Hilary Term Week 2, 2004
The first thing to consider is the morning after pill.
This is a deceptive name as it can be taken up to 72 hours after the unprotected sex.
There are two pills, both taken together. If they are taken with 24 hours then it is 85-90% reliable. It is a big jolt to the system and repeated use does reduce its effectiveness. Though there has been little research in this area, it is unadvisable to use it more than three times in a year.
It is not something to be relied upon, it's for emergencies only.
Pregnancy tests- those available in chemists are excellent, better than those available on the NHS. They are very sensitive, not usually wrong.
When a woman gets pregnant she will feel pre-menstrual, but more so. Then breasts swell, gets sickness and needs the toilet more than usual.
If it is an unexpected pregnancy, the sooner the woman sees the doctor the better as it gives her more time for thought. It is very important to take time making decisions and if a woman runs into an abortion she often later feels depressed and has low self-esteem; it's much better to do grieving before the abortion.
Advisory services: There is the University counseling service, which is non-directional. Also the BPAS (British Pregnancy Advisory Service) is non-directional, but will perform abortions. There isn¿t one in Oxford; nearest are in Reading and London. There are also the Marie Stopes clinics for abortion, and they are performed in the John Radcliffe too.
It is not the doctors' position to morally judge; their duty is to give information to their patients on all there is available legally. They do not have the right to stop someone from having an abortion, but can refer them to another doctor if they don¿t want to sign the form allowing the abortion to take place.
The form for getting an abortion needs to be signed by two doctors; one is your GP, then usually the doctor who performs the abortion. In compliance with the 1967 abortion act the application has to satisfy one of four clauses:
- that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family; or
- that the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; or
- that the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated; or
- that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.
In determining whether the continuance of a pregnancy would involve such risk of injury to health as is mentioned in (1) [or (2)], account may be taken of the pregnant woman's actual or reasonably foreseeable environment.
Types of abortions
Up to seven weeks pregnant: hormonal injection to prevent implantation.
Up to nine weeks pregnant: another type of hormonal injection is given.
These are medical, not surgical, abortions. They work by causing a miscarriage. This can hurt as it causes cramps, as a natural miscarriage would. Risks: this can cause haemorrhaging, but this rarely happens.
Abortion gets more complicated after ten weeks. Then a suction termination is used. With this a local anesthetic is injected into the neck of the womb and the contents are sucked out. This is not a difficult procedure and will not damage the uterus wall if done at a proper clinic. The risks of haemorrhaging, infection and perforation to the uterus wall is high however in illegal operations.
At 14-18 weeks: a combination of hormones are used.
18 onwards: a hysterotomy. This is where a hole in the uterus wall is made and it is emptied. This is only done in exceptional circumstances.
Abortions are illegal after 24 weeks unless very extreme circumstances.
Scans after abortion are necessary to check that nothing has remained in the uterus.
Abortions can affect future fertility if an infection is contracted as a result of the operation, which causes blockage of the fallopian tubes. Also, the cervix (neck of womb) might have trouble tightening up again, but this can be fixed. These are both very rare. As in difficult births, if bleeding doesn't stop then the women will have to have a hysterectomy.
Ectopic pregnancies are when the egg is fertilized in the fallopian tubes. This is potentially life threatening, and it is essential that the embryo is removed as soon as possible.