“Doctor, I don’t want this pregnancy”

“Doctor, I don’t want this pregnancy” Nachii Narasinghan

Meet Jane Smith… • 22 year old, missed 2 periods, not on contraception, attends her appointment anxious and scared. Volunteer GP? Do I see a volunteer GP in the back row third from the right?

Any thoughts?

Induced abortions are legal up to 24 weeks of gestation in Britain under The Abortion Act 1967, but illegal in Northern Ireland. • In cases of substantial risk to maternal life or severe fetal anomalies, the upper limit of 24 weeks is not applicable.

2 doctors agree • The continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated. • The termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman. • The pregnancy has not exceeded its 24th week and the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman. • The pregnancy has not exceeded its 24th week and the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the existing children of the family of the pregnant woman. • There is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.

Confidentiality and Consent • <16 years must be deemed Fraser competent prior to consent being given. • Encourage to involve their parents or guardians in their situation • Should not be broken unless there is any suspicion of child abuse or exploitation. • Those with parental responsibility are the only ones who can give consent for a termination on behalf of a minor who is not deemed to be Fraser competent.

Fraser guidelines • understand the professional's advice • cannot be persuaded to inform their parents • is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment • unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer • the young person's best interests require them to receive contraceptive advice or treatment with or without parental consent

What to do when a patient asks for a TOP? • Assure confidentiality • Encourage to consider alternative options • Calculate gestation • Examine abdomen • UPT if unsure

Listen to and counsel the patient. • Allow her to ask any questions she has. • Ask why she wants a termination and whether she has discussed it with the father, her parents or her friends. • Ask whether she has already made her decision or if she would like more time to think about it, with follow-up in a couple of days. Reinforce that she can change her mind at any point until the procedure.

Sign the HSA1 form (or refer to a colleague)and refer the patient. The earlier in pregnancy a termination is planned the lower the risk of complications. • Ask the patient if she would like any information at this stage about the different kinds of procedures available. Which one? • Discuss future contraception to start straight after the termination.

Follow-up should be within two weeks of the procedure with either the referring GP or the termination of pregnancy service.

Questions/ Comments?

“Doctor, I don’t want this pregnancy”