The Tulip Service is the abortion service for the South Eastern Trust, as well as the regional surgical abortion service. The Tulip Service provides the following services:
- Early Medical Abortion (EMA) up to 11 weeks and 6 days gestation – the taking of medication to end a pregnancy
- Procedural (surgical) abortion under local anaesthetic in the outpatient setting up to 11 weeks and 6 days gestation – a minor surgical procedure to end the pregnancy
- Procedural (surgical) abortion under general anaesthetic as a day case procedure from 5 weeks gestation to 20 weeks gestation –a minor surgical procedure to end the pregnancy
- Procedural (surgical) abortion under general anaesthetic as a day case procedure up to 24 weeks gestation for those who have attended and gone through the regional Fetal Medicine service and who have availed of feticide (an injection through the abdomen to stop the pregnancy heartbeat)
Abortion is the medical term for the ending of a pregnancy. This term applies to:
- Induced abortion – where a pregnant person choses to end a pregnancy. This can also be referred to as a termination of pregnancy or TOP
- Spontaneous abortion – more commonly known as a miscarriage
1 in 3 women in the United Kingdom will have an abortion by the time they are 45 years old. A woman may choose to have an abortion for many different reasons. Those that decide an abortion is the best option for them are not alone. You are not alone.
Choosing to have an abortion may or may not be an easy decision, even if the decision is right for you. You may or may not have mixed feelings about your decision. Relief is the most common feeling following an abortion. However, being sad, grieving or feeling unsure after your procedure does not mean it was the wrong decision.
Having an abortion at any gestation is safer than carrying a pregnancy to term. An abortion performed earlier in the pregnancy is usually safer and recovery easier than in later-term abortions.
Having an abortion does not mean you are more likely in future pregnancies to have a miscarriage, tubal/ectopic pregnancy or increase your risk of infertility in the future. Abortion does not increase your risk of breast cancer or mental health conditions.
Our staff will able to discuss and provide information on the options available during your initial telephone consultation following referral.
The Tulip Service is located in Ward 9 in Lagan Valley Hospital, Lisburn.
For information on abortion care or to discuss counselling please contact the British Pregnancy Advisory Service:
Abortion clinics, Information, Advice and Treatment | BPAS
For counselling options please contact Informing Choices Northern Ireland:
Pregnancy Choices Counselling – Informing Choices NI
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Our Values
We pledge to ensure that those needing our service are best placed to make their own decision regarding their pregnancy. That they have access to evidence-based information, informed healthcare workers and a service that facilitates all their needs.
Courtesy – We will treat all who use our service with the respect and dignity that we would wish ourselves and family to experience and receive.
Compassion – We will listen, support and be kind to those within and needing our service.
Courage – We will strive to empower staff and service users and work relentlessly to ensure services are available for those that need them.
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What is a medical abortion?
A medical abortion is a way of ending a pregnancy using medication instead of surgery. A medical abortion uses 2 medications to end the pregnancy – Mifepristone and Misoprostol.
Mifepristone stops the pregnancy from growing by blocking the pregnancy hormone progesterone. Misoprostol causes the womb to contract and empty.
A medical abortion is ~95% effective meaning it works in 95 out of 100 times. If it does not work then a repeat medical abortion or a surgical abortion may be needed to completely empty the uterus (womb).
Mifepristone is taken first followed by Misoprostol 24 – 48 hours later. 90% (90 out of 100) will complete their abortion the same day that they take the Misoprostol, but for some it can take up to 1 week to fully complete the process.
A face-to-face appointment will be needed. Following this, for those having a medical abortion up to 9 weeks and 6 days, the medication can be taken at home. From 10 weeks onwards the medication must be taken in hospital and so 2 face-to-face appointments are needed or a hospital stay.
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Surgical abortion
A procedural (surgical) abortion involves a minor procedure to end the pregnancy. This can be performed between 5 weeks and 24 weeks gestation.
It is nearly 100% effective and a surgical abortion causes less bleeding compared to a medical abortion.
Up to 14 weeks gestation the procedure can be done under local anaesthetic in the clinic or general anaesthetic in the operating room setting. Between 15 weeks and 24 weeks gestation the procedure is done under general anaesthetic in the operating room setting.
Depending on how far along the pregnancy you are the procedure itself takes about 5 to 20 minutes.
A face-to-face appointment is needed regardless if you are having the procedure done under local or general anaesthetic. Those having a general anaesthetic will have their face-to-face appointment the day before their procedure.
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How to find advice or get an abortion
If you are considering an abortion you can contact the British Pregnancy Advisory Service (BPAS) on 03457304030 or at www.bpas.org for non-directive counselling and support and information on all your choices.
If you are thinking of having an abortion, the Tulip Service will be contacted with your details if you live in the catchment area of the South Eastern Health and Social Care Trust.
If you are not in the catchment area then you will be referred on to a provider in a different trust.
You will then get a phone call from a nurse or doctor from the Tulip Service. Please be advised that the telephone consultation will take 20 – 30 minutes. They will go through a medical questionnaire with you to get some details on your general health.
We will discuss the different options available for abortion – medical or procedural (surgical) – and what is most suitable for you based on your preference and medical history. We can send you further information by email. If you opt for or wish to have a surgical abortion you will have a pre-assessment completed over the phone.
An appointment will be made to attend for your face-to-face consultation depending on this discussion.
We will also discuss future contraception options with you. These are detailed below. We would encourage you to read about them before you attend the clinic.
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Attending the Tulip clinic
During your clinic visit:
- You will be seen by either a doctor or a nurse.
- You will be treated with respect and dignity
- You will not be judged
- This is a confidential service
- Your medical history will be checked
- You may have/require an ultrasound scan*
- All abortion and pregnancy options will be discussed with you
- You will be given impartial advice and medically-sound and evidence-based information on all abortion options available to you
- Lab tests will be performed if you choose to be screened for sexually transmitted infections
- If you opt for a medical abortion you will take the first medication in the clinic
- If you opt for a procedural (surgical) abortion under local anaesthetic this can be performed on the day
- You will sign a consent form if you wish to proceed with a procedural (surgical) abortion
- Information on counselling options and contraception will be discussed. We have a family planning service available on site. Please let the team know if you would like to speak to them about your options.
*Ultrasound scan:
- Not everyone requires an ultrasound scan, but if you do, the nurse or doctor will discuss this with you. It is done to check your dates are correct, or to ensure the pregnancy is definitely inside the womb and not an ectopic pregnancy (a pregnancy located outside of the womb).
- It will either be an abdominal scan or an internal (transvaginal) scan which involves an ultrasound probe being inserted into the vagina and the pregnancy can be seen on a screen.
- The choice to look at the screen during the scan is yours as some women do not wish to see the screen. Just let the doctor or nurse know what you feel comfortable with.
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Contraception
You may or may not wish to start some contraception following your abortion. It is important that you start planning your contraceptive needs as soon as possible. Contraception can commence immediately following your abortion. We can discuss your options with you at your appointment. We would recommend using long-acting reversible contraception (LARC). There are many different types of contraception for you to choose from depending on your preference and your medical history.
Our family planning service are available on site. Please let a member of staff know if you would like to attend their clinic and we will try to arrange this on the day of your abortion or another day that suits you.
We can refer you to our family planning clinic to discuss your options further.
For more information on each type, please visit:
https://www.nhs.uk/conditions/contraception/
https://www.sexualhealthni.info/contraception
https://www.fpa.org.uk/professionals/resources/
- Click on each type then click ‘download’ beside “your guide to”.
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Sexually Transmitted Infections
As part of the clinic attendance and abortion process we will offer you a swab to check for chlamydia. If you think you are at risk of having a sexually transmitted infection please let the doctor or nurse know. You may require antibiotics.
It is always best to get a full check-up for this at your local GUM (genito-urinary medicine) clinic.
For more information on sexually transmitted infections and safer sex, please visit;
https://www.sexualhealthni.info/gum-clinics-northern-ireland
https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/
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What happens at a medical abortion appointment
This will depend how many weeks gestation/how far along the pregnancy you are.
If you are less than 9 weeks and 6 days weeks pregnant –
One face-to-face appointment is needed.
You will have to swallow the first medication (Mifepristone) with water at the clinic in front of the doctor or nurse.
You will then be given a care pack to take home which contains:
- The second medication, Misoprostol. You will take this medication at home 24 – 48 hours after the first medication
- Painkillers
- A pregnancy test. We would like you to use this test instead of a shop bought one
- Instructions and information on how and when to contact us if any problems arise
If you are between 10 weeks and 11 weeks+ 6 days pregnant:
Two face-to-face appointments are needed.
You will have to swallow the first medication, Mifepristone, with water at the clinic in front of the doctor or nurse.
From 10 weeks gestation onwards the second medication, Misoprostol, must also be taken within the clinic. Therefore, you will then need to return to the clinic 1-2 days later to take the second medication. Sometimes more than two visits are needed.
You can then go home with a care pack containing:
- Painkillers
- A pregnancy test. We would like you to use this test instead of a shop bought one
- Instructions and information on how and when to contact us if any problems arise
Alternatively, you can arrange to stay for the day on Ward 9 the day of taking the Misoprostol until the pregnancy passes. If this does not happen before 6pm when the ward closes, an appointment will be made to return the following day for more of the second tablet (Misoprostol) if the pregnancy does not pass overnight at home.
In some cases you may need to be admitted to the gynaecology ward in the Ulster Hospital Dundonald for one or both medications. This decision should be made at the time of your telephone triage appointment.
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What happens after I take both medications?
Once you have taken both medications you can expect to bleed heavily with clots and it is normal to experience period like cramps. Most women say the pain is worse than a heavy period but the amount of pain will vary from woman to woman.
Bleeding may happen before you take the second medication but it is very important to take the second set of tablets (Misoprostol) regardless of whether you bleed or not after taking the first medication.
Within 4-6 hours of taking the second medication you can expect to pass the pregnancy. For a small number of women this can take between 24 hours to 1 week. Passing the pregnancy is like having a heavy period or a miscarriage, for those who have experienced one. Once the pregnancy has passed, the bleeding and cramps will start to settle over time. Bleeding can last up to 4 weeks but should get lighter each day. Some pain and cramping is normal up to a week after the abortion. It should get a little better each day. Painkillers, rest and things like hot water bottles/heat packs can help.
The pregnancy test should be taken no sooner than 3 weeks after passing the pregnancy. Taking this test is your responsibility and is the only way of ensuring that the abortion has definitely happened. If it is negative then the abortion is complete. If it comes back positive you must contact us on the number provided for you in the clinic.
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What are the risks of a medical abortion?
Medical abortion is safe and effective. However, for every 1000 women having an abortion, 1 woman will have a serious complication. The risk of complications increases the further along you are in your pregnancy.
With a medical abortion you may have:
- Stronger cramps and heavier bleeding than during your period
- Nausea, vomiting, diarrhoea
- Headache, dizziness
- A temperature for a short time following the taking of the Misoprostol. If you have a fever for more than 4 hours following the taking of the medication then please seek medical advice as this can be a sign of infection
- Continued bleeding or spotting for up to 4 weeks following the abortion
Other risks include:
- Once the procedure has begun, it cannot be reversed.
- There is a small chance (1 in 100) that it may not work. The chance of failure increases the nearer you are to 10 weeks.
- Bleeding may be very heavy and in rare cases you may need a blood transfusion (1 in 1000 women).
- Pregnancy tissue may be left in the womb (2 in 100 women) which may require further medical treatment or removal by a minor surgical procedure (5 in 100 women).
- Up to 1 in 10 women will get an infection after an abortion
- Other rare complications are possible including the need for abdominal surgery called a laparoscopy (key-hole surgery) or laparotomy (open surgery).
Rarely some pregnancies (1 in 1000) may develop outside the womb. This is called an ectopic pregnancy. Having an abortion will not affect this but it is important that it is picked up. Please ensure you let us know if you have any pain before having an abortion or minimal or no bleeding following a medical abortion so that we can organise an ultrasound scan.
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Procedural (surgical) abortion under local anaesthetic
If you wish to have a procedural (surgical) abortion awake (under local anaesthetic) this is done using vacuum aspiration which removes the pregnancy using gentle suction. This can be done up to 14 weeks gestation and is mostly done in Lagan Valley Hospital. You can discuss this procedure in detail with the Tulip member of staff and information can be sent to you via email.
What does a vacuum aspiration involve?
One face-to-face appointment is needed
It is a minor surgical procedure with a quick recovery time, meaning you can leave the clinic unattended and drive sooner. The surgical procedure itself takes about 5-10 minutes. But, the clinic visit usually lasts 2 – 3 hours because of necessary lab tests and recovery time.
When you attend your clinic appointment a nurse will check all of your details, allergies and if you have taken any painkillers prior to attending. You will have an ultrasound scan to confirm that pregnancy tissue is still present and you will be asked to empty your bladder before the procedure begins. We will give you some painkillers (if you haven’t taken any beforehand) and
2 tablets of Misoprostol to dissolve in your mouth which help prepare the neck of the womb before the procedure – they take at least one hour to work. This medication may cause some side effect such as; nausea, vomiting, diarrhoea, abdominal pain, headache, hot flushes and an unpleasant taste in the mouth. Your pulse, blood pressure and temperature will be taken.
The procedure itself takes only a few minutes but you will be on the couch for a bit longer (around 15-20 minutes). A doctor or specialist nurse will insert a speculum (similar to that used in a smear test) and a cold solution will be used to clean the vagina and cervix (neck of the womb). Local anaesthetic will be applied. The cervix may be opened a little and a plastic tube connected to a gentle suction device will then be inserted in to the womb to remove the pregnancy tissue. You may feel some discomfort similar to crampy period pain. You can request that the procedure is stopped at any time.
The doctor or nurse will perform an abdominal ultrasound scan during the procedure to help ensure all the pregnancy tissue is removed by the suction. We can provide Nitrous oxide (known as gas and air) to help with pain relief. Some patients prefer to listen to music or use their phone as a distraction. At the end of the procedure, if you have chosen to have a coil fitted for contraception this will then be done and adds about 30 seconds to the length of the procedure.
What happens after the procedure?
We will recheck your blood pressure and pulse and ensure that your bleeding is satisfactory. If your blood group is rhesus negative we will offer an injection of anti-D. We would ask that you stay for a short while after the procedure to ensure you are well enough for discharge and that you have passed urine. We would recommend that someone escorts you home. Most women are ready for discharge within 20mins to 2hrs of the procedure. You will be given some antibiotics to reduce the risk of infection. We do not routinely see you after the procedure. We will send you home with an information leaflet on what to expect after and who to contact in case of emergency. You should leave the clinic knowing that the abortion is complete and the pregnancy has been removed.
You can expect some mild bleeding or spotting which will usually settle within 7 days but can continue for up to 14 days. Crampy abdominal pain can occur at home but will usually be controlled with simple over-the-counter painkillers.
We recommend that you avoid sexual intercourse and don’t use tampons until your bleeding has stopped to reduce the risk of infection. You may return to work when you feel able.
If you experience any fever, dizziness, offensive vaginal discharge, very heavy bleeding or severe abdominal pain seek medical attention from your GP or attend your nearest Accident and Emergency department.
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Procedural (surgical) abortion under general anaesthetic
If you would prefer to be asleep for the procedure we will arrange to see you for a pre-procedure appointment the day before the surgical procedure. The pre-procedure appointment is usually on a Tuesday at Lagan Valley Hospital and the surgery on a Wednesday at the Ulster Hospital. At this appointment some or all of the following may happen
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- A vaginal ultrasound will be routinely performed to confirm how many weeks you are and to check the pregnancy is located normally inside the womb.
- Vaginal swabs may be performed if you wish to be screened/checked for sexually transmitted infections
- We will go through the procedure in detail, detailing the benefits and risks of the procedure (see below***).
- You will need to sign a consent form to say that you understand these risks.
- You will be given medication to prepare the cervix (neck of the womb). Depending on how far along the pregnancy you are this will either be tablets to swallow or small dilators called Dilapan, which are placed inside the cervix or both.
- We will discuss the disposal of the pregnancy tissue with you and get you to complete a form depending on your wishes.
- We will discuss the option of Anti-D injections
- We will give advice on what to do about any regular medications you take.
- We will then confirm your theatre slot for the next morning and give you details and information for you to come in to the Ulster Hospital Dundonald for your procedure.
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What are the risks of a procedural (surgical) abortion?
Frequent risks
- Mild bleeding or spotting that lasts for up to 2 weeks is very common but heavy bleeding is uncommon (1–3 in 1000 women).
- Need for repeat procedure if all the pregnancy remains are not removed, fewer than 1 in 100 women (common).
- Pelvic infection, fewer than 1 in 100 women (common).
- Development of intrauterine adhesions, 190 in 1000 (common).
Serious risks
- Perforation of the womb (making a small hole in the wall of the womb), up to 1-4 in 1000 women (uncommon).
- Injury to surrounding structures in case of perforation and need for key-hole surgery or open surgery to the abdomen to treat any damage (~1 in 1000)
- Hysterectomy in the case of uncontrolled bleeding.
- Significant tear of the neck of the womb, less than 0.1 in 1000 women (rare).
- Severe bleeding requiring blood transfusion (1-2 in 1000 women)
Failure (1-2:1000) while incomplete requiring further intervention to complete
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When to seek advice following an abortion
Please contact the Tulip service number provided to you if:
After taking Mifepristone (Step 1):
- You vomit within the first 60 minutes of taking Mifepristone in the clinic.
After taking Misoprostol (Step 2):
- You have had no bleeding 24 hours after taking the Misoprostol tablets.
- You have an unpleasant- smelling vaginal discharge.
- You have signs that suggest you are still pregnant 1 week after your treatment.
- After 1 week
- Your bleeding is not getting lighter.
- You do not feel that you have passed the pregnancy.
- You still feel pregnancy symptoms (such as nausea and breast tenderness).
- If your pregnancy test is still positive or unclear after 3 weeks from performing the medical abortion/passing the pregnancy.
Please attend A+E or telephone 999 for an ambulance if you experience any of the following:
- Heavy vaginal bleeding and have soaked through 2 or more large maxi pads an hour, for the last 2 hours.
- Passing blood clots larger than a lemon for more than 2 hours.
- You have a fever of 38 degrees or higher more than 24 hours after taking the misoprostol.
- Dizziness or vomiting lasting more than 2 hours.
- Severe pain or cramps that don’t get better with pain medication, rest, water bottle/heat pads, especially if the pain is under your ribs or up into your shoulder.
- Loss of consciousness or confusion.
- Worsening pain.
- A severe allergic reaction.
- Chest pain or concerns for a heart attack or stroke.
- Slurred speech.
- Breathing difficulties
- Fits/seizures.
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Counselling
If you would like pre-treatment counselling you can contact the following services yourself
Informing choices NI
Pregnancy Choices Counselling – Informing Choices NI
BPAS
Abortion clinics, Information, Advice and Treatment | BPAS
Common Youth (under 25 y/o)
Free & Confidential Sexual Health & Wellbeing Advice | Common Youth
Informing Choices Northern Ireland charity can also provide a post pregnancy counselling service for those who have had an abortion, or experience other pregnancy loss through miscarriage, stillbirth or traumatic birth.
For more information, please visit
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Domestic Violence
As part of our service, you will be asked about domestic violence. This is confidential discussion and you may or may not wish to disclose any issues you may have with us.
For information on how to get help please visit: https://ndawomensaid.org/
Tel: 08088021414
Txt support to 07797805839
Email: 24hrssupport@dvhelpline.org
https://www.gov.uk/guidance/domestic-abuse-how-to-get-help
- Early Medical Abortion Patient Leaflet
- Pregnancy Remains Leaflet
- Surgical Procedure Less than 12 weeks leaflet
- Surgical Abortion above 12 weeks
Contact Details
If your gestation is less than 19 weeks and 6 days (dated from the first day of your last period) and you wish to discuss your pregnancy choices please call this number:
03457 30 40 30