Medical abortion and surgical abortion: two abortion techniques

How does a voluntary termination of pregnancy work?Abortion)? In France, the right to abortion has been guaranteed by law since 1975 (Veil law), and in 40 years, the terms of abortion have changed. Legally, any pregnant woman, major or minor, who does not want to pursue a pregnancy is allowed to ask a doctor or, in some cases, a midwife, to terminate her pregnancy. Only the woman concerned by the abortion can make the request and, when her decision is made, she must not delay in initiating the procedures. Indeed, some establishments are overcrowded and the deadline for obtaining an appointment can be long, which risks compromising compliance with the legal deadline for abortion.

If the doctor or midwife uses his conscience clause and refuses to perform abortion on the grounds of personal, professional or ethical convictions, he must immediately inform his patient and provide her with a list of colleagues who agree to perform an abortion. . The abortion can be either medicinal or instrumental (or surgical).

Medicated abortion: taking two drugs

What are the holdups ? Medicated abortion is legal in France until the end of the 5th week of pregnancy, i.e. 7 weeks after the start of the last period. In a health establishment, this period can be extended up to 7 weeks of pregnancy (i.e. 9 weeks after the start of the last period).

Which address ? Medicated abortion can be performed by a doctor as well as by a midwife since June 6, 2016. In all cases, the caregiver will carry out a first investigative consultation with a ultrasound to confirm the pregnancy and take note of the decision to abort.

What are the stages? The medical abortion consists of taking two drugs. The first drug is mifepristone. It blocks the action of progesterone, a hormone that maintains pregnancy, promotes contractions of the uterus and opens the cervix. The pregnancy is then stopped. The second drug (misoprostol) is taken 36 to 48 hours later in a doctor’s office, midwife’s office, or at home. It increases uterine contractions and causes abortion, that is, the expulsion of the contents of the egg. It is often advisable to take pain medication at the same time as misoprostol.

How long ? Medicated abortion does not require anesthesia or hospitalization if it is performed before the 5th week of pregnancy. If it takes place between the 5th and 7th week, in a health facility, it will require a few hours of hospitalization. In 60% of cases, the abortion occurs within four hours of taking the second medication. For the remaining 40%, the abortion takes place within 24 to 72 hours of taking this tablet. a sick leave may be prescribed by the doctor or midwife who administered the drugs.

How much does it cost ? All the acts related to an abortion are reimbursed at 100% since April 1, 2016, up to a limit of 282.91 euros for a medical abortion and 35.65 euros for the consultation prior to the operation with investigative ultrasound. Minors and women benefiting from complementary universal health coverage (CMU-C) or State Medical Aid (AME) do not have to advance medical expenses.

What follow-up after the abortion? Drug abortion is 95% effective. A follow-up consultation should take place between the 14th and 21st day after taking the first medication (mifepristone). It is necessary to ensure that the pregnancy has been terminated and that there are no complications. It will also be an opportunity to take stock with the doctor or midwife on the different contraceptive methods possible to prevent the risk of future unwanted pregnancies.

If the pregnancy has not been terminated, surgical abortion should be used.

After a medical abortion, the bleeding generally lasts about ten days but if it is too heavy or too long, an additional consultation is recommended. Finally, a psycho-social consultation is systematically offered after the abortion (it is compulsory for minors).

Surgical or instrumental abortion by suction

What are the holdups ? Instrumental abortion is legal in France until the end of the 12th week of pregnancy, 14 weeks after the start of the last period.

Which address ? Only a doctor can perform surgical abortion in a health establishment.

How’s it going ? The woman who wishes to have an abortion must make an appointment with the doctor of her choice for an investigative consultation with ultrasound. She should also see an anesthesiologist if a General anaesthesiais planned. It is up to the woman to choose whether she prefers local or general anesthesia. In the first case, she will be hospitalized for a shorter time. But women who want to be sure not to feel, see or hear anything prefer the second option. Since January 2016, the reflection periodwhich required two consultations prior to abortion and seven days between these two visits has been abolished by the application of the Health Act. Instrumental abortion consists of aspirating the contents of the uterus using a cannula inserted vaginally, after dilation of the cervix.

How long ? Instrumental abortion requires local or general anesthesia and therefore requires hospitalization of at least 12 hours. The operation itself takes place in an operating theater and lasts about fifteen minutes.

How much does it cost ? All acts related to an abortion have been reimbursed at 100% since April 1, 2016, up to a limit of 463.25 euros for an instrumental abortion without general anesthesia with a hospital stay of less than 24 hours. Minors and women benefiting from CMU-C or AME do not have to advance medical costs.

What follow-up after the abortion? Surgical abortion is 99.7% effective. A follow-up visit 14 to 21 days after the abortion is necessary to ensure that the pregnancy is terminated and that there are no complications. The follow-up consultation should be advanced if the woman expresses at least one of the following symptoms, which may be signs of complication: fever above 38 ° C, significant blood loss, severe abdominal pain and / or malaise. As with medical abortion, a psychosocial consultation is systematically offered to adults and compulsory for minors.

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