutes of Health, MedlinePlus: Abortion – medical

U.S. Department of Health & Human Services, Office on Women’s Health: Unplanned pregnancy

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

This fact sheet is for women who are experiencing an unplanned pregnancy and want information about abortion. Abortion is when a pregnancy is terminated (ended).

Am I pregnant?

The only way to be sure that you are pregnant is by having a pregnancy test. You can have a test at your GP, a women's health centre or a Family Planning NSW clinic or you can buy a urine test from the pharmacy or supermarket. Finding out if you are pregnant as early as possible gives you more time to think about your options. The length of time you are pregnant is measured from the first day of your last period. If you decide to continue the pregnancy, you should see your GP as soon as possible. If you decide to have an abortion, it is best to have it as early as possible.

Someone to talk to:

Unplanned pregnancies happen to women of all ages and from all backgrounds. It is estimated that 50% of Australian women have an unplanned pregnancy and 1 in 4 women have an abortion. It can be helpful to talk about your options with people who are close to you - your partner, a friend or a family member. You can also to talk to a health professional to get more information before you make a decision. There are three options to consider when you are experiencing an unplanned pregnancy:

• continue the pregnancy with a partner or on your own
• continue the pregnancy followed by adoption or foster care
• terminate the pregnancy (abortion).

How is an abortion done?

There are two ways that an abortion can be done. These are surgical abortion or medical abortion.

Surgical abortion

Surgical abortion in NSW is carried out in a clinic by a trained GP or gynaecologist. Before the abortion you will need to have an ultrasound and a blood test. Most surgical abortions are done under sedation, or a light anaesthetic. To have a surgical abortion you will need to be at the clinic for about 4 hours. A surgical abortion is called a suction curette. It takes about 15 minutes to do. It works by using a small plastic tube to gently empty the contents of the uterus. It is safe, simple and low-risk when done under 12 weeks of pregnancy. If it has been more that 12 weeks since your last period the abortion procedure may be more complicated. You can talk to your doctor or the staff at the clinic about this. It is normal to have some mild cramping and light bleeding after the abortion.

Medical abortion

A medical abortion may be done by a trained GP or gynaecologist A medical abortion can be provided when you are less than 9 weeks pregnant. If you are more than 9 weeks pregnant you cannot have a medical abortion. You will need to have an ultrasound and blood test before having a medical abortion. A medical abortion happens in two stages:

• you will be given a tablet called mifepristone to take straight away
• you will then be given tablets to take 24-48 hours later at home. These tablets are called misoprostol

After taking both of these tablets you will experience something similar to a miscarriage. Bleeding may be heavy at first and then becomes lighter. Sometimes bleeding can last longer than 2 weeks. Clinical staff will discuss what to expect after the medical abortion. The staff will give you a 24-hour advice number to call for support.

There are risks involved with all medical procedures, including abortion. Your doctor or the staff at the clinic or hospital will discuss these risks with you.

Abortion: the law

Abortion is legal in all states and territories of Australia under certain circumstances and when done by a registered health professional. Each state and territory has different laws.

Do I need a referral?

You do not usually need a referral from a doctor to get an abortion. You can find services through:

• your local Family Planning NSW clinic
• Family Planning NSW Talkline
• Children by Choice

The clinic that you go to will depend on how many weeks pregnant you are. It is important to let the clinic staff know how many weeks pregnant you are when you make your appointment.

How much will it cost?

The cost of an abortion is different for each state and each clinic. If you have a Medicare card, it will cover some of the costs. Medicare does not usually cover the full cost. Ask how much the abortion will cost when you make your appointment.

On the day

Before the abortion a doctor or nurse will talk with you about what is involved in the abortion, what the risks are and what to do to take care of yourself afterwards. You will usually have an ultrasound and a blood test. You will be able to ask questions. If you are having a surgical abortion, the clinic staff will talk to you about not eating or drinking before the appointment and what to bring with you to the appointment. It often helps to have a support person with you. If you are having sedation someone will need to drive you home. If you are having a medical abortion you will experience the abortion at home and should have a support person with you during that time.

Contraception

It's important to think about what contraception you're going to use after the abortion. You can usually start using contraception on the day of the abortion. If you do this you'll be protected against another unplanned pregnancy straight away.

Follow up

You should seek immediate medical help if you have:

• very heavy bleeding
• fever
• pain that isn't improved with simple pain killers

You can seek help from:

• the clinic where you had the abortion done
• your GP
• hospital emergency department

You will need a check-up 2-3 weeks after a medical abortion. You might need to have another blood test and ultrasound. If you have any concerns after having a medical abortion you can call the Marie Stopes International 24 hour advice number on 1300 515 883.

For more information

NSW Pregnancy Choices Helpline (NSW Health) – www.pregnancychoices.org.au or 1800 008 463

Family Planning NSW Talkline – www.fpnsw.org.au/talkline or 1300 658 886

National Relay Service (for deaf people) – 13 36 77

TIS National's interpreting service – 131 450

Family Planning NSW client resource – Pregnant? Working through your options - www.fpnsw.org.au/health-information/individuals/pregnancy-and-fertility/pregnant-working-through-your-options

Family Planning NSW client factsheet on the law on abortion – www.fpnsw.org.au/factsheets/individuals/abortion/law-abortion-nsw

Family planning NSW client resource on contraception – www.fpnsw.org.au/health-information/contraception/contraception-options

Visit your nearest Family Planning NSW clinic – www.fpnsw.org.au/clinics

Children by Choice – www.childrenbychoice.org.au