Induced Abortion Guidelines

INTRODUCTION
Induced abortion is a controversial topic that ignites complex and emotional debate. Unintended pregnancy is a problem that may never be fully resolved, and women who do not wish to continue a pregnancy will often seek out termination by any means, regardless of safety. This document is not meant to support either side of the abortion debate. Rather, it is intended to assist physicians to present their patients with available options appropriate to their circumstances, to develop a quality management program, based on available evidence, of the current methods for pregnancy termination, and to provide this service safely and effectively.

All patients choosing abortion are entitled to quality care by practitioners who are qualified to perform procedures and to identify and manage complications.

These clinical guidelines were prepared with the best available evidence and professional consensus on induced abortions.

COUNSELLING

Every woman seeking abortion should receive supportive and compassionate counselling on all the options available, including continuing the pregnancy and having the child adopted or seeking assistance should she wish to parent.

Counselling should take place early enough to avoid any delays in the event the woman chooses to terminate the pregnancy. The counsellor should be free of personal bias and responsive to the woman's circumstances.

If the woman chooses to terminate the pregnancy she must have the opportunity to fully understand the nature of the proposed procedure including the type of anaesthesia, safety, potential immediate and long-term complications, and side effects.

The patient needs to know that her care is completely confidential unless she is below the age of consent.

Contraceptive counselling, including risk behaviour and risk reduction strategies (including those to prevent sexually transmitted infections), before and after the termination is imperative to reduce the risk of recurrent unintended pregnancy. The advantages and disadvantages of available contraceptive methods that fit the individual woman's needs, as well as when and how the method of choice will be initiated, should be explained. The physician must assure the patient of the availability of post-abortion counselling.

ABORTION FACILITY

Experience has shown that first trimester and second trimester terminations, up to a gestational age of 16 weeks, can be safely performed by experienced personnel in clinics or physicians' offices. (II-2A) In Canada, the proportion of terminations performed in hospitals has declined since the early 1990s, and the proportion of clinic terminations has increased. A hospital where access to emergency facilities is immediately available is safer for patients with certain health problems (bleeding disorders, major cardiac conditions, etc.) or for those who require a late second trimester termination.