ABORTION

2. N491 Trends in Healthcare: Seminar Presentation ABORTION Kendra Myers Yvonne Salter Emily Overmars

3. Objectives • Explore the history and evolution of abortion in Canada. • Differentiate between the various types and specific procedures of abortions. • Examine the ethical viewpoints in relation to abortion. • Analyse the role of the health care professional (in particular, the nurse) in the delivery of abortion services to the general public. • Discuss the availability of these services within Nova Scotia.

4. Outline • The history of abortion • Current influences on abortion • The different methods of abortion, both medical and surgical, that are used based on the stage of pregnancy • The pro-life perspective that opposes abortion • The pro-choice perspective that supports abortion • The nurse’s role in the abortion process • What a nurse should do if he/she disagrees with the practice of abortion • Emotional issues post abortion, supports and services available • Abortion services available in Nova Scotia

5. Abortion • Induced abortion is the purposeful interruption of a pregnancy • Many factors contribute to a woman’s decision to have an abortion: - Preservation of the life or health of the mother - Genetic disorders of the fetus - Rape or incest - Personal choice Wong, Hockenberry, Wilson, Perry & Lowdermilk (2007).

6. History of Abortion • In 1892, parliament passed Canada’s first Criminal Code, which prohibited abortion, as well as the sale, distribution, and advertising of contraceptives – Many women continued to seek abortions • Abortion was a criminal act in Canada up until 1969 when Canadian physicians and the Canadian women’s movement fought against the prohibition of abortion in the Criminal Code. • In 1988 the Supreme Court of Canada recognized that a woman’s right to continue or to terminate a pregnancy is protected by the Canadian Charter of Rights and Freedoms and struck down the law. (Browne & Sullivan, 2005) (Rodgers & Downie, 2006)

7. Current Influences on Abortion • Canada has no legislative or judicial restrictions on abortion. The circumstances under which abortions can be performed is unregulated. • Repeat pregnancy termination procedures are common in Canada, 35.5% of all induced abortions are repeat procedures (Browne & Sullivan, 2005) (Fisher et al., 2005)

8. Current Influences cont’d • Abortion access throughout Canada has become an issue, with limited improvement since the legalization. • Medication abortion (the use of a drug or combination of drugs to terminate pregnancy) could improve abortion care across Canada.

9. Methods of Elective Abortion • Surgical Abortion: Vacuum Aspiration Dilation and Evacuation Dilation and Extraction Labour Induction • Medical Abortion: Mifepristone Methotrexate and Misoprostol combined (The American College of Obstetricians and Gynaecologists, 2010).

10. Vacuum Aspiration • The cervix is dilated by manually using instruments or by using laminaria. • A uterine aspirator is introduced. • Suction in applied, and tissue is removed from the uterus. • This is the most common type of termination procedure and is used up until 20-22 weeks of gestation. (Bare et al., 2007).

11. (The American College of Obstetricians and Gynaecologists, 2010).

12. Dilation and Extraction • A surgical procedure in which an intact fetus is removed from the uterus via the cervix • Used to terminate a pregnancy after 21 weeks gestation • Also used to removed a deceased fetus • Illegal in the United States (The American College of Obstetricians and Gynaecologists, 2010).

13. Labour Induction • Installation of saline or urea results in urine contractions • Prostaglandins are introduced into the amniotic fluid • Intravenous oxytocin (Bare et al., 2007).

14. Mifepristone • Also known as RU-486 or the “abortion pill” • A progesterone antagonist that prevents implantation of the ovum • As of June 1st, 2005 this drug is no longer available within Canada (Bare et al, 2007).

15. Methotrexate and Misoprostol Combined • Methotrexate - teratogen that is lethal to the fetus • Misoprostol - a synthetic prostaglandin that produces cervical effacement and uterine contractions • Highly effective • Only used in pregnancies up to 49 days from the last menstrual period (Bare et al, 2007).

16. Procedure According to Trimester • First Trimester Methotrexate and Misoprostol Mifepristone Vacuum Aspiration • Second Trimester Labour induction Dilation and Evacuation (D&E) • Third Trimester Labour induction Dilation and Extraction (American Pregnancy Association, 2007).

17. Risks • Incomplete abortion • Infection • Hemorrhage • Damage to the uterus • Death (The American College of Obstetricians and Gynaecologists, 2010).

19. Pro-Choice Argument • Women must have the right to make their own decision • Believe that life begins at birth • A pregnant women is considered one person • All abortions are medically required and not “elective” • All women should have the right to fully funded abortion services (Abortion Rights Coalition of Canada, 2010).

21. Pro-Life Argument • Abortion is viewed as murder • Support fetal rights • Believe that life begins at conception • Concerned about the long term emotional effects on women • God is the giver of life, not the mother • We should protect the sanctity of life (Christian Net, 2008).

22. Nurse Role • Prior to abortion: assist with exploring various alternatives and consequences • Continued support after decision has been made: - Provide information re: procedures, expected discomfort/pain, and type of care needed • Following abortion: assess for grief and facilitate the grieving process (Wong et al., 2006)

23. Nurse Role • Nurses provide postabortal instructions, which vary among health care providers - Instructed to watch for excessive bleeding (> large pad/hr for 4 hrs), cramps, or fever - The woman may expect her period to resume 4-6 wks after the day of the procedure - The nurse offers information re: birth control if not done already - The woman is strongly encouraged to return for a follow-up - Pregnancy test may be performed to determine success of procedure (Wong et al., 2006).

24. Nursing Considerations • It is important for nurses to know the laws regarding abortion • Nurses whose religious or moral beliefs do not support abortion have the right to refuse such an assignment • If possible, nurses should avoid working in environments that will frequently challenge his/her ethical values • Reassignment is usually an option (Wong et al., 2006) (Day et al., 2006)

25. Emotional Effects of Abortion • The way a woman reacts to an abortion is most likely determined by the reason she requested the procedure • Reactions a woman may feel following abortion: shame, anger, regret, fear, anxiety, guilt, sadness, failure, loneliness, decreased self-confidence, disturbed body image, difficulty developing or maintaining relationships, emotional numbness • Postabortal counselling should always be encouraged/provided (Canadians for Choice, 2010).

26. Abortion Services in Canada • Access to procedure is steadily declining • Only 22 abortion clinics across the country • Only accessible in 1 of every 6 hospitals • Most providing hospitals require a doctor’s referral and are located in urban centres

27. Abortion Services in Nova Scotia • Only one facility in NS provides abortions – Queen Elizabeth II in Halifax • Wait time: 1-2 weeks • Gestational limit: up to 15 weeks, 6 days • Fees: Free to all residents of NS • Confidential • Conscious sedation & local anaesthetic (Canadians for Choice, 2010).

28. Nova Scotia Association for Sexual Health • Formerly called Planned Parenthood • Seven locations throughout province (Bridgewater, Sheet Harbour, New Glasgow, Amherst, Sydney, Yarmouth & Halifax) • Offer a variety of sexual health & counselling services The Nova Scotia Association for Sexual Health (NSASH) is dedicated to promoting healthy sexuality throughout the life span, in an environment that respects and supports choice. (Canadians for Choice, 2010).

29. Discussion Questions • When is the fertilized egg considered a human being? • Should nurses sympathise with the pro-life argument or the pro-choice argument? • Do you think the morning after pill is the same as abortion? • If a woman wants an abortion, what rights does the father have?