The Surgical Procedure
Pre-operative: Once the medication has been taken, the patient has time to have a wash or shower before the abortion. Once showered the patient can dress into their own clothes, take any other tablets the operating doctor has prescribed (e.g. antibiotics), and relax while the medication takes effect. She will change into a gown shortly before she is due to have the surgical procedure.
Surgical Procedure: A Staff member will take the patient and any one support person through to the procedure room. This staff member will support the patient throughout the operation whether or not they have their own support person present.
The patient is sedated for this short 5-10 minute operation, not asleep. Once on the bed a nurse will administer an injection of medication that helps to prevent shock (Atropine) and a sedative that also gives pain relief (Fentanyl). The patient then places her legs into rests and she is covered. The support person sits at the head of the bed, while the operating doctor begins the procedure with a vaginal examination to assess the size and position of the uterus. S(he) will then wash the vaginal area with a warm antiseptic solution and insert a speculum to hold the vagina open and make the cervix visible to the doctor whilst S(he) operates. A local anaesthetic (Xylocaine 1%) is injected into cervix, once numb the operating doctor will check that the cervix is open with a series of small rods (dilators). S(he) will then pass a soft plastic tube through the cervix and into the uterus. This is connected to a suction machine, which removes the pregnancy into a collection jar. Often during the 2-3 minutes whilst the suction is being used, the women will experience cramping of the uterus, which can range from a mild to a severe period like cramp. Once the uterus feels empty the operating doctor will carefully check with a curette to ensure all of the pregnancy tissue has been removed, a further 20 seconds of suctioning will complete the abortion procedure, once again uterine cramps are usually experienced during this time.
The pregnancy tissue is taken for checking whilst the nurse helps the patient to put on underwear and a pad. It is usual to have some vaginal bleeding at this stage and it can vary from a period-like amount or in some cases spot bleeding. Before the patient leaves the operating room she will be given any other medications (e.g. Anti-D or contraceptive injection) that she has requested during the morning. It is common for the patient to feel light headed at this stage due to the medications used for the procedure; occasionally some patients may feel nauseated.
Recovery Nurse: The support nurse accompanies the patient into the care of the recovery nurse. This nurse will check the blood pressure and pulse, give the patient plenty of fluids to drink and give any medication that may be helpful for on-going cramps. Most women need to sleep for a short time. After sleeping, the nurse will check that vaginal bleeding is normal then remove the intravenous needle from the hand. The patient can then dress and is offered light refreshments whilst she continues her recovery. After about one hour, if the patient is feeling well and the nurse is satisfied with the recovery, she is allowed to leave the clinic and requested to follow the written aftercare instruction and visit her referring doctor or AMAC for a check up in two weeks time.
What to expect physically following the abortion: Most women will have bleeding at normal period flow or maybe just spotting, it can stop and start for up to 10 days. As long as it is not heavy (see aftercare instructions) this is classed as normal. Uterine cramps can be experienced on and off for a couple of days and any usual pain relief used for period pain can be taken. Severe pain and/or heavy bleeding is not normal and should be investigated by a doctor to exclude any possible complications. Most women are well enough to return to normal activity the following day but strenuous exercise should be avoided until the two-week check up. The pregnancy hormone in the blood reduces rapidly within 48 hours alleviating nausea and breast tenderness.