• Reference Number: HEY-770/2016
• Departments: Gynaecology
• Last Updated: 30 April 2016

Introduction

This leaflet has been produced to give you general information about your partner’s procedure. Most of your partner’s questions should have been answered however if they have any concerns or anything that requires further explanation, please inform your partner that they can discuss any concerns with a member of the team caring for them.

At least half of all pregnancies are unplanned and for one in five pregnancies a woman will choose to have a termination.

What is a termination of pregnancy?

A termination of pregnancy is a procedure to end a pregnancy. A termination of pregnancy is legal in Britain if two doctors agree that certain criteria are met. Most of the criteria relate to the effect that the pregnancy may have on the mental or physical health of women.

We make every effort to involve partners, although partners have no legal rights in relation to termination of pregnancy and our main priority must be the safety and confidentiality of our patients.

Can there be any complications or risks?

Many women have had this procedure and it has proven to have a very good safety record. Every form of treatment has risks and/or side effects. The risks, of having a termination are:

• Excessive vaginal bleeding (this occurs less than 1 in every 1000 terminations)
• Retained pregnancy tissue, or on-going pregnancy (this occurs in 2.3 terminations in every 1000)
• Infection (this occurs 1 in 10 of all terminations, however the risk is reduced as you will have had a sexual health screen and are given antibiotics)
• Risk of complications relating to anaesthetic

The complications above are usually treated very easily

• Uterine perforation (damage to the womb) is rare but can occur in 1 to 4 in every 1000 terminations
• Damage to the cervix can also occur however this is less than 1 in every 100 terminations

The risk to the cervix is minimised with the use of medication that softens and opens the cervix prior to the procedure. In some women we recommend a tablet, to be taken the day before the procedure, to further decrease risks to the neck of the womb or retained tissue.

Having the procedure performed early in the pregnancy reduces all of the above risks and at Hull University Teaching Hospitals NHS Trust, the procedures are carried out by a consultant or a senior registrar.

Short-term emotional distress is common in women having a termination of pregnancy and only a small amount of women experience any long-term psychological problems. This risk has to be balanced with the risks of the psychological problems that may occur if the pregnancy continues. You can request to see a counsellor at any time leading up to or following the termination, especially if you are experiencing emotional distress.

Can there be any complications or risks?

The increased potential for developing either breast cancer or fertility problems (difficulty in getting pregnant again) following a termination of pregnancy, has not been proven. However, a small number of research studies have identified a slightly higher risk of future miscarriage or early birth.

An untreated infection can cause fertility problems. So it is essential that your partner takes all antibiotics prescribed and follows the post-operative care and advice given by their nurse/doctor. This includes contacting your partner’s GP if they have any problems following their procedure.

One of the highest risks after a termination of pregnancy is infection. To minimise the risk, all our patients are given antibiotics. Women are also advised to avoid sexual intercourse until bleeding stops and to use sanitary towels instead of tampons.

It is usual for women to experience some bleeding for several days after a termination of pregnancy. What exactly your partner can expect will be explained before she leaves the department, as it depends upon her procedure. If your partner has any concerns over bleeding, they can contact the ward or department. Telephone numbers are provided on each of the information leaflets.

If your partner feels unwell, then they must seek medical advice. It is always better to seek advice than worry unnecessarily. After treatment some women find their hormone levels swing quite dramatically whilst their bodies adjust. This may result in mood changes and it is common for women to feel a bit sensitive and irritable. This is perfectly normal, but you may find that your partner needs extra support and reassurance.

In the cases of an early termination of pregnancy there is a slight risk of continuing pregnancy. If your partner is still experiencing the symptoms of pregnancy two to three weeks after her termination of pregnancy, she should seek advice from her doctor.

Long term effects

There are no increased risks to future fertility unless a woman contracts an infection that is not properly treated or there is damage to her womb. This is why it is important for your partner to follow our pre and aftercare advice.

There is no evidence that termination of pregnancy causes long-term depression or trauma. After a termination of pregnancy some women feel a sense of loss, even if they believe their decision was right. Others may feel relief. Feelings after a termination of pregnancy depend on individual circumstances. Try to take the lead from your partner and help her in the way that she feels is most supportive.

 What happens at the outpatient appointment? 

• In the absence of a partner, this leaflet may be useful for those supporting women
• The first outpatient consultation can last up to 3 hours and your partner will see a Pregnancy Advice Service (PAS) nurse/ doctor. Your partner will also be offered the opportunity to see a counsellor and may also require an ultrasound scan to determine how far on she is in the pregnancy
• You will be able to stay with your partner for most of the time, provided that this is what your partner wants. At some point in the consultation we will require to see her alone to give her the opportunity for a private discussion

 What will happen on the day of the procedure?

• If you are unsure as to the location of the clinic where the termination of pregnancy will take place, please let the staff know so that they can provide you with directions and/or a map
• Facilities at our hospitals and clinics (where your partner will have her termination of pregnancy) vary. If you wish to wait for your partner, please check parking arrangements and fees. Drinks and snacks are available on most sites
• We will ask your partner not to eat and drink if she is having a general anaesthetic. It is important to follow these instructions, otherwise we will have to delay or postpone her treatment
• Be prepared to wait whist your partner is undergoing the procedure. You will usually be allowed to stay with your partner until she is ready for treatment. We will let you know the time we anticipate that she will be able to go home. Usually there is no need for women to stay in the unit overnight
• We recommend that women have a check-up 2 to 4 weeks after their termination of pregnancy and information regarding the options will be given to her upon discharge
• Termination of pregnancy can take place in the outpatient department or as an inpatient and the procedure varies according to the stage of the pregnancy.
• Depending on medical advice and availability, women are able to choose the procedure that they feel is most suitable for them and their circumstances. The procedures in this service are described more fully in the following leaflets:
• • Medical termination of pregnancy
  • Surgical termination of pregnancy

All procedures can be accessed by self-referral, GPs, Family Planning and Sexual Health Clinics and other services.

The PAS nurse / doctors involved in your partner’s care are happy to answer any additional questions that she may have.

Termination of pregnancy procedures, especially in the early weeks of pregnancy are very safe, but obviously no clinical procedure is entirely without risk. Your partner should discuss her choices of treatment and any possible complications and side effects with the doctor before she makes her decision.

Questions you may ask

Can I tell my friends?

It may be useful for you and your partner to discuss where and how you would like to find additional support. You both may benefit from sharing your feelings with friends. Discuss with your partner who you would like to share this information with. Your partner may prefer not to share this information with others.

Will she feel differently about sex?

There are no reasons why a termination of pregnancy will necessarily affect a woman’s feelings about sex, but when contraception has failed, this in itself might make her feel insecure and worry about further unplanned pregnancies.

How soon can we have sex?

Vaginal penetration should be avoided for two weeks after the procedure or until any bleeding stops. If you both find it impossible to wait, please use a condom to help prevent infection.

My partner had a termination two weeks ago but is still upset. When are things going to be back to how they should be?

After a termination of pregnancy, women can experience a variety of emotions and feelings, some of which may appear contradictory. They may feel relieved but also quite sad. Sometimes there are feelings of loss but these normally decrease with time. All women are different and there is no standard amount of time that it takes for a woman to put her termination of pregnancy experience behind her. The clinic/hospital can provide post-termination of pregnancy counselling at any time after the termination and she can contact them if this would be helpful.

I cannot seem to say the right thing

It can be hard for a person to discuss an unplanned pregnancy. It may feel as though you are pushing a particular view if you keep raising the matter. Equally if you avoid the issue it may seem that you are distant or uncaring. The only guide here is to be led by your partner and ask her what she wants. However, be prepared that what she wants may well vary from day to day, even from hour to hour.

I feel helpless and excluded from what is going on

It is not surprising that some men feel isolated when their partner has undergone a termination of pregnancy. To some extent this is unavoidable given that the final decision about the future pregnancy must ultimately rest with your partner as the pregnant woman. You can ask your partner how she would like you to support her and by respecting her wishes, you will be doing the best you can.

 This is affecting our relationship. What can we do?

It can be very difficult to cope with an unplanned pregnancy, particularly if you both have different expectations from your relationship. One of the hardest situations can be when there is a difference of opinion over continuing the pregnancy. It may be helpful to seek professional help if you find that your relationship is suffering.

The organisation ‘Relate’ can provide professional counselling and can be contacted on: (01482) 329621 or www.relate.org.uk

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.