The Cedar Clinic provides Early Medical Abortions (EMAs) up to 9 weeks and 6 days gestation.
Currently we offer medical abortions only (this means taking medication, not surgery).
If you are less than 10 weeks pregnant (no more than 9 weeks and 6 days since the first day of your last period) – call 03457 30 40 30.
If you are more than 10 weeks pregnant, you can access free abortion care in England. You can contact the UK government funded Central Booking System provided by MSI Reproductive Choices on 0333 234 2184.
For information regarding early medical abortion or to discuss counselling, please contact the British Pregnancy Advisory Service.
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What is medical abortion?
A medical abortion involves 3 steps.
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.
If you are above 8 weeks pregnant, a second dose of misoprostol will be required.
4-6 hours after taking the second medication (Misoprostol) 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.
For more information please visit:
https://informingchoicesni.org/
https://www.rcog.org.uk/en/patients/patient-leaflets/abortion-care/
It is important to note that not all this information will apply to Northern Ireland. Although abortion is legal now in Northern Ireland, we are restricted to early medical abortions up to 9 weeks and 6 days using medication only.
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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.
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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.
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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.
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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.
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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.
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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
CondomsFor more information on each type, please visit:
https://www.nhs.uk/conditions/contraception/
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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/
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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.