Friday 25 May 2018

How proposal to allow abortion up to 12 weeks will work...

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Eilish O'Regan

Eilish O'Regan

The most controversial part of proposals to liberalise our abortion law is to allow unrestricted termination of pregnancy up to 12 weeks. How will it work?

The precise details have yet to be unveiled, but the plan is to have GPs and obstetricians provide the service. It involves a medical abortion where a woman takes two kinds of medications to bring on a form of miscarriage.

Is there much involved for the woman and doctor?

The woman informs the doctor she is seeking an abortion. She will not have to justify her reasons. A consultation will take place and the doctor is obliged to provide all information about the procedure. The woman needs to be screened for medical history such as blood pressure and diabetes, which may make her unsuitable for one of the drugs, mifepristone. The pregnancy must be dated and may need a scan, causing delay if she is referred to a public clinic.

So can she can just get a prescription and go home to take the pills?

No. It is a major decision. There will be a gap of around two days before it goes ahead in case she changes her mind.

If she decides to go ahead, what then?

For pregnancies under nine weeks it may be possible to take the medications mifepristone and misoprostol at the same time. But she may also have to take the mifeprisone at the surgery and return one to three days later for misoprostol. It can be taken under the tongue, vaginally or in the space between gum and cheek. The law may allow the medications to be taken at home, but this has risks. She will be given antibiotics, pain medicine and advice on how to take care of herself.

Are there side-effects?

The woman will have cramps and bleed heavily. The pregnancy usually passes in four to five hours.

How safe is it?

Medical abortion has a very good safety record. But in one in every 1,000 cases the bleeding can be serious, needing transfusion. Another risk is infection. Treatment may also be needed if the uterus is not emptied fully.

Is there any risk the pregnancy will not be terminated?

This happens in fewer than one in 100 women.

Is there follow-up care?

A woman should have a check-up in around four to six weeks to see if she has recovered physically and emotionally.

How ready are doctors to deliver the service?

It will only happen if the Eighth Amendment is repealed. Expect a long delay in drafting legislation. GPs say they are not trained in providing medical abortions. In the UK, GPs refer a patient to a dedicated abortion clinic run by the NHS or a provider like Marie Stopes. The advantage is they are licensed and regulated, and provide medication on site.

If a doctor does not want to provide it, what happens?

They will have to refer the woman to a doctor who has signed up. GPs can have ethical objections and opt out. Issues like resources, workload and fear of litigation, as well as higher insurance fees, can influence participation. Family planning clinics will be involved.

What happens if a teenage girl is pregnant and wants an abortion without telling her parents?

These are the kind of quandaries that would put the plan to the test. It's a matter for the legislation.

It is proposed to allow for termination in later pregnancy where a woman's health or life are at risk. It will include risk of suicide. What is involved?

These will require sign off by two doctors, except in case of emergency. The woman will undergo a procedure in a maternity or acute hospital.

Will a woman whose unborn has a fatal foetal abnormality also be entitled to an abortion?

Yes, with no time limits.

Will women from Ireland still go to the UK?

Yes. Irish law will still exclude abortion on grounds of severe disability, which is allowed in the UK.

Irish Independent

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