Monika Axelsson et al.
Speeches:
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Abortions at home in Gothenburg
Monika Axelsson, Liselotte Holmqvist (Sweden)
Sahlgrenska University Hospital, Gothenburg, Sweden
monika.axelsson@vgregion.se
Background. This poster describes patient satisfaction in women choosing to perform their abortions at home. Since 1975, the number of abortions in Sweden has varied between 30 000 and 38 000 annually; some 2 500 per year are performed at the Abortion Department at Sahlgrenska University Hospital/Östra. New abortion methods have been introduced since the Swedish Abortion Act was passed in 1975. Medical abortion in early pregnancy is undergoing constant development and more women currently choose it over the surgical method. An increasing number of women, currently 20-25%, want the possibility to conclude their abortions at home. A quality review was performed in order to develop and improve the method.
Method. A questionnaire was filled out by 60 women at their follow-up appointment with at midwife four weeks after the ”home abortion”.
Results. The average age was 34.3. Seventy-one percent had given birth, of whom 64.5% had given birth vaginally. Previous abortions were reported by 34.9%; 90.7 appreciated being scheduled for all abortion-related appointments at the first visit; 69.8 found the interval from the positive pregnancy test to the completed abortion appropriate, while the rest thought that the interval was too long.
Conclusion. Women choosing to conclude their abortions at home report that the method works well for them and they are satisfied with their choice. Questionnaire results also show that information and access to care are important.
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Regarding medical abortions at the Gynaecological Clinic in Majorna
Monika Axelsson Närhälsan Västra Götaland, Gothenburg, Sweden - monika.axelsson@vgregion.se
We started the office with the idea of facilitating so-called early medical abortions that are terminated at home. After contact with and visits from the The National Board of Health and Welfare, in addition to hard work on routines and quality as well as medical safety, we finally managed to get the permit to open our doors. To summarize the results from the survey, the information given corresponds with the patients´ expectations. The patient receives sufficient analgesics to take home which is crucial. Measuring the level of pain is difficult but I have used a scale without numbers that goes from no pain to severe pain and most fall in the middle of the scale. 37% have chosen the lower end of the scale, meaning less pain, while 42% have chosen the higher end of the scale. 17% chose the middle of the scale. 82% thought they had received enough analgesics. 7% asked for emergency care during 4 weeks following the procedure due to bleeding, dizziness, pain, and so on. An interesting finding was the choice of contraception, where most patients have chosen combined birth control pills (32%) or no protection (22%). The conclusion is that we offer a good service at the gynaecology clinic in Majorna to women that wish to carry out an abortion. What could be explored further, and should be discussed, is the fact that such a high percentage of the women chose to use no contraception after abortion. One solution could be to offer an additional follow-up visit later on. However, important is to be able to offer abortions that are as good and safe as possible.
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The midwife’s role in care of abortion patients
Axelsson Monika. RNM, Holmqvist Liselott. RNM, abortion clinic, Göteborg, Sweden
In Sweden, abortion has been legal since 1975. The law stipulates that termination of
pregnancy is the woman’s own choice until week 18. After this gestational age, an
application must be made to the National Board of Health and Welfare. This application is
made jointly by the gynaecologist, who makes a medical assessment, and a social
worker/counsellor, who makes a socio-psychological assessment. The Board approves or
denies the application, based on the special conditions pertinent to the case.
Counselling with a social worker/counsellor is offered to all women until pregnancy week
18; after week 18 counselling is compulsory.
34 800 abortions are performed every year in Sweden. This corresponds to 20.1 abortions
per 1000 women. The most common age group is 20 – 24.The statistics for 2003 show a
decrease in abortions among teenagers for the first time since 1995.
The woman can choose the medical or surgical method surgery until the ninth week of
pregnancy. At the abortion clinic at Sahlgrenska University Hospital/Östra(SUÖ), the staff
consists of four midwives and two auxiliary nurses. Two doctors work at the clinic. Social
workers/counsellors are available when required for consultations. Midwives work in
abortion clinics in Sweden. In many clinics, midwifes are employed, and together with
gynaecologists, social workers/counsellors and auxiliary nurses run the organisation.
The midwife has a unique position, she has a broader view of both the woman’s and man’s
sexual health. She can thus provide information to the patient/woman and give advice and
support prior to the abortion decision. The midwife provides contraceptive information and,
according to Swedish law, prescribes hormonal contraceptives and inserts IUDs and
implants. Cooperation with the social workers/counsellors with their greater knowledge and
education about abortion issues, is positive.
In order to improve our care of and approach to our patients, we performed a study to
evaluate our work in 2001.With the help of a questionnaire, 50 women were questioned
during their follow-up visit. They answered 21 questions concerning clinic environment,
staff availability, information, competence, confidentiality, approach and pain relief.
Most patients were satisfied with the information, with the exception of that regarding pain.
Some patients felt that experiencing labour-like pains/contractions was unpleasant.
Bleeding was also an area, which surprised some of our patients, who had expected tobleed less. The majority of women were satisfied with their care, but thought that the
appointment with the gynaecologist was stressful. We will proceed to improve our
organisation, based on the results of our study.
It is our ambition that a midwife is the first person the patient meets when she requires an
abortion, because the midwife has a unique knowledge of women and their sexual health.
This knowledge should lead to the midwife being responsible for making appointments and
providing advice by telephone, including information on abortion and contraception
methods, so that the woman is well prepared when she comes for her gynaecologist’s
appointment. In our opinion, it is important that women be offered a follow-up appointment
with the midwife after the abortion, regardless of whether it is medical or surgical. Offeringbleed less. The majority of women were satisfied with their care, but thought that the
appointment with the gynaecologist was stressful. We will proceed to improve our
organisation, based on the results of our study.
It is our ambition that a midwife is the first person the patient meets when she requires an
abortion, because the midwife has a unique knowledge of women and their sexual health.
This knowledge should lead to the midwife being responsible for making appointments and
providing advice by telephone, including information on abortion and contraception
methods, so that the woman is well prepared when she comes for her gynaecologist’s
appointment. In our opinion, it is important that women be offered a follow-up appointment
with the midwife after the abortion, regardless of whether it is medical or surgical. Offeringbleed less. The majority of women were satisfied with their care, but thought that the
appointment with the gynaecologist was stressful. We will proceed to improve our
organisation, based on the results of our study.
It is our ambition that a midwife is the first person the patient meets when she requires an
abortion, because the midwife has a unique knowledge of women and their sexual health.
This knowledge should lead to the midwife being responsible for making appointments and
providing advice by telephone, including information on abortion and contraception
methods, so that the woman is well prepared when she comes for her gynaecologist’s
appointment. In our opinion, it is important that women be offered a follow-up appointment
with the midwife after the abortion, regardless of whether it is medical or surgical. Offeringbleed less. The majority of women were satisfied with their care, but thought that the
appointment with the gynaecologist was stressful. We will proceed to improve our
organisation, based on the results of our study.
It is our ambition that a midwife is the first person the patient meets when she requires an
abortion, because the midwife has a unique knowledge of women and their sexual health.
This knowledge should lead to the midwife being responsible for making appointments and
providing advice by telephone, including information on abortion and contraception
methods, so that the woman is well prepared when she comes for her gynaecologist’s
appointment. In our opinion, it is important that women be offered a follow-up appointment
with the midwife after the abortion, regardless of whether it is medical or surgical. Offeringthis service is our ambition, albeit a long-term goal, since it currently depends on the
economical situation in the hospitals. Unfortunately, these women are not a high priority.