THE HSE has announced that abortion services can now be carried out at maternity hospitals, GP clinics, family planning clinics and women's health clinics as of New Year's Day.

Have you got any further questions that need answered? Visit the HSE’s My Options website.

Abortion is legal?

Yes. This is after the country—and Limerick—overwhelmingly voted in favour of removing the constitutional ban on abortion on May 25 last.

After a lot of deliberation in Leinster House, President Michael D Higgins signed the Health (Regulation of Termination of Pregnancy) Act 2018 into law on December 20.

The chosen date for rolling out of the services was January 1 (this Tuesday). This means, if the service provider is HSE-approved, abortion services are both legal and functioning as of January 1.

So not every service provider will be carrying out services?

That is correct. GPs who have signed up for abortion services may do so, and not all family planning clinics are fully approved just yet, though this expected to be sorted in the coming weeks.

Why aren’t some GPs providing abortion services?

A GP doesn’t have to provide abortion if they don’t wish to, for a number of reasons, but mainly due to conscientious objection. This means that carrying out the procedure goes against their religious or moral beliefs.

How do I know if a GP provides the service or not?

That’s a good question and is one of the most commonly asked by the public. The answer is you will have to ask the GP. If they don’t, they should refer you to another GP who does provide the service. The HSE says if they’re not helpful “try see another one”. It is likely that there will be a demand for a thorough resource where women can find out how to access an available service.

Is there a resource available?

Other than the freephone service, it appears not, but the HSE is working on it.

When can one have an abortion?

You can have an abortion if your pregnancy is no more than 12 weeks or 84 days. If you are nine to 12 weeks’ pregnant, you must have it in a hospital setting.

Can one have an abortion after 12 weeks?

Only in exceptional circumstances; if continuing the pregnancy puts your life at risk; if the pregnancy risks serious harm to your health; and if it is likely to lead to the death of the foetus before or within 28 days of birth due to problems with its development.

What should one do if they are unsure how many weeks they are pregnant?

The HSE advises that you may need an ultrasound scan in this case.

If one needs to access abortion services, when should they seek help?

As early as possible, the HSE advises. A GP or doctor has to certify that you are, in fact, within 12 weeks’ pregnant. The law states that there must be three days between receiving this certification and having the abortion.

This three-day period, the HSE states, can give you time to decide “for sure if you want to go ahead with the abortion”.

People should be cognisant that GPs are already under immense pressure, so it is possible there could be a delay in getting an appointment for a consultation.

What’s involved in this consultation?

This is called a pre-abortion consultation. You can avail of one at a GP, family planning or women’s health clinic. During this consultation you will:

• have a pregnancy test to confirm you’re pregnant

• be certified that your pregnancy will be no more than 12 weeks at the time of the abortion — you might be referred for an ultrasound scan to check how many weeks pregnant you are

• be asked about why you want an abortion and whether you’re sure about your decision

• be offered the chance to talk things over with a counsellor

• talk to a health professional about the abortion methods available

• be told about any risks and complications

• be offered contraceptive advice and a prescription if requested

• be given information and advice on sexually transmitted infections (STIs)

• have a blood test to find out your blood type if over seven weeks pregnant

• be given a waiting period of at least three days before the abortion

How does the procedure work?

A pregnancy can be ended by taking medication or by having a minor surgical procedure.

How does the medical abortion work?

It’s a three-step procedure. The patient takes a mifepristone pill with a doctor present. This stops the hormone that allows the pregnancy to continue, resulting in the lining of the uterus to break down. The patient can go about their day as normal.

The patient may feel the urge to vomit, however, if this occurs within an hour of taking the tablet, they should make contact with their GP in order to take the tablet again. Patients should be conscious that once this step is taken, the abortion has commenced and it is irreversible.

Within 24 to 48 hours, the patient is required to take two misoprostol tablets. These can be taken at home, depending on the pregnancy. Patients must place the two tablets between the gum and cheek to allow them to dissolve.

Misoprostol causes the womb to contract, which can result in cramping and bleeding. Expect heavy bleeding to start within two hours, though this can occur sooner or later.

Patients are advised to schedule this procedure, and to take time off and to make sure there are supports at home if available.

There are side effects, such as nausea, vomiting, diarrhea, temporary flushes or sweats and headaches. Some people may need to take ibuprofen for pain relief.

Step three is waiting for the pregnancy to end. You must stay in the hospital if you are nine to 12 weeks until the pregnancy is fully terminated. Bleeding generally lasts for up to a week.

What about the surgical process?

This type of abortion is called vacuum aspiration, a five- to 10-minute procedure that uses a suction to remove the pregnancy.

The patient is given medication to insert into the vagina in order to soften the cervix, three to four hours before the procedure. A patient is offered local or general anaesthetic and procedural sedation.

After the surgery, the patient will need to remain in the hospital for a number of hours. Patients are advised to not driver for 24 hours.

Are there complications associated with surgery?

Yes there are risks. In one in every 600 abortions, the pregnancy is not fully removed. There could be heavy or irregular bleeding and infection. It is possible that the cervix or womb could suffer an injury. There is a “very rare” chance of injury to the bowel, bladder and serious injury to the cervix.

Mental health problems, such as feeling down or upset, are also risks associated with the procedure.

What’s the success rate?

99%. In the event of the 1%, the procedure will need to be repeated.

What if I want to purchase pills online and not see a doctor?

You can purchase pills online but it is against the law. There are also major health risks associated with illicitly-purchased medication. If the pills are not genuine, which is possible, the pregnant woman could suffer from complications. These pills can also be intercepted via customs.

But if you have taken a pill unsupervised, please contact a GP as soon as possible. You are advised to bring the tablet’s information with you in order to assist diagnosis and treatment.

Will having an abortion affect my chances of becoming pregnant in the future?

According to the HSE, no. Nor does it increase your risk of miscarriage, placental problems or an ectopic pregnancy, which is a pregnancy that grows outside the womb.

What about mental health problems?

“You are not more likely to have mental health problems if you have an abortion”, though you may feel a range of emotions after the procedure, HSE My Options states. Patients are advised to speak to a counsellor, for free, if they need to.

“You are just as likely to have a mental health problem if you continued with the pregnancy,” the HSE states.

You said that the counselling is free?

The My Options freephone service (see below) will provide free over-the-phone counselling by experienced professionals, and they can refer you to face-to-face counselling.

It will be available, as of Tuesday, 9am to 9pm, Monday to Friday. And it will be available 10am to 2pm on Saturdays.

When can I return to normal activities?

Most women do so within one or two days. But each woman is different.

Can I go back to work?

That’s completely up to you. However, you are advised to take one to two days off after the procedure so you can rest.

Can I travel after the procedure?

It’s advised that you don’t travel within 24 hours. But if you must, make sure that you know how to access emergency services wherever you are going. This is just to reassure yourself or whoever you are with, just in case there is a complication.

For how long do I have to wait before having sex?

You can have sex once you feel you are ready to do so. But patients must be aware that you can immediately get pregnant after an abortion. Contraception is advised if you do not wish to get pregnant.

Can I take a bath after the abortion?

Yes, you can. But if you have had an anaesthetic and you wish to take a bath within 24 hours, make sure you have someone nearby to keep an eye on you. It is possible that you could feel drowsy after the procedure.

I have an unplanned pregnancy, are there support services available for me?

Yes, right here.

Does the HSE have a freephone line if I need help?

Yes, it was launched with the My Options service. You can contact them at 1800 828 010, and the number is fully operational as of this Tuesday morning.

I still have some questions, where should I go?

The HSE’s My Options website is pretty thorough. If the information doesn’t suffice, try contacting their freephone.