TLDR… what’s the lowdown?
- Contraceptives can fail – it’s not your fault
- Options include continuing with the pregnancy for parenthood or adoption, or abortion
- Abortion is REALLY common – 1 in 3 women in the UK will have an abortion before the age of 45
- There are different options for abortion procedures and how to access one – see below for more info
- Contraception after an abortion is really important and really easy! Make sure to discuss with your doctor after your appointment
Modern contraception is really effective, some methods are over 99% effective, meaning less than one woman in 100 will get pregnant in a year of using that method. But the ONLY 100% effective method is abstinence so as long as sex exists, unintended pregnancy will too.
Let’s face it, life sometimes throws unexpected things our way. So it’s not unusual to miss a pill, forget when your next injection is due or be under stress that affects your fertility tracking. This can often have no consequence, but even if you are using your contraception perfectly, there will be rare cases when unintended pregnancies occur.
Here is an ‘everything you need to know’ guide to support you, or a friend who has experienced an unintended pregnancy.
What to do when you find out you’re pregnant…
Firstly, take a deep breath and know that you are not alone. Unintended pregnancy is common and around half of women are actually using contraception when they accidentally fall pregnant. It might be worth speaking to someone you trust and sharing your feelings, and remember, you are not to blame, your body is a fertile being trying to populate the planet.
What are my options?
I’m shocked and surprised but also pleased!
This might be unplanned but you are delighted! In that case, CONGRATULATIONS. Please start taking your pregnancy vitamins – folic acid and vitamin D – which can be bought from any pharmacy (the separate vitamins are much cheaper than the expensive pregnancy ones and just as effective).
Have a read about the dietary and exercise advice from the NHS here, and consider trying to stop smoking and drinking alcohol if this is relevant. If you know the date of your last period, use this to calculate how many weeks pregnant you are here.
Book in with your community midwife via a phone call to your GP. Register quickly with a GP if you haven’t already got one – antenatal care is very important for your wellbeing and that of the growing pregnancy!
I’m overwhelmed and don’t really know what I want….
This is completely understandable, and please don’t rush into any decisions. If you are thinking through your options, consider following the advice above and starting pregnancy vitamins until you have weighed up your options and decided if this is a pregnancy you want to continue with or not.
Many people find it difficult to speak to their family, but there are plenty of places you can find support. We recommend using a counselling service that is non-judgemental, impartial and has no agenda other than to support your decision making.
If you live in the UK, our recommendations are:
- The British Pregnancy Advisory Service
- MSI Reproductive Choices
- National Unplanned Pregnancy Advisory Service
- Referral through your local NHS abortion service which can arrange counselling
I don’t think becoming a parent right now is the best decision for me….
If you do not want or cannot have a child at this moment, you have options including termination of pregnancy (abortion) or adoption after delivery.
This is where you deliver the baby but legally give up the right to be their parent after birth. Pregnant people may choose this option if they have passed the legal date for an abortion or they do not want an abortion due to personal or religious reasons.
In some circumstances, women may want to keep the pregnancy and adoption concealed from friends and family – this can also be arranged through the NHS with the help of social workers. For more information please see here.
Abortion or Termination of Pregnancy
1 in 3 women in the UK will have an abortion before the age of 45.
Abortions are common with more than 200,000 performed in England and Wales alone in 2020. Women, trans men, and non-binary people from all backgrounds, religions, races, marital groups and age groups undergo abortions, for a mixture of reasons including having an uintended pregnancy or a problem with the pregnancy.
In fact, while the teenage abortion rates are going down, the number of women choosing abortion over the age of 35 is increasing. This could be due to the increased difficulties in accessing contraception services over the pandemic, socio-economic factors, or the wider access and introduction of telemedical abortions. So if you choose this, please remember, you are NOT alone.
In the UK, we have the legal right to choose what we do with our bodies and at The Lowdown, we fully support this. You only have to watch Season 2 Episode 5 of Call the Midwife to realise how important access to safe, funded abortion care is. Worldwide, every minute of every day, 67 women resort to unsafe or ‘backstreet’ abortions, leaving them at risk of septicaemia, organ damage, infertility, and in some cases death. We are incredibly lucky to live in a country where women can avoid these risks and we want to work hard to further remove stigma surrounding abortion.
You have the RIGHT to choose an abortion for a pregnancy if continuing will affect your mental or physical health, or that of existing children or the unborn child.
How do I arrange an abortion?
There are several options to book an abortion.
- Call your GP who can refer you to the local NHS abortion service
- Visit your local sexual health clinic who can also make this referral – check here for your nearest
- Self refer to a private clinic or charity. 99% of women who do this will get the treatment paid for by the NHS, it doesn’t mean you have to foot the bill yourself. Private clinics and charities are government regulated, safe and confidential. They include:
How long will it take to get an appointment?
This is a really common cause of anxiety for women. The guidance is that every person has an appointment to discuss their options within 1 week of referral and the abortion procedure within 2 weeks of referral (so 1 week later).
What happens at an abortion appointment?
Traditionally, appointments are always face to face in an NHS or private clinic. Here, you will be seen by a healthcare professional (usually a specialist nurse) who will spend time talking through your options and checking you are happy with your decision. You may be offered further counselling if you are still not sure, but this is NOT compulsory. A medical assessment will be carried out to check how many weeks pregnant you are. The assessment might involve:
- An ultrasound scan to see how many weeks pregnant you are. This may need to be with a small probe inserted into your vagina if the pregnancy is very early. Ultrasounds are not needed for everyone and you do not have to see the scan if you do not want to
- A blood test to check your blood type
- Swabs to check for a sexually transmitted infection (STI).
Following this, you and your healthcare professional will discuss the best option for your abortion procedure.
Medical Abortion – What happens when you take the abortion pill?
85% of women choose to have a medical abortion. A medical abortion is carried out using 2 tablets taken 24-48 hours apart.
- Mifepristone is the first tablet which blocks the hormone progesterone. Progesterone is needed to keep the pregnancy growing, so the tablet stops the pregnancy’s growth.
- Misoprostol is the second tablet which opens the cervix (neck of the womb) and causes the womb to contract so the pregnancy is passed out of the vagina. If suitable, you can take this at home if you are less than 10 weeks pregnant, otherwise you will need to be in a clinic for this second stage. It’s a good idea to take some painkillers 10 minutes before the second tablet such as paracetamol and ibuprofen. We don’t recommend aspirin as this can make bleeding more heavy. The second tablet can be given inside the mouth to dissolve in the side of the cheeks or up inside the vagina. You might have fewer side effects if you use the vaginal method.
You should expect to start bleeding within 3 hours of taking the second tablet. If not, you may need more medication and this will be explained clearly before you start the treatment.
You’ll be advised to use sanitary towels only rather than tampons or a menstrual cup to reduce infection and track your bleeding.
Most abortions are complete within 1-2 days and your bleeding should become lighter after the pregnancy has passed. However, sometimes the bleeding can go on for up to 2 weeks.
What will the abortion look like?
If you are completing the abortion at home you might be worried about what to expect to come out. Usually, you will have large blood clots and what we call ‘pregnancy tissue’. This shouldn’t be larger than the size of a lemon. In most cases, you cannot see a recognisable foetus (very early baby) within this pregnancy tissue.
Afterwards, you can either flush this down the toilet or wrap it in tissue and put it in a normal household bin inside a plastic bag. In the hospital, the pregnancy tissue will be collected and it is your choice whether you take this home, or leave at the hospital where it will usually be cremated.
Can I have abortion pills at home?
During the COVID pandemic, rules were quickly changed by the government to allow women to continue to get access to abortions. Telemedical appointments were introduced. These are where the initial medical assessment is completed through a telephone or video appointment instead of in person at a clinic. Then if you are less than 10 weeks pregnant and suitable for an at home abortion, the pills can be sent to an address chosen by you. You will still be checked up on by the clinic with another telephone appointment and support will still be available.
The new system has had brilliant feedback from women, who have found it easier to access an abortion. This is especially true if you live a long way from a clinic, have children to care for, or have reasons that mean you wouldn’t be safe to attend a clinic for an appointment.
Research studies have shown that it is SAFE to have an abortion at home. At home abortions can also be quicker, with waiting times reduced from 11 to 6 days in one research study. After the success of telemedical abortions through the pandemic, the devolved governments across the UK are considering changing the law to continue with ‘at home abortions’ permenantly. We’re expecting a decision by the end of 2021, and The Lowdown fully supports this renewed commitment to expanding access to abortion care.
15% of women choose a surgical abortion. The abortion is carried out by an experienced gynaecology doctor. Depending on how many weeks you are, you may be offered the procedure using local anaesthetic which could shorten how long you have to stay in the clinic.
If you are further on in the pregnancy (over 12 weeks), you will require medication before the procedure to help the neck of the womb open, and may be advised to have a general anaesthetic or stronger sedation. Either way, you can usually go home on the same day.
What happens after a surgical abortion?
- If you are breastfeeding, wait for 5 hours after taking the tablets before breastfeeding again as tiny amounts of the tablets might be found in the breast milk
- Pregnancy sickness and nausea should stop within 1-2 days (very quickly!) but sore boobs may continue for up to 3 weeks
- If you are over 10 weeks pregnant and your blood tests showed that your blood type is Rhesus D negative, you will require an injection to prevent rhesus disease
- It’s advised to not have sex for 2 weeks after the procedure to avoid infection
- You can go swimming as soon as the pregnancy has passed if you’d like
- You should avoid alcohol for 24 hours after the abortion but drink plenty of water
- Your vagina will clean itself naturally using it’s own discharge, don’t use douches or intimate washes
- After 3 weeks, you should take a pregnancy test. If you do one too early, it might still be positive. If it’s positive after 3 weeks – call your clinic back.
What to look out for after an abortion?
There are some rare risks associated with abortion, and you should be aware of the signs so you know when to get help.
- Infection (10%) can cause a fever, smelly vaginal discharge or ongoing pain and bleeding – ring your clinic for help if you experience any of these
- Failed abortion (<1%) is when the procedure hasn’t worked and you don’t pass the pregnancy – ring your clinic to discuss your next options
- Heavy bleeding that needs a blood transfusion (0.1%). If you are bleeding through a pad every 30 minutes, please ring your clinic for advice and help
- Surgical abortion also has a very small risk of damage to the cervix and womb (0.1%-0.4%).
I’m under 16 will my parents find out?
Access to abortion services is completly confidential. Healthcare professionals will only share information about you if we have reason to be concerned that you, or anyone else is at risk of harm.
If you are under 16, understand all of the advice about abortion, its implications, and it is in your best interests to have treatment without your parents knowing, then we will not tell them. You will be asked if you would like to tell your parents, but if you don’t that is your choice.
I have concerns about my safety if anyone finds out
Sadly, there is a higher risk of domestic violence against pregnant women and there are other circumstances where people may feel vulnerable requesting an abortion. If you are worried about your safety, please tell your healthcare provider.
The ‘at home abortion’ service allows you to access an abortion without needing to travel to a clinic, and the pills can be sent to a different address. During your telephone appointments, tell your healthcare provider you are worried about someone finding out and a safe word can be arranged to stop the telephone call if needed.
Contraception after an abortion
You are fertile almost immediately after an abortion, with 90% of women releasing an egg within 1 month of the procedure – so don’t forget to think about contraception going forward! This will be discussed at your appointment, and even if you are having an abortion at home, contraception can be delivered to your door.
You will be pleased to know that all forms of contraception can be started safely after an abortion. The progestogen-only pill, implant and injection can even be started when you have the first abortion pill (although having the injection can increase your risk of having a failed abortion). The combined pill, patch or ring can be started immediately after an abortion and even the copper or hormonal coil can be inserted after a pregnancy has passed (unless there is an infection). You don’t need to use any extra protection if contraception is started within 5 days of the abortion. If you have been using fertility awareness methods, be aware that they may not be as effective after an abortion while your cycle gets into a rhythm again, and your diaphgram size may have changed so it’s worth getting this checked again.
Need more advice after using a contraception method which has failed for you? Look at our website or use our Get Advice service for help finding something suitable.
So that’s a lot of information about what happens if your contraception fails but we hope you’ve found it useful. If you need to know more about abortion or your other options please see the websites below:
One of The Lowdown’s fab Clinical Directors, Dr Frances Yarlett MBBCh (Hons) BSc (Hons) MRCP (2016) MRCGP DFSRH completed her medical training from Cardiff University in 2013. She is currently working as a salaried GP partner in Sheffield with an interest in complex medical patients and women’s health. Fran is really passionate about patient choice and wants to empower women to take control of their bodies and contraception needs.