Abortion Service (Cedar Clinic)

Abortion is legal in Northern Ireland and a confidential, free service is available in all trusts. We currently offer early medical abortion and surgical abortion under local anaesthetic up to 11 weeks and six days of pregnancy through the Cedar Clinic based in Altnagelvin Hospital.

If you are more than 12 weeks pregnant we can offer initial telephone consultation and assessment to discuss all available options and refer you to the correct pathway

We accept referrals through the British Pregnancy Advisory Service (BPAS). Please complete the online BPAS self-referral form if you are sure of your decision and have had a positive pregnancy test.

Click here to contact BPAS or alternatively, call 03457 30 40 30

If you are undecided and would like counselling/support please contact:

Informing Choices NI – 028 9031 6100

Common Youth – 02890328866 (under 25s only)

BPAS – British Pregnancy Advisory Service

When the Cedar Clinic receives a referral, you will be contacted via a telephone call (from an unknown number) within five working days by a member of the team. Our team of nurses and doctors will discuss your options, assess your suitability for treatment and arrange a face to face appointment date.

Please note pregnancies are dated from the first day of your last period or by ultrasound scan. Pregnancy tests stating 1-3 weeks pregnant are misleading and only an estimate from time of conception (3 weeks is the maximum reading obtained regardless of how many weeks pregnant you are).

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• What is medical abortion?

  A medical abortion involves 3 steps either as an Inpatient or Outpatient dependant on how many weeks pregnant you are. Less than 9 weeks and 6 days can be carried out safely as an outpatient and pregnancies greater than 10 weeks up to 11 weeks and 6 days are provided as an inpatient service.

  < 9 weeks and 6 days pregnant (Outpatient Service)

  Step 1: You are given the first medicine, Mifepristone. This stops the pregnancy by blocking the pregnancy hormone progesterone. This medication is taken in the presence of a doctor or nurse in the Cedar clinic. You will swallow a small tablet with water.

  Step 2: The second medication, Misoprostol, causes the womb to contract. You will experience cramping, bleeding and loss of the pregnancy similar to that of having a miscarriage. This medication is taken 1-2 days after the first medication. It is important that you leave this gap to ensure that both medications work properly.

  A second dose of misoprostol will be provided and you will be given instruction on when to take this dose.

  4-6 hours after taking the second medication (Misoprostol) it is likely you will pass the pregnancy at home. For a small number of women it can take up to 24 hours to completely pass the pregnancy.

  Step 3: We will send you home with a pregnancy test. Please use the one we provide for you and not a shop bought test. It is important you wait the 3 weeks before performing the pregnancy test as tests done before this may show a false positive result.

  >10 weeks pregnant to 11 weeks 6 days (Inpatient Service)

  Step 1: You are given the first medicine, Mifepristone. This stops the pregnancy by blocking the pregnancy hormone progesterone. This medication is taken in the presence of a doctor or nurse in the Cedar clinic. You will swallow a small tablet with water. Between 24-48 hours we will arrange admission to the ward.

  Step 2: The second medication, Misoprostol, causes the womb to contract. You will experience cramping, bleeding and loss of the pregnancy similar to that of having a miscarriage. This medication is taken 1-2 days after the first medication. It is important that you leave this gap to ensure that both medications work properly. Further doses of this medication will be given every 4 hours whilst an inpatient until the pregnancy is passed.

  Step 3: We will send you home with a pregnancy test. Please use the one we provide for you and not a shop bought test. It is important you wait the 3 weeks before performing the pregnancy test as tests done before this may show a false positive result. For a small number of women it can take up to 24 hours to completely pass the pregnancy.

  For more information please visit:

  Informing Choices NI

  Royal College of Obstetricians and Gynaecologists | Abortion Care

  BPAS | British Pregnancy Advisory Service

• How do I get a medical abortion?

  If you are considering an early medical abortion you can contact 03457 30 40 30 for non-directive counselling and support and information on all your choices.

  If you wish to proceed with an abortion, the Clinic will be contacted with your details if you live in the catchment area of the Western Trust.

  If you are not in the catchment area then you will be referred on to a provider in a different trust.

  You will then get a phone call from a nurse or doctor from the Cedar Clinic. They will go through a medical questionnaire with you to get some details on your general health.

  You will be given a date and a time to attend an appointment with a nurse or doctor. At this appointment you may or may not need an internal (transvaginal) scan to confirm your dates or confirm the location of the pregnancy.

  We will also discuss future contraception options with you. These are detailed below. Please read about them carefully before you attend the clinic. Ideally we would like you to leave your appointment with some form of contraception.

• What is surgical abortion?

  In the Cedar Clinic, we offer a procedure called Vacuum Aspiration (MVA or EVA), up to 11 weeks and 6 days of pregnancy under local anaesthetic and either oral or inhalation pain relief. Surgical abortion involves inserting an instrument called a speculum into your vagina (same as for smear/coil).

  Local anaesthetic is injected into the neck of your womb (cervix), a small tube is then passed through your cervix into your womb and attached to a suction machine or syringe.

  The pregnancy tissue is then gently removed through the tube under ultrasound guidance and the procedure takes approximately 15-20 minutes but you can expect to be in the clinic for a couple of hours.

  You will be expected to attend the clinic 24-48 hours before the procedure for a scan and medication to prepare the neck of the womb. You will also be offered a blood test to check your blood group and tests for sexually transmitted infections. The nurse or doctor will explain the procedure to you and ask you to sign a consent form. An information leaflet will be provided, and contraception discussed if you wish.

  For pregnancies greater than 11 week and 6 days up to 19 weeks and 6 days a nurse or doctor will discuss available options for surgical management with you.

  Please see further information here.

• I am unsure of whether I want a medical or surgical abortion?

  The team within the Cedar Clinic will give you as much information as possible to help you decide what the right choice is for you.

  Visit the National Institute for Health and Social Care Excellence website for a useful decision-making aid, comparing medical and surgical abortions.

• What happens at my abortion appointment?

  You will be asked to read and sign a consent form that details the risks of having an abortion.

  Not everyone requires an ultrasound scan, but if you do, the nurse or doctor will discuss this with you. It is done to check your dates are correct, or to ensure the pregnancy is definitely inside the womb and not an ectopic pregnancy (a pregnancy located outside of the womb). This is usually an internal (transvaginal) scan which involves an ultrasound probe being inserted into the vagina and the pregnancy can be seen on a screen.

  The choice to look at the screen during the scan is yours as some women do not wish to see the screen. Just let the doctor or nurse know what you feel comfortable with.

  The nurse or doctor will discuss the three steps of the abortion process with you. This involves taking two different medications and a pregnancy test.

  You will have to swallow the first medication (Step 1) with water at the clinic in front of the doctor or nurse.

  You will then be given a care pack to take home which contains:

  -The second medication (Step 2). If you are over 8 weeks pregnant a second dose of the medication will also be supplied

  – Painkillers

  – Anti- sickness medication (if required)

  – A pregnancy test (Step 3). We would like you to use this instead of a shop bought one

  – Instructions and information on how and when to contact us if any problems arise

  Reliable contraception needs to be started as soon as possible after the procedure. Please read the information below about your choices. The nurse or doctor can provide some of these at the clinic for you. Otherwise you will need to make an appointment with your GP or local family planning clinic to get this.

• Safe Access Zones

  Safe Access Zones have been introduced at health service locations providing abortion services across Northern Ireland from 29 September 2023. The Zones are being established under Assembly legislation to protect women and girls accessing abortion treatment services, information, advice and counselling, and to protect staff working at these locations.

  The Safe Access Zone includes the protected premises, as well as the public area outside the protected premises which lies within a distance between 100m-250m from each entrance to, or exit from, those premises, as set by the operator of the premises.

  Safe Access Zone map (PDF)

  

  For more information on all Safe Access Zones in NI, please visit the Department of Health website.

• Safe Access Zone FAQ

  What is a Safe Access Zone?

  A Safe Access Zone (SAZ) provides protected space where designated activities are not permitted.

  What is their purpose?

  Safe Access Zones are designed to protect women and girls accessing lawful abortion services, information, advice and counselling, and protect staff providing these services.

  The law makes it illegal for these protected persons to be impeded, recorded, influenced or to be caused harassment, alarm or distress within the Safe Access Zones.

  The definition of protected person in the legislation includes a person accompanying a woman/girl accessing the services, as well as the woman/girl herself. It also includes a person providing services to the protected premises as well as those working there.

  What does a Safe Access Zone cover?

  Under the legislation, Safe Access Zones can be established in the vicinity of health care premises providing lawful abortions, as well as at premises where information, advice or counselling about abortion services are provided. The Zones will include the protected premises where these services are provided, as well as adjoining public space between 100m-250m from entrances or exits of the protected premises.

  When are they being introduced?

  Five Health and Social Care Trusts decided to introduce Safe Access Zones from September 29, 2023. These will be located at:

  HSC Trust	Area	Distance
  Southern Trust	Craigavon Area Hospital	100m
  Southern Trust	Daisy Hill Hospital	130m
  Belfast Trust	College Street	130m
  Belfast Trust	Bradbury Wellbeing and Treatment Centre	150m
  Northern Trust	Causeway Hospital	100m
  Western Trust	Altnagelvin Hospital	100m
  South Eastern Trust	Lagan Valley Hospital	100m
  South Eastern Trust	Ulster Hospital	100m

  Under what legislation is this being done?

  SAZs are being established under legislation passed by the NI Assembly – the Abortion Services (Safe Access Zones) Act (Northern Ireland) 2023. Read the legislation on the GOV.UK website.

  Who is a protected person?

  A protected person is a person attending protected premises for the purposes of:

  • accessing the treatment, information, advice or counselling provided there; OR
  • accompanying a person accessing the treatment, information, advice or counselling provided there, at the invitation of that person; OR
  • working in, or providing services to, the protected premises.

  What are protected premises?

  Protected premises are premises where treatment, information, advice or counselling relating to the lawful termination of pregnancy is provided in accordance with the Abortion (Northern Ireland) (No.2) Regulations 2020, and where the approved operator of the premises has notified the Department of Health that they wish to establish a Safe Access Zone.

  The Safe Access Zone includes the protected premises, as well as the public area outside the protected premises which lies within a distance between 100m-250m from each entrance to, or exit from, those premises, as set by the operator of the premises, as shown on these maps:

  Safe Access Zone map (PDF)

  

  What is an offence?

  The Act makes it a crime to do an act in a Safe Access Zone, either intentionally or recklessly, that will or might:

  • directly or indirectly influence a protected person in their decision to attend an abortion clinic; OR
  • prevent or impede their access; OR
  • harass, alarm or distress that protected person.

  Who enforces the SAZ?

  The PSNI has powers of enforcement under this legislation and can be contacted by a member of staff at the protected premises, or by a member of the public, in the event of any potential breach of the law.

  Any breaches of the Act will be dealt with appropriately and those found guilty of an offence could face a fine of up to £2,500 (not exceeding level 4 on the standard scale).

  Will these be the only Safe Access Zones?

  The legislation does not set a figure for the number of SAZs in NI.

  What about private addresses in Safe Access Zones?

  The Safe Access Zone requirements do not apply to private properties. However, anyone living, working in or visiting private properties within the Safe Access Zone will be required to abide by the Zone requirements when in the designated public spaces.

  How will I know if I am in a Safe Access Zone?

  Public signage including maps will be placed at the Zones by Health Trusts/ operators of premises.

  What does a Safe Access Zone cover?

  A Safe Access Zone covers a protected premises in its entirety as well as the designated public space around the premises which may be between 100m and 250m from its entrance/exit. Where services are provided at hospital locations the protected premises means the entire hospital site.

  Where can I find out more information about operational Safe Access Zones in my area?

  More information including maps will be available on Health Trust websites.

  Do Safe Access Zones just apply to health service facilities?

  Non-statutory providers of information, advice or counselling about abortion services can also establish a Safe Access Zone.

  What abortion services are lawful in NI?

  Details of abortion service provision in Northern Ireland are provided on the NI Direct website.

  How will the effectiveness of Safe Access Zones be monitored?

  The Safe Access Zone area is monitored by staff and the PSNI. The Department of Health will produce an annual report.

  Does this impact on the right to protest or free speech?

  The legislation criminalises certain actions within the strictly designated public areas in the vicinity of these services. The Supreme Court has ruled that Safe Access Zones legislation is not incompatible with the Convention rights of those who seek to express opposition to the provision of abortion services in Northern Ireland. Read more information is available on The Supreme Court website.

   

• What happens at home?

  1-2 days after taking the first medication (Step 1), you will take the second medication that is sent home with you in your pack (Step 2 – Misoprostol). Once you have taken these you can expect to bleed heavily with clots and it is normal to experience period like cramps. Most women say the pain is worse than a heavy period but the amount of pain will vary from woman to woman.

  Bleeding may happen before you take the second medication but it is very important to take the second set of tablets (Step 2).

  Within 4-6 hours of taking the second medication you can expect to pass the pregnancy. For a small number of women it can take up to 24 hours to completely pass the pregnancy. This is like having a heavy period or a miscarriage for those who have experienced one. Once the pregnancy has passed, the bleeding and cramps will start to settle over time.  Bleeding can last up to 4 weeks but should get lighter each day. Some pain and cramping is normal up to a week after the abortion. It should get a little better each day. Painkillers, rest and things like hot water bottles/heat packs can help.

  The pregnancy test (Step 3) should be taken no sooner than 3 weeks after completing Step 2 to confirm the abortion has been completed – this is your responsibility. If it is negative then the abortion is complete. If it comes back positive you must contact us on the number provided for you in the clinic.

• What are the risks of abortion?

  For every 1000 women having an abortion, 1 woman will have a serious complication. The risk of complications increases the further along you are in your pregnancy.

  The medications can have some side effects and the doctor or nurse will ensure it is safe for you to take. The side effects include:

  • Nausea
  • Vomiting
  • Diarrhoea
  • Warmth/Chills
  • Headache
  • Dizziness

  The risks of the abortion include:

  Once the procedure has begun, it cannot be reversed.

  There is a small chance (1 in 100) that it may not work. The chance of failure increases the nearer you are to 10 weeks.

  Bleeding may be very heavy and in rare cases you may need a blood transfusion (1 in 1000 women).Pregnancy tissue may be left in the womb (2 in 100 women) which may require further medical treatment or removal by a simple operation (3 in 100).

  Up to 1 in 10 women will get an infection after an abortion

  Serious infection of the womb or fallopian tubes after termination may later lead to difficulties in getting pregnant.

  Other rare complications are possible including the need for abdominal surgery called a laparoscopy (key-hole surgery) or laparotomy (open surgery).

  Rarely some pregnancies (1 in 1000) may develop outside the womb. This is called an ectopic pregnancy. Having an abortion will not affect this but it is important that it is picked up. Please ensure you let us know if you have any pain before having an abortion so that we can organise an ultrasound scan.

  HAVING AN ABORTION DOES NOT INCREASE THE RISKS OF INFERTILITY, BREAST CANCER OR MENTAL HEALTH ISSUES.

• When to seek advice

  Please contact the emergency Cedar Clinic service mobile provided to you if:

  After taking Mifepristone (Step 1):

  If you vomit within the first 60 minutes of taking Mifepristone (Step 1) in the clinic.

  After taking Misoprostol (Step 2):

  You have had no bleeding 24 hours after using Misoprostol (Step 2).

  You have severe cramps or abdominal pain or discomfort that is not helped by pain killers, a hot water bottle/heat pad or rest.

  You have a fever of 38 degrees or higher more than 24 hours after taking the misoprostol.

  An increase in pain/cramps or bleeding more than 24 hours after taking misoprostol.

  You have an unpleasant- smelling vaginal discharge.

  You have signs that suggest you are still pregnant 1 week after your treatment.

  After 1 week:

  • Your bleeding is not getting lighter.
  • You do not feel that you passed the pregnancy.
  • You still feel pregnancy symptoms (such as nausea and breast tenderness).

  If your pregnancy test is still positive or unclear after 3 weeks from passing the pregnancy.

  Please attend A+E or telephone 999 for an ambulance if you experience any of the following:

  Heavy vaginal bleeding and have soaked through 2 or more large maxi pads an hour, for the last 2 hours.

  Passing blood clots larger than a lemon for more than 2 hours.

  Dizziness or vomiting lasting more than 2 hours.

  Severe pain or cramps that don’t get better with pain medication, rest, water bottle/heat pads, especially if the pain is under your ribs or up into your shoulder.

  Loss of consciousness or confusion.

  Worsening pain.

  A severe allergic reaction.

  Chest pain or concerns for a heart attack or stroke.

  Slurred speech.

  Breathing difficulties.

  Fits/seizures.

• Contraception Options

  There are many different types of contraception.

  Currently in the Cedar service we offer 3 types of contraception:

  Mini-pill (progesterone only pill)
  The contraceptive implant  (Nexplanon)
  The contraceptive injection (Depo-provera)

  Other options that you can get from your GP or local family planning clinic include:

  The combined contraceptive pill
  Mirena coil (IUS)
  Copper coil (IUD)
  Male and female sterilisation
  Contraceptive vaginal ring
  Caps or diaphragms
  Condoms

  For more information on each type, please visit:

  https://www.nhs.uk/conditions/contraception/

  https://www.sexualhealthni.info/contraception

  https://www.fpa.org.uk/professionals/resources/

• Chlamydia Screening

  As part of the abortion process we will offer you a swab to check for chlamydia. If you think you are at risk of having a sexually transmitted infection please let the doctor or nurse know. You may require antibiotics.

  It is always best to get a full check-up for this at your local GUM (genito-urinary medicine) clinic.

  For more information on sexually transmitted infections and safer sex, please visit:

  https://www.sexualhealthni.info/gum-clinics-northern-ireland

  https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/

• Domestic Abuse

  As part of our service, you will be asked about domestic violence. This is confidential discussion and you may or may not wish to disclose any issues you may have with us.

  For information on how to get help please visit:

  Derry/Londonderry, Strabane, Limavady  and Dungiven – Foyle Women’s Aid

  Omagh – Omagh Women’s Aid

  Fermanagh – Fermanagh Women’s Aid

  Tel: 08088021414

  Text support to 07797805839

  Email: 24hrssupport@dvhelpline.org

  https://www.gov.uk/guidance/domestic-abuse-how-to-get-help

  As part of our service, you will be asked about domestic violence. This is confidential discussion and you may or may not wish to disclose any issues you may have with us.