Terminating a pregnancy is a major decision and a difficult one to make. Dr Sarah Brewer outlines the options

Despite the availability of effective contraception, it is estimated that one in three babies is unplanned - though not necessarily unwanted. Many unplanned pregnancies end in abortion, which is the voluntary termination of pregnancy. If you do find yourself unexpectedly pregnant and are unsure whether you want to give birth to the baby, it's important to consider all your options carefully so as to make the right decision for you.

Your options include keeping the baby, having the baby cared for by relatives more able to take on this responsibility than yourself, having the baby adopted through an agency, or having a termination of pregnancy. Abortion is a legal procedure and every woman's right, should she not want to go through with the pregnancy.

Termination for abnormality
Sadly, between 2 and 5 per cent of babies conceived have a congenital abnormality, which may be associated with a variety of special needs. This will usually be detected during the routine ultrasound scans and, if the abnormality is severe, you may be offered a termination for abnormality. When faced with having to make such a difficult decision, it may help to know that the national charity, Antenatal Results and Choices (ARC), is available to befriend and support those considering antenatal testing, those who are waiting anxiously for test results, and those who are faced with the difficult decision about whether or not to end an abnormal pregnancy.

Making the decision - weighing up options
On discovering you are pregnant, your doctor is a good first port of call. He or she can confirm how advanced the pregnancy is, provide information on the options available in your local area, and refer you for counselling.

The decision to have an abortion is not a decision you should have to make on your own, so try to bring yourself to talk to your partner and, if appropriate, family and friends, to see if there is any way you can manage to fit a baby into your life. It may be that you would feel happier having the baby and placing him or her for adoption. Only take the decision to terminate the pregnancy once you have fully considered that this is the only option for you.

If you decide a termination is the best decision for you, try to talk through your decision with supportive people. This will help you to feel more reconciled with it later. Clinics offering abortion will have supportive counselors available for you to discuss your decision with.

You can also speak to someone at the CARE confidential helpline Tel 0800 028 2228 www.careconfidential.com to help you discover more clearly how you feel about the situation you are in. The counselors are trained in non-directional counseling - so you will not be pushed in one direction or the other

Requesting an abortion
If you decide to have a termination, you will need to see your doctor as soon as possible. Most abortions take place between the tenth and twelfth week of pregnancy.

Although a termination can be performed up until the twenty-fourth week of pregnancy (or beyond if a disability is diagnosed), this is getting very close to the time when a foetus is capable of surviving on its own with appropriate intensive neonatal care. For ethical reasons, some doctors prefer not to carry out terminations at this stage, and some will not carry out the procedure if you are more than twelve weeks pregnant.

Abortion procedures
In some cases you may be offered a medical termination that does not involve surgery. You will be given a tablet called Mifepristone, which works by blocking the action of the pregnancy hormone, progesterone. After taking the Mifepristone, a vaginal pessary that softens the cervix will be inserted 36-48 hours later, and a 'spontaneous' miscarriage will usually follow. Medical abortion only fails once in a hundred pregnancies.

A surgical termination of pregnancy is carried out under general anaesthetic. A pessary may be inserted beforehand to help soften the cervix and make the procedure easier. The surgeon will then dilate the cervix and gently insert a suction device to remove the foetal matter.

What are the risks?
It is important to know that any surgical procedure involving the womb does carry a small risk of complications, such as infection, perforation or damage to the cervix, although it is rare for a previous termination of pregnancy to affect future fertility.

Research involving over 9,000 women has found no difference in fertility rates between those who had previously had a termination, compared with those who had not. Very rarely, heavy bleeding may occur which cannot be stopped. The surgeon may then be forced to carry out a hysterectomy to stop a life-threatening haemorrhage.

Antibiotics are usually given to cover the termination and reduce the chance of infection. If your blood group is Rhesus negative you will be given an injection of anti-D at the time of your operation. This will help to prevent you making anti-Rhesus antibodies (if the foetus is Rhesus positive), which might affect a future pregnancy.

Afterwards
After a termination you may feel some discomfort similar to bad period pains, which usually settles after a couple of days. There will usually be some mild bleeding, which often comes and goes before settling down into a brownish discharge, which may in turn last up to three weeks. Use sanitary pads, not tampons, during this time. Seek medical advice if the pain or bleeding does not settle or if you develop an offensive discharge or a fever.

Your first period will usually occur within four to six weeks. Most doctors advise you to refrain from sex for three weeks after a termination of pregnancy. It is a good idea to sort out a form of contraception as soon as possible, and before resuming your sex life.

Some women are so relieved at having had a termination that they do not have any adverse emotional problems afterwards. However, most women feel some sadness and some become very distressed and confused about what has happened. It is important to really think through all your options before going ahead with a termination to help avoid taking any actions that you might regret later. If you feel distressed after a termination, you can ask for counselling to help you through what is often a difficult time.

Resources:
You can also contact the British Pregnancy Advisory Service Actionline 08457 30 40 30 www.bpas.org who will offer practical advice on your options