You have the right to choose
Surgical abortion
Only one visit is required for a surgical abortion at Clinique médicale Fémina and lasts about 3 h on average. The procedure is performed on pregnancies of up to 12 weeks (starting on the first day of your last period). It is performed by dilation, suction and curettage and lasts about 8 to 10 minutes. Thanks to medication used during the procedure, pain is minimal, often non-existent, and most patients have no recollection of the surgical procedure.
During that procedure, a warm and caring nurse will be by your side, tending to your physical and emotional needs. It will be necessary for you to rest in our recovery room for about an hour after the procedure. The person accompanying you cannot be present during the procedure. The next day, you will be able to resume your regular activities; however, you should avoid any strenuous exercise. As well, you are not allowed to drive for 24 h after the abortion. It is important to know that this procedure does not affect a woman’s fertility. It is possible to become pregnant in the weeks following the abortion which is why effective adequate contraception is important.
- to have your valid Quebec Health Insurance Card (RAMQ) or a confirmation of registration letter from the RAMQ. This will allow for you to receive our services free of charge. If you do not have a Quebec Health Insurance Card, you will need to incur the cost of the service. Our secretary will provide you with the financial details.
- to know the first day of your last regular period.
- to advise us if you are diabetic and take insulin.
Before the appointment:
- You need to be fasting 3 h before the appointment (no food or liquid).
- No alcohol or drugs 24 h before and after your appointment.
- Take your prescribed medication, if any, at the regular time.
- Complete the online questionnaire.
At the clinic, after reading the pre-and-post abortion documents, a counselor will ask you to come into her office for a preparatory interview. This is not an evaluation of the reasons for your choice, but rather an opportunity to validate your answers on the medical questionnaire and to answer your questions.
Shortly after the interview with the counselor, the recovery room nurse will call you to get you ready for the procedure. She will give you a hospital gown and will bring you to a private bathroom where you will be able to change. A urine sample will be collected to test for Chlamydia and Gonorrhea (STIs). She will then show you where to leave your clothes and bring you to a comfortable bed where you can wait to be called.
In the operating room, an ultrasound examination will be done first. Once this is completed, the nurse will position you on the operating table in the lithotomy position (same as with a gynecological exam). If necessary, the nurse will place a small mask on your nose for you to inhale nitrous oxide (laughing gas). This will help you to relax and will ease the pain to some degree.
Also, a plastic catheter will be inserted into a vein in your arm and will be used to administer medication according to your needs. This catheter will remain in place as long as you are in the clinic. All of this is to ensure that the abortion is performed in the safest possible conditions. From the same catheter, the nurse will draw a few drops of blood to determine a part of your blood type called Rhesus (Rh). About 15 % of the population do not have this in their blood. If that is your case, you are confirmed to have Rh negative and the nurse will give you an injection of immunoglobulin (similar to a vaccine) to help prevent your body from producing antibodies in order to protect your future pregnancies.
Most of the patients are given a strong painkiller (via the catheter in their arm) that will prevent most of the pain and anxiety that could be experienced during the procedure. Each patient has different needs and we respect that. Again, be assured that we use the safest medications and that the dosage is adapted to each woman’s needs.
Having prepared the surgical instruments, the doctor will start by inserting a warm speculum in your vagina. Then, the doctor will proceed with the local anesthesia of your cervix. The technique that will be used to perform the abortion is dilation and suction with curettage. This is the safest technique and takes about 8 to 10 minutes.
After an abortion, it is important to take care of yourself both physically and emotionally. It is normal to experience various feelings such as sadness or anger. You may also feel relieved. You may also not feel like having sexual intercourse; respect your own rhythm. Each woman reacts in her own way. Physically, we suggest that you rest the day of the abortion. Most women resume their usual activities the day following the procedure with their pregnancy symptoms fading away over the next few days. We recommend waiting one week before participating in strenuous exercise.
Medical abortion
Only one visit at the clinic is necessary for a medical abortion at Clinique médicale Fémina, that will be followed by a telephonic appointment two-three weeks after. It can be performed on pregnancies of up to 9 weeks (starting on the first day of your last period). The medications used are Mifepristone which stops the pregnancy and Misoprostol which expels the pregnancy. Mifepristone is, usually, administered at the clinic during the first visit. Misoprostol must be taken at home 24 to 48 h after the first visit. It is in fact, a miscarriage induced by medication. The expulsion may take up to a few hours to be completed.
Pain and bleeding vary with patients, from light (as with a period) to severe (especially during the expulsion). A caring and supporting person needs to be with you on the second day during the expulsion of the pregnancy. This method is not recommended if no one is aware of your situation. You will need to be absent from work or school for a minimum of 2 days: the day of your first appointment (day 1) and the day of expulsion of the pregnancy (day 2 or day 3). The success of the procedure will only be confirmed on your telephonic appointment 2 to 3 weeks later. Approximately 5 % of patients will have to have a curettage in the following weeks if the abortion is incomplete. Some women will experience bleeding for up to 3 to 4 weeks and sometimes even until their first period. This procedure does not affect a woman’s fertility. It is possible to become pregnant in the weeks following the abortion, even during bleeding, which is why effective adequate contraception is important.
- To have your valid Quebec Health Insurance Card (RAMQ) or a confirmation of registration letter from the RAMQ. This will allow for you to receive our services free of charge. If you do not have a Quebec Health Insurance Card, you will need to incur the cost of the service. Our secretary will provide you with the financial details.
- To know the first day of your last regular period.
- To advise us if you are diabetic and take insulin.
Before the appointment:
- You need to be fasting 3 h before the appointment (no food or liquid) (if you are not sure about the method you want).
- No alcohol or drugs 24 h before and after your appointment.
- Take your prescribed medication, if any, at the regular time.
- Complete the online questionnaire.
At the clinic, after filling out the medical questionnaire and reading the pre-and-post abortion documents, a counselor will meet with you for a preparatory interview. This is not an evaluation of the reasons for your choice, but rather, an opportunity to validate your answers on the medical questionnaire and to answer your questions. It is during this interview that your choice of method will become clearer. A urine sample will be collected to test for Chlamydia and Gonorrhea (STIs).
Mifepristone is an anti-hormone. It acts by blocking the effects of progesterone, a hormone that is needed for pregnancy to continue. Misoprostol is a prostaglandin and causes contractions of the uterus and dilation of the cervix which helps push out the contents of the uterus. Both Mifepristone and Misoprostol work together to terminate a pregnancy.
Before you receive the medication, you will talk to a doctor and a nurse and then an ultrasound will be performed. If we assess that your pregnancy is 63 days (at the most) since the beginning of your last period, and that a medical abortion is a good choice for you, you may start the treatment.
There are two steps in the process.
- One (1) tablet of Mifepristone (green box) will be taken by mouth as directed by your health professional. Some women can experience bleeding between the first and second steps of treatment. Contact us if you have any worries or concerns during the office hours indicated on your document of departure.
- 24 to 48 h after you take Mifepristone you need to take the Misoprostol tablets. It is up to you when you take the tablets within this time period. You should plan the process to fit in with your daily schedule. You will take the four (4) Misoprostol tablets from the orange box at the same time. Misoprostol tablets should be taken by holding the tablets in your mouth, between the cheek and gum, for 30 minutes. Any fragments left after 30 minutes have to be swallowed with a glass of water. After this you can expect some vaginal bleeding, cramps and to pass some pregnancy tissue. This commonly occurs within 4 hours, but in some cases may occur anywhere between 30 minutes and 48 h after taking the Misoprostol tablets. It is recommended to rest for 3 hours after taking the Misoprostol tablets. The bleeding lasts on average for 11 days and may be heavy for 2 to 3 days.
Vaginal bleeding:
- The onset of bleeding usually occurs within 4 hours of taking the Misoprostol tablets and most women will experience the onset within 48 h.
- Bleeding can range from light to heavy. Bleeding is usually more than a typical menstrual period, but should diminish once the pregnancy is expelled.
- Vaginal bleeding does not mean that the pregnancy tissues have been expelled, but it is normal to see blood clots and tissues. A follow-up assessment is very important to confirm the termination of the pregnancy.
- Sometimes bleeding can occur after taking the Mifepristone but before taking the Misoprostol.
- The bleeding lasts on average for 11 days. Light bleeding can continue for 30 days or more, but does not normally go beyond the first menstrual period following your treatment.
Cramping:
- Cramping can start within 4 hours of taking the Misoprostol tablets.
- Cramping can range from mild to severe and is usually more than a typical menstrual period.
- Significant cramping should diminish once the pregnancy is expelled. This does not usually last longer than 24 h.
If pregnancy symptoms do not fade away after one week, please contact us to have your follow-up visit earlier.
A personal choice
Comparison table
In order to help you choose which method is best for your situation, here are the answers to some of the most commonly asked questions by patients.
| Surgical abortion | Medical abortion | |
|---|---|---|
| When can you have an abortion at our clinic? |
Up to 12 weeks of pregnancy. - As soon as a gestational sac is visible in the uterus on the ultrasound (approximately 5 weeks after the first day of your las menstrual period). |
Up to 9 weeks of pregnancy (63 days since the first day of your last menstrual period). - As soon as you have a positive pregnancy test, but preferably when a gestational sac is visible in the uterus on the ultrasound. - Method contraindicated if you live more than two hours away from the clinic or a hospital or if you plan to travel within two weeks after taking the first step. |
| Fees | Free with your valid RAMQ card. - Without a valid RAMQ card: fees are subject to change without notice. Please call the clinic for more information. |
Free with your valid RAMQ card. - Without a valid RAMQ card: fees are subject to change without notice. Please call the clinic for more information. |
| How does it work? | Under conscious sedation, the doctor, assisted by the nurse, gently aspirates the contents of your uterus, and using a light curettage, ensures that the uterus is empty. | A 1st drug (Mifepristone) is taken at the clinic to stop the pregnancy and a second medication (Misoprostol) is taken at home between 24 and 48 h later to induce uterine contractions that will expel the pregnancy.
- This time frame of 24 to 48 h is not flexible - it must be respected. |
| How many appointments are necessary? | One visit of approximately 3 hours including registration, counseling, procedure (10 minutes) and a rest period at the clinic (mandatory minimum of 1 h). | A first appointment at the clinic and the 2nd one, by phone, 7 to 14 days after the first appointment and occasionally a 3rd appointment is required. |
| Duration of the procedure | Usually less than 10 minutes. | 95 % of abortions are declared complete at the telephone appointment 1 to 2 weeks later. |
| Pain | Minimal in the majority of cases, thanks to conscious sedation. | Light to very strong especially when expelling the pregnancy. - Painkillers are prescribed for home use. |
| Bleeding | Light or absent early on but sometimes heavier between the 3rd and 5th day. - After 1 week, bleeding should be very mild, but may last up to 3 weeks. - Rarely, some women do not bleed at all. |
Can be very heavy after taking Misoprostol. - Light bleeding may persist until the first menstrual period. |
| Risk on future fertility | Almost zero, less than 1 in 1000 (Asherman's syndrome). Fertility returns immediately after the procedure. | No risk, fertility returns immediately. |
| Contraception | An IUD can be inserted during the procedure. | You need to start your contraception (pill, patch or ring) on the 3rd day after taking Misoprostol. - An IUD can be inserted as soon as the abortion is considered complete but ideally after the 1st normal period. |
| Risk of failure | It is extremely rare for a pregnancy to continue after the procedure. - 1 to 2 % of cases will require curettage for tissue retention (this is not considered a failure, but a normal risk associated with the procedure. |
About 1 % of pregnancies will continue and require curettage. - About 4 % of cases will require a second dose of Misoprostol or you can decide to undergo a curettage procedure to complete the abortion. |
| Possible complications | 1 to 2 % of placental retention requiring a second curettage. - Very rare: hemorrhage, infection, laceration of the cervix, uterine perforation, anesthetic reaction, intrauterine adhesions. |
About 5 % hemorrhage or incomplete abortion requiring curettage. - Very rare: allergy to drugs. - Exceptional: severe and dangerous infection. |
| Side effects | Requires the use of anesthetic drugs (conscious sedation) that have some short-term side effects, e.g. nausea, dizziness, vomiting (rare), and amnesia (may be considered a benefit by some women. | Mifepristone: little or no side effects. - Misoprostol: severe abdominal cramps, frequent diarrhea. Rarely : nausea, vomiting, headache, dizziness, fever and chills. |
| Emotional aspect | Possible anxiety related to the procedure but well controlled by conscious sedation and the presence of an attentive and empathetic staff member. | Anxiety related to the expectation that abortion will occur and be complete. - Anxiety at the idea of visualizing pregnancy products. |
| The choice to continue or terminate a pregnancy is a significant event and can bring up a multitude of emotions. Whether it is to deepen a reflection, to vent or to exchange with people who are attentive and caring, whether it is before or after, there are different resources. | ||
| Confidentiality | A file is created at the clinic and is only accessible by our staff and the Régie de l'assurance maladie du Québec. | A file is created at the clinic and is only accessible by our staff and the Régie de l'assurance maladie du Québec. |
| Do I have to be accompanied? | Yes, for the return home. - Forbidden to drive a motor vehicle for 24 h. |
It is strongly recommended that a person be present with you at home to provide support when needed during the expulsion of the pregnancy. |
- Up to 12 weeks of pregnancy
- - As soon as a gestational sac is visible in the uterus on the ultrasound (approximately 5 weeks after the first day of your last menstrual period)
- Up to 9 weeks of pregnancy (63 days since the first day of your last menstrual period)
- - As soon as you have a positive pregnancy test, but preferably when a gestational sac is visible in the uterus on the ultrasound
- - Method contraindicated if you live more than two hours away from the clinic or a hospital
- Free with your valid RAMQ card.
- - Without a valid RAMQ card: fees are subject to change without notice. Please call the clinic for more information
- Free with your valid RAMQ card.
- - Without a valid RAMQ card: fees are subject to change without notice. Please call the clinic for more information
- Under conscious sedation, the doctor, assisted by the nurse, gently aspirates the contents of your uterus, and using a light curettage, ensures that the uterus is empty
- A 1st drug (Mifepristone) is taken at the clinic to stop the pregnancy and a second medication (Misoprostol) is taken at home between 24 and 48 hours later to induce uterine contractions that will expel the pregnancy
- - This time frame of 24 to 48 hours is not flexible - it must be respected
- One visit of approximately 3 hours including registration, counseling, procedure (10 minutes) and a rest period at the clinic (mandatory minimum of 60 minutes)
- Minimum of 2 visits; the 2nd visit, 7 to 14 days after the first visit and occasionally a 3rd visit is required
- Usually less than 10 minutes
- 95% of abortions are declared complete at the control visit 1 to 2 weeks later
- Minimal in the majority of cases, thanks to conscious sedation
- Light to very strong especially when expelling the pregnancy
- - Painkillers are prescribed for home use
- Light or absent early on but sometimes heavier between the 3rd and 5th day
- - After 1 week, bleeding should be very mild, but may last up to 3 weeks
- - Rarely, some women do not bleed at all
- Can be very heavy after taking Misoprostol (you have to accept that) since this procedure is similar to a miscarriage
- - Light bleeding may persist until the first menstrual period
- Almost zero, less than 1 in 1000. Fertility returns immediately after the procedure
- No risk, fertility returns immediately
- An IUD can be inserted during the procedure
- You need to start your contraception (pill, patch or ring) on the 3rd day after taking Misoprostol
- - An IUD can be inserted as soon as the abortion is considered complete but ideally after the 1st normal period
- It is extremely rare for a pregnancy to continue after the procedure
- - 1 to 2% of cases will require curettage for tissue retention (this is not considered a failure, but a normal risk associated with the procedure)
- About 1% of pregnancies will continue and require curettage
- - About 4% of cases will require a second dose of Misoprostol or you can decide to undergo a curettage procedure to complete the abortion
- 1 to 2% of placental retention requiring a second curettage
- - Very rare: hemorrhage, infection, laceration of the cervix, uterine perforation, anesthetic reaction
- About 5% hemorrhage or incomplete abortion requiring curettage
- - Very rare: allergy to drugs
- - Exceptional: severe and dangerous infection
- Requires the use of anesthetic drugs (conscious sedation) that have some short-term side effects, e.g. nausea, dizziness, vomiting (rare), and amnesia (may be considered a benefit by some women)
- Mifepristone: little or no side effects
- - Misoprostol: severe abdominal cramps, frequent diarrhea. Rarely : nausea, vomiting, headache, dizziness, fever and chills
- Possible anxiety related to the procedure but well controlled by conscious sedation and the presence of an attentive and empathetic staff member
- Anxiety related to the expectation that abortion will occur and be complete
- - Anxiety at the idea of visualizing pregnancy products
- A file is created at the clinic and is only accessible by our staff and the Régie de l'assurance-maladie du Québec. Note that the RAMQ and the CIUSSS Jeanne-Mance are the only two organizations aware of the abortions as they are the paying agencies.
- A file is created at the clinic and is only accessible by our staff and the Régie de l'assurance-maladie du Québec. Note that the RAMQ and the CIUSSS Jeanne-Mance are the only two organizations aware of the abortions as they are the paying agencies.
- Yes, for the return home
- - Forbidden to drive a motor vehicle for 24 hours
- It is strongly recommended that a person be present with you at home to provide support when needed during the expulsion of the pregnancy