Module 2: Early Medical Abortion

6. Patient communication and support

General patient safety and support

This 16 minute video is an example of a conversation about EMA between a health practitioner and a person requesting an abortion. Questions asked and discussed include: What does an EMA involve, what side effects can I expect and how will I know if the bleeding is too heavy?

Health practitioners need to ensure that people having a medical abortion in the community are aware of what to expect from the process and have adequate support available to them.

It is very important that practitioners ensure that:

• a safe reliable method of communication chosen by the person for ongoing communication is noted
• the patient has access to 24-hour support during the EMA process
• the patient has access to transport / telephone / emergency health services
• the patient has an adult at home with them who is aware of the EMA

Patient centred information provision

Patients having an EMA at home (outside of a clinic or hospital ward) need to be given clear information about how and when to take the medicines during the EMA process, and what to expect in terms of pain and side effects during and after the abortion. An example of a patient booklet containing information and advice which abortion providers can modify to their needs is available within this EMA module. The DECIDE website is also recommended as a good source of information for patients.

When and how to seek emergency medical attention

Discuss with the person how and when to reach an abortion provider after-hours for telephone advice. Encourage them to call if:

• there is no or scant or little bleeding within 12 to 24 hours of taking misoprostol
• bleeding soaks two or more maxi pads for two or more consecutive hours, or one maxi pad an hour for more than 10 hours
• they feel dizzy or faint
• they have unmanageable pain despite taking prescribed analgesics
• they have unmanageable nausea, vomiting or diarrhoea despite taking prescribed medicines
• they have a sustained fever > 38 degrees for > 3 hours or new onset of fever > 24 hours after taking misoprostol
• there are other prolonged or severe side effects

If the clinician or the patient themselves are concerned, they should seek urgent health advice or attention from the closest health facility that provides after-hours care.

Counselling

Practitioners must advise people that abortion counselling is available on request throughout the process of their abortion and afterwards if requested, at no charge to them.