Unwanted pregnancy

An unplanned pregnancy can be a confusing, stressful and difficult time. Depending on the results of the pregnancy test, there are several care pathways available. You can help a woman to be aware of these. View the video of 'Hannah's story' and think about how you might respond if you were the nursing staff member in this situation then select the pregnancy results in the activity that follows to see the care pathways and people who can support the woman in her decision making.
 
View the video about Hannah and think about how you would deal with this situation if you were the member of the nursing staff involved. To read a transcript of the audio in this video, select the link Hannah's story (Word 15KB).

How you can help

The first step is to confirm the pregancy by taking a pregnancy test as soon as possible.You can advise her that a test kit can be obtained from the GP, a walk-in centre or local family planning clinic.They can also be purchased from most chemists, and some pharmacists may provide pregnancy testing services. Every woman experiences different combinations of pregnancy symptoms which may include:

• a late or missed period
• swelling or tenderness of breasts
• more frequent visits to the toilet to pass urine
• nausea or vomiting ('morning' sickness can occur at any time of the day)
• changes in appetite.

Select the pregnancy results on the animation below to see the care pathways and people who can support the woman in her decision-making about the future of her pregnancy.

Action point

• Check your role in pregnancy testing - is it to provide the kit or to carry out the test? Do you know how to do this correctly? This may be something you can arrange when you are next at work.
• Make a list of where a woman could obtain a pregnancy testing kit in your area. Would this make a useful leaflet for patients? Or something you and your colleagues could refer to at work? It will save you time if it's prepared in advance.

Termination of pregnancy

If a woman feels that terminating the pregnancy (commonly referred to as an 'abortion') is in her or her family's best interests, then she should have access to safe, supportive and non-judgmental advice and help from an expert. No-one else should pressure her into either continuing with the pregnancy or having an abortion.

Abortion has been legal in Great Britain since 1967 and is available up to 24 weeks gestation under certain grounds to protect a woman's physical or mental health, or that of any existing children. Abortion can be accessed beyond 24 weeks if there serious risk to the life of the woman, or evidence of severe foetal abnormality.

There are just under 200,000 abortions performed in England and Wales and about 120,000 in Scotland. All abortions must be agreed by two doctors (or one in an emergency), and carried out by a doctor, in a government approved hospital or clinic. The 1967 Abortion Act applies to England, Scotland and Wales but was never extended to Northern Ireland where abortion can only be obtained if the woman's life is at risk, or in some cases, foetal abnormality.

Around 90 per cent of abortions are carried out at under 13 week's gestation. Later abortions (after 20 weeks) are extremely rare - about 1.6 per cent of the total. At least a third of British women will have had an abortion by the time they reach the age of 45 years.

Methods of terminating pregnancy

There are two methods of 'abortion' - medical abortion (sometimes called the 'abortion pill'), and surgical abortion, which involves a minor procedure. Both are safe, straightforward and effective. Early medical abortion involves taking two doses of medication over two visits 6 to 48 hours apart, which cause the pregnancy to pass like a heavy period. Surgical abortion is where the pregnancy is removed vaginally by a surgical 'suction' procedure.

These options must be considered very carefully. If the woman is ambivalent or unsure, she should talk to someone she can trust. Remember the final decision is hers and a counsellor can help her to discuss the options and explore her feelings. There are your feelings to consider too, and those of your colleagues. Some people will have strong objections to abortion, and inexperienced staff may need support when they are first faced with a new situation.

Here are some frequently asked questions about abortion presented as a short quiz so you can test your knowledge about the answers.

A final word: oral contraception and 'nil by mouth'

Imagine it's you who takes the call from a woman who's attending her local hospital for day surgery tomorrow. Sophie has to be 'nil by mouth' from midnight tonight, but normally takes her oral contraceptive pill first thing in the morning. What should she do? Take a moment to consider how you would reply, then check your facts below.

• The most important thing is to find out what sort of pill Sophie is taking. What is it called? Is it a combined oral contraceptive containing both oestrogen and progestogen (COC), or is it a progestogen-only pill (POP)?
• Only then can Sophie can then be accurately advised - and you can find out more about these contraceptives in the 'Useful resources' section.
• If Sophie experiences vomiting she may need to use a barrier method such as condoms or Femidon (female condom).
• If she has been prescribed or given antibiotics she will need to use a barrier method of contraception such as a condom or Femidon for the whole duration of the course of antibiotics, plus seven additional days after the course is completed.
• Sophie should be given information about emergency contraception in the event of an episode of unprotected sex.