Abortion by Telehealth

What is an abortion by telehealth?

Abortion by telehealth, or teleabortion, is where you have an appointment with a nurse and a doctor over the phone instead of coming to a clinic.

You are emailed the required forms before your appointment. We will then mail you your medication and any aftercare materials required.

The abortion by telehealth process

You will usually have two appointments with a doctor

What do I need to do before my first appointment?

• Read this information booklet and make a note of any questions you might have.
• Write down the first day of your last menstrual period so that the doctor can estimate how pregnant you are.

What happens during my first doctor’s appointment?

• The doctor will talk to you by yourself during the first appointment.
• They will ask you about your decision and whether you are sure.
• They will ask about your medical history and previous pregnancies.
• They will explain the treatment, any risks and the process for follow up.
• You can ask any questions you might have.
• They will discuss your contraceptive options and sexual health screening.
• Some contraceptive methods can be started immediately.
• They will send you an ultrasound referral to have an ultrasound. You can have this done anywhere that is convenient to you.
• You must not have this ultrasound any earlier than 6 weeks after the first day of your last menstrual period. This will help us determine if the pregnancy is in the uterus (womb), how many weeks pregnant you are and if you can continue with the abortion by telehealth process.

What happens during my second doctor’s appointment?

• The doctor will discuss the ultrasound scan report and confirm that you are able to proceed with the abortion by telehealth process.
• They will talk to you about your decision and review the information given in the first appointment.
• They will review the treatment with you, including any risks.
• You can ask any questions you might have.
• You will also complete the consent to treatment form with the doctor.

Consent form

At the end of the second appointment and before we send you the medications, you will be asked to give your consent. We will send you a link to the online consent form before your second doctor’s appointment.

How do I get my medication?

If the doctor determines it is safe for you to proceed with the treatment, we will send your medication by courier to your postal address. You, or an authorised person, must be present to receive it.

The pack contains:

• the medications needed for a medical abortion
• pain relief medication – the doctor will explain how to use these
• medication to help with nausea
• Check4® low sensitivity urine pregnancy test
• information on how to complete your follow-up self assessment including Check4® low sensitivity urine pregnancy test information
• discharge letter – please take this with you if you need to visit another doctor or hospital.

The medical abortion process

The 2 steps of a medical abortion

Medical abortion happens in 2 steps. You will take 2 different tablets that work together to end the pregnancy.

Step 1 (green box)

The first tablet you will take is an anti-hormone. It will stop the hormone that is needed for a pregnancy to grow.

• This tablet is swallowed with water.
• Most people will not feel anything after taking this tablet, and can do their usual activities, however:
  • you may have some light bleeding and mild cramps during this time
  • you may have heavier bleeding, but this is not common.

You will begin Step 2 between 36-48 hours after Step 1. You should choose a time when you can be at home resting for at least 6 hours, and when you can have a support person with you.

Step 2 (purple box)

The second tablets you will take are a prostaglandin. This will make your uterus cramp and will make your cervix relax so the pregnancy can pass.

• There are 4 tablets in Step 2. You can take them at any time within 36–48 hours of taking Step 1.
• Put all 4 tablets into the pouch of your mouth between your gum and cheek and keep them there. The tablets will go soft but may not completely dissolve; the medicine in the tablet will absorb through your cheek.
• After 30 minutes, you can swallow what is left in your mouth with some water.

Illustration key:

1. Tablets are absorbed through your cheek

Between 30 minutes and 24 hours after taking Step 2 (usually within 4-6 hours) you may have the following:

• cramps in your uterus
• bleeding from your vagina
• start to pass the pregnancy.

Illustration key:

1. Cramps and bleeding.

After your treatment

What to expect during your medical abortion

These are some symptoms you will probably experience during your medical abortion. If you experience any of the uncommon symptoms or are worried about anything you’re feeling, you can call our free support line on 1300 888 022.

Pain management

If you have pain, you can manage it with these methods.

Uterine massage

Frequent, firm massaging of your lower tummy area will help your uterus (womb) muscles, and can reduce bleeding and cramping. It can also help prevent blood clots.

• Lie on your back, sit on the toilet or in a comfortable position
• Feel at the top of your pubic bone, press down firmly and massage in a downwards direction with your hand. You can use your fingertips, knuckles or the heel of your hand.
• Do this massage hourly for 3 minutes at a time, on the day of your abortion, then 5 times a day, or until your cramping/bleeding has stopped.
• If you have discomfort during the massage, don’t stop the massage but take pain medication.

After your medical abortion

Follow up

Follow up 2-3 weeks after your appointment is essential to make sure the abortion has worked.

• You will be given a special urine pregnancy test to use at home no earlier than 14 days after you have completed Step 1. You will also complete a self-assessment to ensure that the abortion has been successful and there are no complications. You have been provided with an instruction sheet to help with this.
• If you need further assessment we may refer you for blood tests or an ultrasound, make an appointment for you at one of our clinics, if convenient, or ask you to see your local health practitioner.

Medical risks

Medical abortion is very safe, but like any medical treatment, has some risks. These risks do not include all complications, but are the most common or serious.

Contraception and aftercare

We will give you information about your contraception options.

Contraception options

Within just 2 weeks of your treatment, your body can release an egg; so it’s possible to fall pregnant again before your next period. This is why we strongly suggest starting contraception as soon as possible if you don’t want to become pregnant. Please take the time to look at our contraception brochure. Ask your doctor for fact sheets on any of the contraceptive methods you are interested in.

Contraception after your medical abortion

In most cases you can start a contraceptive method immediately. If you have chosen an IUD this can be inserted as soon as we have confirmed your abortion is complete. Speak with your GP or local women’s health centre if you are unable to attend one of our clinics.

• Long-acting reversible contraception (LARC) options (e.g. IUDs, implants, injections) are the most effective at preventing pregnancy.
• You can start contraception such as the contraceptive pill or vaginal ring the day after Step 2 of treatment and these methods will be effective immediately.

Free aftercare line

Our aftercare phone service connects you to experienced registered nurses, at any time of the day or night.

Call our aftercare nurses on 1300 888 022 if you experience any of the following problems or have any concerns:

• passing clots larger than a tennis ball size
• heavy bleeding that lasts longer than 2 weeks
• soaking a maxi pad every 30 minutes for more than 2 hours
• fever, chills, strong pain or other side effects which continue more than 24 hours after taking Step 2
• having strong abdominal pain that doesn’t stop
• feeling nauseous more than 1 week after your treatment
• feeling tired or generally unwell
• having sore breasts for 2 weeks after your treatment
• not menstruating as usual, 4-8 weeks after your treatment
• persistent pregnancy symptoms.

Call us IMMEDIATELY if you have possible signs of an infection:

• fever
• feeling generally unwell (flu like symptoms)
• ongoing abdominal pain
• unusual vaginal discharge.

Our aftercare phone service: 1300 888 022

Check4® is a registered trademark of Quadratech Diagnostics Limited

Care and support before, during and after your procedure

Call us on 1300 003 707 for any questions about your appointment.

For medical concerns call our aftercare line on 1300 888 022.