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 must begin a medical abortion by 9 weeks gestation, calculated from the first day of your last menstrual period, or by an ultrasound scan.

Whether you need an ultrasound to proceed will depend on information about this pregnancy, your medical history and your preference. The doctor will discuss this further during your first appointment.

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.
• Complete the electronic intake form that will be emailed to you when you make your appointment.

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 this pregnancy, previous pregnancies and your medical history.
• They will explain the treatment, any risks and the process for follow up.
• You can ask any questions you might have.
• Depending on your history, you may be able to proceed to book your second appointment without having an ultrasound. The doctor will discuss whether this is a safe option for you.
• If you need or prefer to have an ultrasound, we will send you a form to use anywhere that is convenient to you. Once we receive the report, you will book your second appointment.
• 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 talk to you about your decision , discuss any test results, and review the information given in the first appointment.
• They will review the treatment with you, including any risks.
• They will explain the follow up assessment, which differs depending on whether you have had an ultrasound or not. If you are proceeding without an ultrasound, you will need to have a blood test before and after the treatment. We will send the test forms to you.
• 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 or during your second doctor’s appointment.

How do I get my medication?

There are two ways you can get your medication:

1. Delivery
   • We can send the medication by courier to your home, a chosen address, or some parcel lockers (but not to a PO box).
   • Delivery usually takes 1–3 business days.
   • Someone will need to be there to sign for the package. If no one is home, it will be taken to the local post office to be collected.
   • There are additional costs for delivery.
2. Local pharmacy
   • We can send you an eScript (electronic prescription) for the medication, which you can take to a local pharmacy to collect.
   • Not all pharmacies keep the medication in stock. It’s a good idea to call ahead and check availability.
   • If you choose this option, you’ll pay the pharmacy directly for the medication. We won’t charge you for it.

You will also be prescribed pain relief and anti-nausea medication. Your doctor will explain how and when to take them.

The medical abortion process

Medical abortion is a 2 step process. 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 to 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 to 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

• 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

It is essential to make sure the medical abortion has worked.

• If you had blood tests before and after your medical abortion, unless you hear from us, you’ll only need to complete a simple self-assessment to check that the abortion was successful and there are no complications. We’ll email the self-assessment to you. Please complete it 14 to 21 days after taking Step 1.
• If you didn’t have blood tests, we will post you a special urine pregnancy test to use at home. This should be done 14 to 21 days after taking Step 1. You’ll also complete a self-assessment at the same time to check that the abortion was successful and there are no complications.
• 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.

Visit msiaustralia.org.au for further information and fact sheets on different contraceptive methods.

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.

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, by 6 to 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

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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.