This page provides information about the option of a medical termination of pregnancy at home (up to 11+6 weeks gestation). It supports the information that is given to you over the phone or in clinic if you want to take tablets at home.

How does a medical termination work?

Medical termination is a two part process in which medication is used to stop and then expel the pregnancy. A tablet called mifepristone is first used to block progesterone, a hormone needed in pregnancy. After that another tablet called misoprostol helps the pregnancy come out. This medication can be placed high in the vagina or under the tongue. You will be given more information about how to take the medicines separately.

Contact details

Although the procedure is at home we are here to support you with it. Please do contact Ward 6 (the gynaecology ward) on 01324 566390 if you need to.

How is the treatment organised?

You will either have a telephone appointment with a nurse, or a face to face appointment with a nurse or doctor. You may have an ultrasound scan at the face to face appointment to check what is happening with the pregnancy and how pregnant you are. If you do not have this scan it is because staff have decided it is not necessary for you based on answers to questions you have given. After you have spoken to the clinic staff you will be given the tablets to take at home, or arrange to pick them up from Forth Valley Royal Hospital, Ward 6. In your pack will be both parts of the treatment, anti-sickness medication and strong painkillers. You can take the treatment at a time to suit you. Some people choose to take the first tablet in clinic if they attend face to face.

What happens after the first part of the treatment?

You may feel a bit sick after the first tablet (mifepristone). If you have been feeling sick in pregnancy you may wish to take an anti-sickness tablet and then take the first tablet an hour later to reduce the chance of you being sick. If you are sick within two hours of taking the first tablet please phone us as we may need to give you another tablet. After taking the first tablet you won’t usually notice anything, although some people can experience some bleeding and pain. A small number of people expel the pregnancy after the first tablet. If you experience heavy bleeding or severe pain after the first tablet please phone us for advice. If you have only a small amount of bleeding and the pain eases with paracetamol then just proceed as planned with taking the second part of the treatment.

What happens during the second part of the treatment?

The second part of the treatment (misoprostol) is when the pregnancy will actually pass. These tablets are taken 2 days (36-48 hours) after the first. You can time this to suit you, anytime within the 36-48 hours is fine. You will be given detailed instructions on how to take these tablets with your medication but they can be placed under the tongue or high in the vagina (it doesn’t matter and it’s up to you). If your pregnancy is less than 10 weeks, you will be given 6 tablets for the second part of the treatment. When it is time for you to take the second part, place 4 tablets under your tongue or in your vagina. Usually the cramping and bleeding will start fairly quickly. If it does not, wait 4 hours to see if it begins. If after 4 hours you have had only a little bit of bleeding and cramping, or you haven’t had any, and do not think you have passed the pregnancy, put the other 2 tablets under your tongue and follow the instructions for how to take them this way.

If your pregnancy is between 10 and 12 weeks, you will be given an extra 2 tablets (8 in total). If you take the first 4 tablets, wait 4 hours, and take the second two tablets, and still don’t have any bleeding and don’t pass the pregnancy, wait another 4 hours, and then take the final 2 tablets by placing them under your tongue.

What do I need at home?

Misoprostol induces cramping and bleeding – you may see large blood clots or tissue. Bleeding is generally heavier than a period (it may be much heavier) and the crampy pains are worse than period pains. They may be much worse. If the pregnancy is under 8 weeks you may only see a sac or you may only see blood clots. If you are over 10 weeks you may see something that is more recognisable as a fetus. If you are concerned about anything you see at the time of abortion you may phone Ward 6 for advice and support. There is no need for you to look if you don’t want to.

All products of conception (what you pass with the bleeding) can be passed into the toilet and flushed away, or if there is anything in your pad it can be thrown away into the dustbin.

The second part of the treatment can make you feel sick, you may vomit or have diarrhoea. You also may feel shivery and shaky. These are not nice feelings to have but they are normal and because of the medicine.

The pregnancy is usually passed 4-5 hours after taking misoprostol, but it may be quicker or take longer than this. If you have not started to bleed within 24 hours of taking all of the second part of your treatment provided, please phone Ward 6 on 01324 566390. You may be asked to attend for review, and we will discuss further treatment options with you. These may include a repeat scan, a repeat pregnancy test and more medication.

The most important thing you need at home is someone with you. There needs to be someone over 16 with you, who speaks English, so that they can call an ambulance just in case you need one (the risk of this is very small). You will have the number of Ward 6 at Forth Valley and you can call us if you are unsure about anything.

You should also have some simple painkillers like paracetamol and ibuprofen (if you can take it). You will be given stronger painkillers with your medication but not everyone needs or wishes to use these. Hot water bottles and heat pads can also help with pain relief. You will be bleeding and sometimes quite heavily so we would recommend large sanitary pads, maternity or for very heavy flow.

Important symptoms to be aware of

You will usually start to feel better as soon as you have passed the pregnancy. There are some warning signs that you might be experiencing complications so please contact Ward 6 for advice if you experience any of the following.

• Heavy bleeding soaking through two sanitary pads an hour for two hours or more in a row.
• Abdominal pain or cramping not relieved by the medication (including the stronger painkillers you will be given).
• Feeling feverish, hot and sweaty or cold and shaky.
• Vaginal discharge that is smelly.
• Nausea, vomiting, diarrhoea or feeling faint more than 24 hours after taking the second part of your medication.

What are the risks of medical termination?

The procedure is very safe but like all medical treatment there are some risks. The main risks are:

• The procedure not working. About 1 in 100 people are still pregnant even after taking the treatment. If this happened we would offer you further treatment to ensure you were no longer pregnant. Sometimes there can be small amounts of pregnancy tissue left inside, which may or may not require further treatment. Occasionally, patients require a surgical procedure but this only happens very rarely. In this case we may need to give you further treatment, or in a small cases you may need to have a surgical operation.
• Infection (about 1 in 100). You may need antibiotics if this happens.
• Haemorrhage (excessive bleeding). The risk of this is only about 1 in 1000.

We know that having a termination of pregnancy does not affect your fertility in the future or your ability to have children.

How long will I bleed for after the procedure?

You may bleed for 2 to 3 weeks following the termination, but some women bleed less than this and some may continue to bleed up to their next period. Generally the bleeding should get lighter each day and should not smell unpleasant. Usually we advise that you use pads or period pants rather than tampons until your next period.

When can I have sex again?

You can have sex when you feel comfortable to. If you do not want to become pregnant again then using contraception will help prevent this. You will be able to discuss all forms of contraception with the clinic staff, and we can give you most methods home with you to make it easier for you to start.

What happens after the procedure?

We will give you a pregnancy test to do 3 weeks after the second part of the treatment. It is very important you do this so we know you are not pregnant. If you do it earlier than 3 weeks it may show as positive because there may still be some pregnancy hormones left in your body. The best time to do it is the first urine you pass in the morning as that is the most concentrated. If it is positive (even a faint positive) please contact Ward 6.

How will I feel after the termination?

Most people feel relieved when the termination is over. However, people experience a wide range of emotions and each person’s experience is unique. If you would like to discuss your termination further with a support service – however you are feeling – you can contact:

Abortion Talk on 0333 090 9266. Their talkline is open Monday, Tuesday, Wednesday and Thursday 7pm-10pm, Outside these hours you can leave a message or request a call back.