Termination of pregnancy

Surgical termination of pregnancy

• Remember to keep within the scope of your practice when providing information, explaining procedures or answering questions. Be prepared to consult with or refer to suitably trained colleagues whenever necessary.
• Prepare the woman and her partner for what to expect and who will be involved in their care.
  Ensure that the woman and partner are cared for in the appropriate environment by staff who are sensitive to their needs.
• Ensure that all staff supporting the woman and partner before, during and after the procedure are aware of the baby’s condition and communicate sensitively, using appropriate language and terminology.
• Aim for continuity of carer where possible.
• Sensitively prepare the woman and partner that following a surgical procedure there will not be a baby to see or hold.
• Explain that a full post mortem examination will not be possible, however some tests e.g. genetic may still be available.
• Be clear about whether the woman wishes someone else to attend with her, and if so, who.
• Allow women and partners time to take in information and ask as many questions as necessary.
• Prepare the woman for what she can expect regarding bleeding, pain and common emotional reactions and provide written information.
• Be aware that some women will want to take their baby/fetus home with them.
• Ensure the woman has a key contact in case of any questions or concerns - a template contact card is available.
• If women and partners are not already fully aware of support organisations, explain how they can help and give contact details.
• Explain a previous pregnancy loss form could be added to the woman’s notes, if she wishes (a template form is available.
• Record the care plan on the woman’s maternity record including planned continuity of care and key contact.
• Make sure the woman and her partner have made arrangements to get home safely.

Medical termination of pregnancy

• Remember to keep within the scope of your practice when providing information, explaining procedures or answering questions. Be prepared to consult with or refer to suitably trained colleagues whenever necessary.
• Prepare the woman and her partner for what to expect during labour and delivery, including information on the likely appearance of the baby.
• Discuss the arrangements, including place of birth, memory making, including the option of seeing and holding the baby. Respect and support the women and partners’ decisions.
• Ensure all staff seeing the women and partners before, during and after
  labour and birth are aware of the baby’s condition and communicate sensitively.
• Ensure continuity of carer where possible.
• Discuss the possibility of the baby showing signs of life at birth and what this will mean.
• Depending on gestation, the option of feticide may be discussed by the fetal medicine team. Ensure the woman and her partner understand why this is offered. If referral to another unit is required, ensure good communication between units.
• Enable the woman to have a partner or a support person with her at all times.
• With the woman’s consent, keep her partner or support person informed and be prepared to offer them emotional support.
• Prepare the woman for what she can expect regarding bleeding, pain and common emotional reactions after delivery, and who to contact if she has any concerns.
• Be aware that some women will want to take their baby/fetus home with them.
• Ensure the woman has a key contact in case of any questions or concerns - a template contact card is available.
• If women and partners are not already fully aware of support organisations, explain how they can help and give contact details.
• Explain a previous pregnancy loss form could be added to the woman’s notes, if she wishes - a template form is available.
• Record the care plan on the woman’s maternity record including planned continuity of care and key contact.
• Make sure the woman and her partner have made arrangements to get home safely and if not help them think about options.

Additional considerations for selective termination or multifetal pregnancy reduction

• Remember to keep within the scope of your practice when providing information, explaining procedures or answering questions. Be prepared to consult with or refer to suitably trained colleagues whenever necessary.
• Prepare the woman and her partner for what to expect, depending on the gestation.
• If the woman and her partner need to attend another unit, explain why and ensure good communication between units.
• Ensure the woman and her partner know who their key contact is, if they have not already been identified, and when and how they can communicate with them if they have any questions.
• Ensure a follow up appointment has been arranged for the woman and her partner.
• Acknowledge the potential difficulty of having a baby who has died remaining alongside the living baby or babies.
• Prepare the woman and her partner for what they can expect during the remainder of the pregnancy, labour and birth.
• Tell the woman and her partner there are unlikely to be any visible remains after the birth of the surviving baby or babies if the procedure is carried out in early pregnancy.
• When recording on the woman’s care plan, offer to use the ‘Butterfly Sticker’, available from the Twins Trust, and ensure staff recognise this as identifying women and partners of a surviving baby who have suffered the loss of a baby/babies from a multiple pregnancy.
• Offer referral for specialist psychological support if there are signs that might indicate PTSD or clinical depression.

How will we know we have achieved our aim?

Women and partners will tell us they were treated with respect and kindness by all staff and felt well informed and supported when making difficult decisions.

Staff will say they feel confident and competent in caring for and supporting women and partners having to make difficult decisions about ending their pregnancy.

Go to Marking the loss, making memories