How an abortion regime will operate
It has been agreed that terminations here should be fully integrated into the health system, says .
Surgical abortion could be carried out in the State’s 19 maternity units under proposals being considered by obstetricians, although the overwhelming majority of abortions would be medical, using the abortion pill.
No firm plans were drawn up in advance of Friday’s vote, but serious consideration has been given to how an abortion regime might operate in Ireland.
It is agreed, medically and politically, that unlike the situation in England and Wales, where there are standalone private clinics, funded by the NHS, pregnancy terminations here should be fully integrated into the Irish health system.
Adopting that type of model would also ensure there would not be stigmatisation of women seeking abortions, or the prospect of protests at individual clinics.
Women would attend their GPs and in some, anticipated to be a small number of cases, may have to be referred to a maternity unit for a scan.
There are a number of early pregnancy units in our 19 maternity units with ultrasound scanners and most of these are open in the morning, not being used during the rest of the day.
It is being considered that these units could be used by GPs to refer patients seeking an abortion if the GP feels a scan is necessary to accurately date the pregnancy, or there are fears of a complication such as an ectopic pregnancy.
It is difficult to estimate how many abortions there will be in Ireland annually, but one assumption could see a total of 6,000 abortions a year — based on the numbers of women ordering the abortion pill over the internet and travelling to the UK — with numbers expected to increase initially and then reducing when the ancillary recommendations of the Oireachtas Committee on the 8th such as sex education and free contraception are up and running.
There may be a higher number of surgical abortions initially, performed in hospitals, but these would also be expected to decrease as time went on.
It could be anticipated that 10% of the overall number of abortions might be surgical, and these would be spread between the 19 maternity units.
One senior Irish obstetrician speculated that given the law will state a 12-week limit doctors will need, in some cases, to have access to ultrasound to date a pregnancy accurately.
According to the obstetrician they and colleagues are used to dealing with “missed miscarriages” where they need to use surgical methods, commonly known as a D&C.
Not all women are suited to medical abortion using drugs, and it is expected there will also be particular cases where a medical abortion will be deemed unsuitable and the surgical option will be used.
The Institute of Obstetricians and Gynaecologists last month agreed they would establish “principles of safe practice” that would underpin care for women in the event of repeal.
The Irish College of General Practitioners had said that if the referendum was passed, and legislation enacted, it would draw up clinical guidelines where the legislation impacted on GPs.
Minister for Health Simon Harris has given assurances that if the referendum was passed the Department of Health would consult with representative bodies of all relevant medical practitioners on the details of legislation to be drawn up.
There will be a right by doctors to conscientiously object if they do not agree with abortion.
This could cause difficulties in our smaller maternity units, with just two or three obstetricians, if there were objections or individual obstetricians did not want to become known as the “abortion doctor”.
A new contract between GPs and the Government is currently being negotiated.
Another question for the Government and doctors is whether to allow Irish women take abortion pills at home.
Last year Scotland became the first part of the UK to do so. Pro-life campaigners are set to challenge that move in court.
There were 12,063 terminations of pregnancy in Scotland in 2016 and almost three-quarters were carried out at less than nine weeks gestation.
The vast majority of these (89.4%) were medical rather than surgical procedures.
It has been the case that women in Scotland had to take the pills, two sets of medication 24 to 48 hours apart — issued with the consent of two doctors — inside a hospital or licensed clinic.
The change to at home brings Scotland in line with the US, France and Sweden.
In the overwhelming majority of cases women take the abortion medication and it simply works.
According to a Scottish study around 2% of women needed to return to the clinic due to pain and bleeding and about 13% called the clinic to seek reassurance.
The abortion pill is very effective. For people who are eight weeks pregnant or less, it works about 98 out of 100 times.
From 8-9 weeks pregnant, it works about 96 out of 100 times. From 9-10 weeks, it works 93 out of 100 times.
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