ABORTIONN491 Trends in Healthcare: Seminar Presentation

Kendra MyersYvonne Salter

Emily Overmars

Objectives Explore the history and evolution of abortion in

Canada. Differentiate between the various types and

specific procedures of abortions. Examine the ethical viewpoints in relation to

abortion. Analyse the role of the health care professional

(in particular, the nurse) in the delivery of abortion services to the general public.

Discuss the availability of these services within Nova Scotia.

Outline The history of abortion Current influences on abortion The different methods of abortion, both medical and surgical,

that are used based on the stage of pregnancy The pro-life perspective that opposes abortion The pro-choice perspective that supports abortion The nurse’s role in the abortion process What a nurse should do if he/she disagrees with the practice

of abortion Emotional issues post abortion, supports and services

available Abortion services available in Nova Scotia

Abortion Induced abortion is the

purposeful interruption of a pregnancy

Many factors contribute to a woman’s decision to have an abortion:

- Preservation of the life or health of the mother

- Genetic disorders of the fetus

- Rape or incest

- Personal choice

Wong, Hockenberry, Wilson, Perry & Lowdermilk (2007).

History of Abortion In 1892, parliament passed Canada’s first Criminal

Code, which prohibited abortion, as well as the sale, distribution, and advertising of contraceptives – Many women continued to seek abortions

Abortion was a criminal act in Canada up until 1969 when Canadian physicians and the Canadian women’s movement fought against the prohibition of abortion in the Criminal Code.

In 1988 the Supreme Court of Canada recognized that a woman’s right to continue or to terminate a pregnancy is protected by the Canadian Charter of Rights and Freedoms and struck down the law.

(Browne & Sullivan, 2005) (Rodgers & Downie, 2006)

Current Influences on Abortion

Canada has no legislative or judicial restrictions on abortion. The circumstances under which abortions can be performed is unregulated.

Repeat pregnancy termination procedures are common in Canada, 35.5% of all induced abortions are repeat procedures

(Browne & Sullivan, 2005) (Fisher et al., 2005)

Current Influences cont’d Abortion access throughout Canada has

become an issue, with limited improvement since the legalization.

Medication abortion (the use of a drug or combination of drugs to terminate pregnancy) could improve abortion care across Canada.

Methods of Elective Abortion Surgical Abortion:

Vacuum Aspiration

Dilation and Evacuation

Dilation and Extraction

Labour Induction

Medical Abortion:

Mifepristone

Methotrexate and Misoprostol combined

(The American College of Obstetricians and Gynaecologists, 2010).

Vacuum Aspiration

The cervix is dilated by manually using instruments or by using laminaria.

A uterine aspirator is introduced. Suction in applied, and tissue is

removed from the uterus. This is the most common type of

termination procedure and is used up until 20-22 weeks of gestation.

(Bare et al., 2007).

(The American College of Obstetricians and Gynaecologists, 2010).

Dilation and Extraction

A surgical procedure in which an intact fetus is removed from the uterus via the cervix

Used to terminate a pregnancy after 21 weeks gestation

Also used to removed a deceased fetus Illegal in the United States

(The American College of Obstetricians and Gynaecologists, 2010).

Labour Induction

Installation of saline or urea results in urine contractions

Prostaglandins are introduced into the amniotic fluid

Intravenous oxytocin

(Bare et al., 2007).

Mifepristone

Also known as RU-486 or the “abortion pill”

A progesterone antagonist that prevents implantation of the ovum

As of June 1st, 2005 this drug is no longer available within Canada

(Bare et al, 2007).

Methotrexate and Misoprostol Combined

Methotrexate - teratogen that is lethal to the fetus

Misoprostol - a synthetic prostaglandin that produces cervical effacement and uterine contractions

Highly effective Only used in pregnancies up to

49 days from the last menstrual period

(Bare et al, 2007).

Procedure According to Trimester

First Trimester

Methotrexate and Misoprostol

Mifepristone

Vacuum Aspiration Second Trimester

Labour induction

Dilation and Evacuation (D&E) Third Trimester

Labour induction

Dilation and Extraction

(American Pregnancy Association, 2007).

Risks

Incomplete abortion Infection Hemorrhage Damage to the uterus Death

(The American College of Obstetricians and Gynaecologists, 2010).

Pro-Choice Argument

Women must have the right to make their own decision

Believe that life begins at birth A pregnant women is considered one

person All abortions are medically required and

not “elective” All women should have the right to fully

funded abortion services

(Abortion Rights Coalition of Canada, 2010).

Pro-Life Argument

Abortion is viewed as murder Support fetal rights Believe that life begins at conception Concerned about the long term

emotional effects on women God is the giver of life, not the mother We should protect the sanctity of life

(Christian Net, 2008).

Nurse Role

Prior to abortion: assist with exploring various alternatives and consequences

Continued support after decision has been made:

- Provide information re: procedures, expected discomfort/pain, and type of care needed

Following abortion: assess for grief and facilitate the grieving process

(Wong et al., 2006)

Nurse Role

Nurses provide postabortal instructions, which vary among health care providers

- Instructed to watch for excessive bleeding (> large pad/hr for 4 hrs), cramps, or fever

- The woman may expect her period to resume 4-6 wks after the day of the procedure

- The nurse offers information re: birth control if not done already

- The woman is strongly encouraged to return for a follow-up

- Pregnancy test may be performed to determine success of procedure

(Wong et al., 2006).

Nursing Considerations

It is important for nurses to know the laws regarding abortion

Nurses whose religious or moral beliefs do not support abortion have the right to refuse such an assignment

If possible, nurses should avoid working in environments that will frequently challenge his/her ethical values

Reassignment is usually an option

(Wong et al., 2006) (Day et al., 2006)

Emotional Effects of Abortion The way a woman reacts to an abortion is

most likely determined by the reason she requested the procedure

Reactions a woman may feel following abortion: shame, anger, regret, fear, anxiety, guilt, sadness, failure, loneliness, decreased self-confidence, disturbed body image, difficulty developing or maintaining relationships, emotional numbness

Postabortal counselling should always be encouraged/provided

(Canadians for Choice, 2010).

Abortion Services in Canada

Access to procedure is steadily declining Only 22 abortion clinics across the

country Only accessible in 1 of every 6 hospitals Most providing hospitals require a

doctor’s referral and are located in urban centres

Abortion Services in Nova Scotia Only one facility in NS provides

abortions – Queen Elizabeth II in Halifax Wait time: 1-2 weeks Gestational limit: up to 15 weeks, 6 days Fees: Free to all residents of NS Confidential Conscious sedation &

local anaesthetic

(Canadians for Choice, 2010).

Nova Scotia Association for Sexual Health

Formerly called Planned Parenthood Seven locations throughout province

(Bridgewater, Sheet Harbour, New Glasgow, Amherst, Sydney, Yarmouth & Halifax)

Offer a variety of sexual health & counselling services

The Nova Scotia Association for Sexual Health (NSASH) is dedicated to promoting healthy sexuality throughout the life span, in an

environment that respects and supports choice.

(Canadians for Choice, 2010).

Discussion Questions

When is the fertilized egg considered a human being?

Should nurses sympathise with the pro-life argument or the pro-choice argument?

Do you think the morning after pill is the same as abortion?

If a woman wants an abortion, what rights does the father have?