Termination and Contraceptive Choices

If your circumstances change, or you find an alternative provider, we kindly ask if you could let Gynaecology Outpatients Department (GOPD) know, by telephoning 01270 612212 and leave a message on the answer phone. This will allow somebody else to take the appointment slot.

At Mid Cheshire Hospitals NHS Foundation Trust (MCHFT) we provide a confidential non-judgmental service for unplanned pregnancies and contraception advice. You can be assured that confidentiality will be maintained regardless of age or circumstance, unless the Nurse deems referral to other agencies would be in your best interests, this will be discussed with you first.

A termination of pregnancy (abortion) is legal up to 23 weeks and 6 days (Abortion Act 1967). MCHFT offers treatments from 6 weeks up to 12 weeks. If we cannot provide treatment the Nurse will support and help you to gain treatment at an alternative clinic providing options up to 23 weeks and 6 days.

A termination of pregnancy at any time in pregnancy is a safe procedure and serious complications are uncommon. However, no procedure is without risks completely, but major problems are rare. Vaginal bleeding, abdominal pain and cramping are expected side effects of a termination of pregnancy. Having a termination is not an easy decision and you may experience a range of emotions and feelings and cope in different ways. We recommend having someone with you after the procedure to provide support. Alternatively talk to your GP if you are finding it difficult to cope or contact GOPD on 01270 612212 and ask to speak to one of the Family Planning Nurses.

This information is designed to help you make a decision. You will be asked when booking your appointment when your last menstrual period was. Please note reception staff are non-clinical and therefore they are unable to answer questions about any treatment options.

As space is limited and other clinics will be running, we kindly ask you to limit the amount of people you bring to your appointment to one person, if you have any difficulties with this, please let a member of staff know. Your first appointment will be on a Wednesday dependent on availability, if an appointment is not available the reception staff will recommend that you contact one of the Pregnancy Advisory Clinics. The Nurse looking after you will try to provide appointments to suit your circumstances. 

If you are between 14 years and 16 years you do not need your parents’ permission and you do not have to attend for any appointments with them. However, we do encourage you to have support from a responsible adult (18+ years). If this is difficult for you, your Nurse will support you. Your confidentiality will be maintained, however if the Nurse deems it necessary to involve other agencies for your safety and wellbeing, they will discuss this with you first. If you are 13 years or younger and feel frightened or threatened the Nurse has a duty of care to support you and inform other agencies, this will be discussed with you first.

Please note: treatment will not begin on this day as this is to discuss your options and to sign consent forms, if applicable.

You will be greeted by a Health Care Assistant who will record your height, weight, BMI, blood pressure and pulse. You will be offered a chlamydia self-swab. At times there may be a student present, if you would prefer them not to be in the room, please inform a member of staff. You will also be introduced to the Sonographer who will perform an abdominal (tummy) ultrasound scan. This will be undertaken to assess the gestational age of the pregnancy. You will need to have a comfortable semi-full bladder. Sometimes if you are early in the pregnancy (before 6 weeks) the Sonographer may offer you an internal vaginal scan. This is not painful but may be a little uncomfortable. The Sonographer will let you know the scan findings and you will be given the opportunity to ask the Sonographer any questions.

Following the scan, you will be seen by one of the Family Planning Nurses to discuss your options. Regardless of age, personal or social circumstance, this appointment is confidential, therefore you will be seen alone for part of your consultation and your support person will be invited to join the consultation later, if you wish them to.

You can take as long as needed to make your decision and the Nurse will advise you of your options. If following the scan, you wish to continue with the pregnancy the Nurse will discuss this with you. 

If you wish to remain pregnant and you are less than 10 weeks pregnant, you can self refer via the online Maternity Outpatients Self Referral Form or scan the QR code to the left). Alternatively, you can call the Antenatal Clinic on 01270 273127.

Medical termination is offered from 6 weeks to 9 weeks and 6 days.

Possible side effects/risks:

• Side effects of medication used: Nausea, diarrhoea, headache, chills. These should resolve within 24 hours and will not affect your treatment working.
• Excessive vaginal bleeding, such that you may need a blood transfusion 1 in 1000.
• On going pregnancy, requiring further treatment 1 in 100.
• Retained tissue of pregnancy. Further treatment may be necessary to remove tissue 2 in 10.
• Infection 1 in 10.

Should complications occur, further treatment, including a mid-line incision (below belly button) may be needed to repair any damage or to stop internal bleeding, this is rare.

Following your first consultation two further appointments will be made for you to begin treatment.

The first appointment to begin treatment will give you the opportunity to ask any further questions or withdraw your consent. If you wish to proceed, the Nurse will give you a tablet to swallow with water, this is called mifepristone. The tablet blocks the pregnancy hormone and starts the lining to break down and therefore the pregnancy cannot continue. Continue to eat and drink as normal. You can come alone and use public transport for this appointment. We recommend if you are under 16 years, you have support from a responsible adult (18+ years).

The medication used may cause side effects but should subside within 24 hours, as listed above.

You will be given a time to return to GOPD (within 24-48 hours) to complete your treatment. We recommend that you have somebody to support you on this day. Eat and drink as normal. You will be asked to attend at approximately 8:30am, however if you have difficulty arranging this, speak to the Nurse. We recommend not using public transport as bleeding and cramping can be unpredictable.

The second appointment will take approximately 20 minutes. Four small pessaries of misoprostol will be inserted into your vagina, this is usually not painful. This softens the cervix and starts the process of the womb to contract, to expel the pregnancy which will happen at home.

You will have bleeding, and clots (which can be the size of small lemon), cramping and pain which can be more than a period.

You may experience side effects of the medication used, see advice following your procedure section.

The process on average takes approximately 2-6 hours however this is unpredictable and could be sooner or later.

You may see the pregnancy tissue as it passes, this is more likely after 9 weeks of pregnancy.

You will be advised on which pain relief to take. Ibuprofen and paracetamol are usually sufficient. Always read and follow the manufactures instructions.

You will be asked to repeat a pregnancy test in 4 weeks and a test will be provided for you.

You will be given contact numbers and encouraged to call if you have any concerns. We do not routinely call you due to confidentiality unless you request a call back. A discharge letter is automatically sent to your GP unless you specifically request it not to be. If applicable, your parents will not be contacted or informed.

Manual Vacuum Aspiration (MVA) is offered from 6 weeks to 9 weeks and 6 days.

Possible side effects/risks:

• Side effects of medication used: Nausea, diarrhoea, headache, chills. These should resolve within 24 hours and will not affect your treatment working.
• Excessive vaginal bleeding, such that you may need a blood transfusion 1 in 1000.
• Perforation of the uterus (womb). This happens because the womb becomes softer than it normally is when pregnant. 1 in 1000.
• Damage to cervix, (scaring of the cervix) may need monitoring during a future pregnancy. Misoprostol suppositories are administered to minimise the risk. 1 in 100.
• On going pregnancy, requiring further treatment 1 in 100.
• Retained tissue of pregnancy. Further treatment may be necessary to remove tissue. 2 in 100.
• Infection 1 in 10.

Should complications occur, further treatment, including a mid-line incision (below belly button) may be needed to repair any damage or to stop internal bleeding, however this is rare.

Following your first consultation, you will need to attend GOPD on one more occasion. The Nurse will arrange a blood test prior to treatment, this is to ensure you are not anaemic (low iron levels) and determine your blood group. If you are a Rhesus negative blood group, you will be offered an Anti D injection, which is recommended as future pregnancies could be affected.

You will be asked to arrive an hour before your treatment begins. The appointments are usually in the afternoon. You can drive and come on your own, but you may feel you need support, which we advise. Please note your support person will be asked to wait in the waiting room and can join you after the procedure. Alternatively, the Nurse looking after you can contact them when you are ready to be discharged home.

To prepare you for the procedure you will be given some pain relief, anti-sickness medication and antibiotics before the procedure and medication to help soften the cervix, either pessaries vaginally or tablets to dissolve under your tongue.

You will be taken to the clinic room and a Nurse will remain with you throughout to support you. You will be awake throughout the procedure, and will hear noises from the equipment being used, but you will not see anything. You will be positioned on the couch and your legs will be supported. A metal instrument (speculum) will be placed into the vagina to gently open the vagina. Gel will be administered into the vagina which slightly numbs the area. A fine needle is then used to inject the cervix to numb the area, this may sting initially, but only for a few seconds.

Your cervix will be gently stretched using some small metal dilators, you may feel a little pressure and cramping. The instrument to remove the pregnancy will be gently inserted into the womb, this may need to be inserted more than once to ensure all tissue is removed. At this point you will experience cramping more than a period and you will be encouraged by the Nurse to use the gas and air pain relief (Entonox). The procedure takes less than 10 minutes.

If you have chosen a coil for your contraception this can be inserted at the same time, after the MVA has been complete.

All tissue is disposed of in a sensitive and respectful way, following the Human Tissue Authority guidelines. If you have a specific request about how you would like the tissue to be disposed of, discuss with the Nurse before the procedure.

Cramps may continue for 1-2 hours but should soon settle with pain relief, which you can continue at home. You will have bleeding like a period, with small clots tailing off to light bleeding / brown discharge. This can continue up to your next period.

You will be taken to the recovery room where you will be offered a drink and biscuit. When you feel ready you can be discharged home, see advice following your procedure section. 

Surgical termination is offered from 7 weeks up to 12 weeks.

Possible risks:

• Excessive vaginal bleeding, such that you may need a blood transfusion 1 in 1000.
• Perforation of the uterus (womb). This happens because the womb becomes softer than it normally is when pregnant 1 in 1000.
• Damage to cervix, (scaring of the cervix) may need monitoring during a future pregnancy. Misoprostol suppositories are administered to minimise the risk 1 in 100.
• On going pregnancy, requiring further treatment 1 in 100.
• Retained tissue of pregnancy. Further treatment may be necessary to remove tissue 2 in 100.
• Infection 1 in 10.

Should complications occur, further treatment, including a mid-line incision (below belly button) may be needed to repair any damage or to stop internal bleeding, however this is rare

At your first consultation the Nurse will answer any questions you may have. You will be asked to sign the consent form, complete all necessary paperwork and be given an appointment to attend the Treatment Centre (TC) for your procedure. This is usually on a Friday at 11.30am (occasionally the day and time can differ).

Blood tests will be needed 3-4 days before your procedure to see if you are anaemic and what is your blood group. If you have a Rhesus negative blood group, you will be offered an Anti D injection which is recommended, as future pregnancies could be affected.

You will be told not to eat or drink anything from 7.00am on the morning of your procedure.

On arrival at the TC you will be met by staff, shown to your bed and admitted for your procedure. This will give you an opportunity to ask any questions or you can withdraw your consent, if you wish.

The procedure list begins at 1.30pm (the list of patients having a procedure done that day). Dependent where you are on the list, will determine the time you can go home. A Nurse will take you to the anaesthetic room to monitor your pulse, blood pressure and heart rate. A small plastic tube called a cannula will be inserted into the back of your hand using a fine needle (which will be removed after the procedure) to administer the anaesthetic. When you are asleep you will be transferred into theatre. The procedure takes approximately 10 minutes.

All tissue is disposed of in a sensitive and respectful way, following the Human Tissue Authority guidelines. If you have a specific request about how you would like the tissue to be disposed of discuss with the Nurse, prior to the procedure.

When you wake up after your procedure, you will be monitored for 20-30 minutes in the recovery room. When the Nurse is happy with your recovery you will be taken back to the ward in the TC, where you will be offered a drink and biscuit / toast.

When the Nurse is satisfied that you are fully recovered, they will call your support person to come and collect you. You will not be able to drive, operate machinery or make important decisions for 24 hours following a general anaesthetic. We recommend that you have a responsible adult (18+ years) to be available for any support you may need.

You will be given advice about what to look out for when you get home and when to contact someone if you are concerned, see Advice following your procedure section.

You will be asked to repeat a pregnancy test 3 weeks after your procedure, a test will be provided for you.

You will have bleeding and small clots like a period which could be to up to your next period. It is possible to get pregnant before your next period. If you have requested contraception, the Nurse will explain to you when you should start taking them. You should also read the instruction leaflet in the box provided.

Contact your GP, GOPD or out of hours Doctor / Emergency Department if you experience any of the following:

• Signs of deep vein thrombosis (DVT) - (A blood clot in the leg) Red, painful, swollen calf.
• Signs of pulmonary embolism (PE) - (A blood clot in the lung) Feeling unwell, shortness of breath, shoulder tip pain, coughing up blood and pain in upper chest or back.

Both of these symptoms need urgent attention, go straight to Emergency Department.

• Generally feeling unwell.
• A temperature above 38°C.
• Vaginal discharge with an unpleasant odour.
• Abdominal tenderness or pain that’s unmanageable with pain relief taken.
• Excessive bleeding - soaking more than two thick sanitary towels within an hour.
• No significant bleeding, pain or cramping 48 hours following a medical termination.
• Signs you still feel pregnant.

Bleeding can be unpredictable with clots passing up to a week after treatment. Bleeding should start to lessen within a week of treatment tailing off to a brown discharge, however this is unpredictable and can last up to your next period. If you have any of the signs of the above, contact GOPD in the first instance and speak to one of the Nurses for advice (see bottom of the page for contact details).

After procedure care advice

• Avoid tampons until the bleeding has settled to avoid introducing infection.
• You may feel fine the following day and feel able to resume your normal activities.
• You can take a bath or shower as normal, avoid hot tubs and swimming for a week.
• If you have had a general anaesthetic, you should not drive, operate machinery or make important decisions for 24 hours after.
• Avoid sexual intercourse until the bleeding has stopped or use condoms to avoid infection. It is possible to ovulate 10-14 days after a termination even before your next period resulting in another pregnancy.
• You will be given a pregnancy test to repeat in 3-4 weeks.
• There is no follow up after your treatment, unless you have a positive pregnancy test. If you feel well in yourself, we will ask you to repeat another test in a weeks’ time. If you feel unwell contact your GP.
• Avoid consuming alcohol until your treatment is complete.
• Keep well hydrated and eat as tolerated.

Contraception will be discussed at your first appointment. MCHFT can provide, the following. For all other methods, please contact your GP or Family Planning Clinic.

Combined pill (C.O.C): Begin within 5 days after treatment. Take for 21 days with 7 day break.

Mini pill (P.O.P): Begin within 5 days after treatment. Taken continuously with no break.

Depo Provera (injection): Can be given at the time of treatment and will require further injections at Family Planning Clinic or GP Surgery every 12 weeks.

Mirena coil or copper coil: Can be fitted at the time of treatment for an MVA or surgical termination of pregnancy or at your Family Planning Clinic / GP at a later date.

Implant: We do not provide the implant. You will be recommended to contact your Family Planning Clinic or GP as soon as possible.

Please note there is no contraception that is 100% affective and it is possible to get pregnant if not taken or used correctly.

Emergency contraception is available from larger Pharmacies, Family Planning Clinics or GP’s, usually free of charge.

What happens if I’m under 16 years of age?

You do not need your parents’ consent if you are 14-16 years old, however we recommend that you confide in a responsible adult (18+ years). Staff will offer you full support during your treatment. If you are 13 years or younger and feel frightened or threatened the Nurse has a duty of care to support you and inform other agencies, this will be discussed with you first.

Will having a termination of pregnancy affect my chances of having a pregnancy or an ectopic pregnancy in the future?

There is no evidence to support this.

Can I breastfeed during my treatment?

If you are breastfeeding during treatment, small amounts of the medications used may cause your baby to have an upset tummy.

Do I need a follow up visit?

We do not routinely contact you following your procedure, however you will be given contact numbers if you have any concerns.

What happens if I change my mind?

You can withdraw your consent at any time before any medications are taken or treatment begins, the Nurse will discuss your options.

How may I be affected emotionally?

Having a termination is not an easy decision and you may experience a range of emotions and feelings, and everyone copes in different ways. We recommend having someone with you afterwards to provide support. Alternatively talk to your GP if you are finding it difficult to cope or contact GOPD and ask to speak to one of the Family Planning Nurses.

When can I resume intercourse?

Whenever you feel comfortable you can potentially ovulate (release an egg) as soon as 10 days after the procedure even before your period, so is it possible you can become pregnant again. We recommend using condoms or take reliable contraception started within 5 days after treatment.

What happens if I have additional support needs?

Please inform reception staff when booking your appointment if you need more support. If English is not your first language, an interpreter will be provided at your request. Partners, friends, or relatives are not allowed to interpret on your behalf.