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Ending a pregnancy for fetal abnormality

Ending the pregnancy surgically

There are several ways of ending a pregnancy for fetal abnormality - here we discuss what is likely to happen to women who have a termination at around 13 weeks. Procedures may vary though from hospital to hospital, and some gynaecologists prefer one technique to another.

Most NHS hospitals can offer a surgical termination (also known as STOP) up to 13 weeks. Women will usually be treated in a hospital daycare unit. The procedure takes about 10 minutes and the woman will generally be offered a general anaesthetic so that she is not awake. During the procedure, the woman's cervix will be gently stretched so that a small instrument can be passed through into the womb and the pregnancy removed by suction. The process is sometimes referred to as 'suction evacuation' or vacuum aspiration, though most women we talked to thought they had had a D & E (dilatation and evacuation) which is the surgical procedure that can be performed later than 13 weeks. For more detail about these processes (see Patient.co.uk).

In NHS hospitals later pregnancies are usually ended by induction, a process that involves the woman going through labour and delivering the baby naturally. This process is also referred to as a medical termination. Women's experiences of induced labour and birth are discussed in 'Ending the pregnancy by induction'.

The reason most NHS hospitals can only offer STOP up to 13 weeks is that there aren’t enough NHS doctors trained to perform D&E. This expertise can be found in the independent sector (where most terminations for non medical reasons are carried out).  

Several women felt they couldn't have coped with labour and a normal delivery, so were relieved to have the option of a surgical termination. Most were unsure what procedure they had gone through - all they could remember was being given the anaesthetic and then coming round again. 

 

Though she had a surgical termination she was cared for in a maternity ward where she felt able...

Though she had a surgical termination she was cared for in a maternity ward where she felt able...

Age at interview: 38
Sex: Female
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We were, yes, we were in hospital, so we were transferred up to the, say, one of the maternity wards, although we were given our own room so we didn't have to be, see lots of other pregnant women. And the hospital staff were very sensitive. And I asked to speak to the chaplain, who came along, because the list I was on wasn't until sort of the afternoon list. So I was trying to gather as much information as I could, and I think the more I spent gathering information in the morning, the more I felt, 'Well, this is the only thing to do'.  

And they were debating whether I would have to go through labour or whether I would have to, whether I could have an ordinary termination, because of the timing. So I think it was kind of now or never.  

And having spoken to the chaplain who'd seen this before, kind of helped me sort of come to terms with it. I was sort of worried about, 'Would it hurt the baby? How much will the baby know? What happens to the baby afterwards?' And those were the things we did manage to find out. 

Can you tell me the answers to those questions?

Well, they said that, I mean I was really concerned that obviously I'm going under, but what happens to the baby? And they, the anaesthetist was explaining that probably that would just put the baby to sleep. If I'm going to sleep the baby's gone to sleep. And if we wanted a funeral we could have one.  
 
 

Because she was just under 14 weeks pregnant she chose to end her pregnancy surgically and does...

Because she was just under 14 weeks pregnant she chose to end her pregnancy surgically and does...

Age at interview: 34
Sex: Female
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So they said, 'Right we'll book you an appointment back at your local hospital to see like your consultant there and they said you need to make a decision,' because I was coming up for 14 weeks then. And because I said I couldn't go through with the birth - I just couldn't do it. I'd had two live births and the thought of actually giving birth to a baby that I was never going to hold, I was never going to have just, I think I would have ended up in a mental asylum. I really do.

I had a choice. I could have gone, I went to sleep or I could have given birth as such - I had a choice. I still had at that time of when I was able to make an informed choice of doing it. And I thought the easiest way for me would be to go to sleep. All what goes on - I think it was just such an extreme like unfortunate lot of things that happened after - it doesn't always happen like that. You can have your operation and then it all falls into place after. You've still got the psychological trauma of actually losing the baby but... I don't know, it's the same as any death. You have to grieve. You have to go through all those things and all the anger, all the tears, all the why's, the what if's, and then eventually you reach a point where you do get on and you do live again.

Many women said they had expected the surgical termination to be straightforward physically and less upsetting than going through an induced labour and birth. However having been through the experience, several women concluded that there were good and bad things about ending a pregnancy surgically. Several felt that the procedure too clinical and wished they had had  more contact with a sympathetic midwife. Some women also wondered with hindsight, if it would have been better for them emotionally to have seen and held the baby.

 

She was booked into a day surgery unit at the last minute because she wanted to avoid going...

She was booked into a day surgery unit at the last minute because she wanted to avoid going...

Age at interview: 41
Sex: Female
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It was you know, it was, it was awful. When it came to the... actual termination, I was sort of wheeled into the theatre. I think my husband, I think he must have come in with me, and then sort of taken out. And I just remember lying on the bed and looking at the... you know, looking at the room, and the next thing is, I was asleep. And it only took half an hour. 

And the next thing is I was awake again, and... I think, I don't know about a surgical termination, I mean, there are, it's swings and roundabouts, but when I woke up, what I saw, and the image that haunted me for a long time afterwards was, there was a sort of a little trolley that obviously had a container - you can't see your baby when you've had a surgical termination because a, like a vacuum is used so, you know wouldn't be recognisable as a baby I suppose so you can't see the baby - and there was this container with a white cloth draped over, which... and I remember waking up and thinking, 'Oh' you know, and I felt fine, a bit groggy but fine. And I just looked at this you know, I mean, I just wanted to pull the... you know, [I] was just like so drawn to this, and that image did haunt me. I mean, it still does, it really did for some months afterwards, that's what I would see you know like this burning, you know, vision. 

I think it, to be quite honest, it was a bit surreal having a termination like that. What I felt afterwards - I felt different - I felt physically empty, and it was very bizarre to think, 'Well, I was pregnant this morning, and now I'm not'. It was horrible actually and it was horrible going to bed that night. I sort of wanted the day to end, because it didn't feel right you know, so much had happened in the day. And I don't know... it's not so much I think it was the wrong decision, because I understand why I made the decision, and I think it would have been terribly hard to have said, 'No, I'll go ahead and have labour to terminate this pregnancy,' but I don't think it was the right you know, I do wonder if it was the right thing to do. And if I, I hope I never find myself in that situation again, but if I did, I don't think I'd have a surgical termination, just because I think I'd like to have seen the baby and I didn't. 

And I think, you know I've read quite a lot, heard about other people's experiences, who have had terminations in similar situations, and some people do choose not to see the babies - some people think they won't see their baby and then decide to at the last minute - almost invariably where people do see their baby, while it's very distressing at the time, afterwards they're like, 'Oh I'm really glad I saw my baby, and I'll never forget that and I've got a picture'. 

And I do think, in the months that followed, it was very hard for me to make sense of what had happened. It would have been a very traumatic and very difficult to have given birth to the baby, and seen him, but I think it would have made it more real. I think for me personally - and it may be a lot to do with my own emotional make-up - but there was a bit of an issue of, the whole thing just felt, seemed like a complete and utter nightmare. It didn't seem very real. It seemed so awful, it seemed unreal. And I wonder if seeing a real baby may have helped me to get back some sense of reality. But I would have had to have paid quite a price for that. 
 
 

She was treated in a gynaecology unit and missed being cared for by a midwife or having someone...

She was treated in a gynaecology unit and missed being cared for by a midwife or having someone...

Age at interview: 36
Sex: Female
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But anyway I was booked in for the following Wednesday and I went in for the termination. It was all very clinical I found, very cold, you know there was no midwives there. It was just, you know, you're going in for an operation basically, you couldn't eat the night before and it was all, I found that really hard.

No, I had the second, I had, for the second termination I was in, I went into a gynaecology ward, definitely yeah, it was not a labour ward at all. So I went in for the operation on, it was one day, and they actually, you go in, I think it happened at 1 o'clock, and when I came out I just was, I was put, put in a recovery area. Just given a few painkillers and a few hours later they came to check on me and they said, 'Oh, you're all right to go home now'. So I went home. 

And it was very strange, it just felt like, I don't know, there was no, nobody talk, nobody to talk to you or anything like that. It was just like, and I remember just before going in for the, before they gave me the general anaesthetic, I just felt like I had to tell someone that this was not a choice - I'm not here because I want to have an abortion or anything - because I was worried people, I don't know why I was worried, but I thought people might think, 'Oh, she's having another'. Because I knew there were lots of people before me, and they were going for the same thing. So I thought, 'Well I don't want to be just a person who's just going in because they don't want the baby'. So I said, 'This is a much wanted baby that I'm ending'. But no one really said very much I think. And, yeah, I was very, very upset as well for that one as well. 

Some women wanted hospital staff to know that they were not ending the pregnancy lightly and did not want to be seen by others as having a termination for non-medical reasons.

Ending a pregnancy surgically means that the baby's body will not remain intact, and some women regretted later that they had not seen the baby or known his/her sex. Several experienced heavy bleeding afterwards because part of the placenta had been left behind in the womb and had to go back into hospital for more treatment - usually D & Cs - when this had happened some women found the experience upsetting and unpleasant.

Parents also had to decide in advance of the procedure whether they want to keep the baby's remains for burial or a funeral. Some hospitals now follow guidelines (see guidelines - Royal College of Nursing 'Sensitive disposal of Fetal Remains') about how to deal with the baby's remains, but when arrangements went wrong and the baby was lost, parents were let down and upset.

Last reviewed July 2017.
Last updated June 2014.

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