Early Medical Abortion at Home (EMAH): Patient Information (Guidelines)

Please note: The guidance below is being updated to come into line with COVID-19; the new, draft guidance, awaiting approval from CEG, is available in the COVID-19 section

This information should be read alongside the Termination of Pregnancy booklet for Raigmore Hospital. Some women prefer to have their termination in the familiar and private surroundings of their own home.  Home termination is increasingly available in Scotland and the medicines used can only be given by specialised clinics. Research done with the help of Grampian and Lothian women has shown that home termination can be an acceptable and a safe option for women who think it will be the best way for them.  Hospital termination of pregnancy is still available for all women who prefer it. You may choose home termination if your scan shows that you will be less than 9 weeks pregnant on the day of the termination and you prefer the medical method of termination (tablets) rather than the surgical termination (operation).

Women considering home termination must:

• Be a maximum gestation of 9 weeks by ultrasound scan
• Have a responsible adult at home when taking the second tablet
• Have a reliable telephone for incoming and outgoing calls
• Be over 18 years of age
• Live within 30 minutes travel of Raigmore (e.g. Inverness, Nairn, Dingwall, Evanton)
• Speak and read English.
• Be available for follow up in 2-3 weeks
• Agree for GP contact, who may be informed if you fail to follow up

Visit to Hospital

On your visit to hospital you will be given a mifepristone tablet to swallow.  You can go home shortly afterwards.  You may not feel any different and can carry on with your normal activities.  Some women have light vaginal bleeding and there is a tiny chance that you will miscarry at this stage.  You may also experience some period pains and may take paracetamol based tablets to help.  Instead of being admitted to a hospital room as standard for medical termination you will be given misoprostol tablets to take at home.  These should be taken 1-2 days after the first tablet. The misoprostol tablets should be put under the tongue to dissolve.  They should not be swallowed.
You will also be given antibiotics to take at home to reduce the risk of infection.
We will let you know about your swab and blood results from the clinic unless your results are normal.  If you need treatment, we will either give you the treatment at the hospital visit or arrange for further follow up.  If your blood type is rhesus negative you may also require an anti-D injection.  During the hospital visit, we can also insert an implant or start the contraceptive injection if you wish.  

What happens next?

We insist that you have someone with you all day when you take the misoprostol tablets. The misoprostol tablets should be taken 1-2 days after your hospital visit. The misoprostol tablets cause the womb to contract and pass the pregnancy.  This happens soon or in 2-8 hours.  Most women say the process feels like strong period pains.
Some women feel sick, have diarrhoea or feel hot and cold for a few hours after the tablets.  You can eat and drink during this time as normal.  Use pain control tablets used for period cramps if needed.  Some women find they are more comfortable walking around or soaking in a warm bath rather than lying in bed.
You may see or feel the soft pregnancy tissue coming away.  You can flush any clots or tissue down the toilet.  Your bleeding and cramps should become lighter after the pregnancy has come away. 
You or your companion can phone the nurses at any time for advice or if you would like to come into the ward. (Ward 9B – 01463705376)
You should come into the hospital if the bleeding is heavier than a heavy period or you feel dizzy.  Call ward 9B if this happens.

Telephone Follow-up

The medical termination works for about 98 out of 100 women at this stage of pregnancy.  However, approximately 2 in every 100 women need further medication or a surgical procedure.
It is extremely important that you telephone the clinic 2- 3 weeks later to have check up.

Social gynaecology clinic 01463 704431

We advise you not to have sex or use tampons till after your check up appointment.  As with hospital terminations there is a small chance of heavy bleeding or infection, if you notice this or have a high fever please contact us at the hospital.

How long will I bleed for?

The amount of bleeding at the time of the abortion varies but most women describe the bleeding as ‘much heavier than my period’ and it may include some large clots. You can then expect to bleed for around two weeks although this could continue for one month or longer. If you experience continuous and heaving bleeding (SOAKING three or more pads in an hour while resting) contact the clinic, or go to A&E urgently. If you have not started bleeding within 72 hours of your second tablets, contact the clinic as the procedure may not have been effective. It is advised that you use sanitary towels and NOT tampons whilst you are bleeding.   

When should I start contraception ?

You should start contraceptive pills, patches, or the vaginal ring the same day as the second tablet. We should be able to supply you with these before going home.  We should also be able to give you an injection or insert an implant when you visit the hospital for the first tablet.  If for some reason we are unable to do so, then we will tell you where you are able to get these. We can also arrange for you to have an intrauterine method inserted at the Highland Sexual Health once you have had your follow-up appointment.  We have a Contraception Clinic every week and can arrange an appointment for you to have any of these methods after your abortion.