Abortion Care

The Bay Centre at Women’s College Hospital provides an inclusive and holistic approach to abortion care services. We offer a broad range of abortion options in addition to comprehensive counseling, assessment and follow up. We strive to make the Bay Centre a safe space for all our patients. What matters to us is that you make a fully informed choice that is right for you. These services are for anyone who is experiencing an unplanned or unexpected pregnancy.

To estimate your gestational age, or the number of weeks that you are into the pregnancy, use the first day of your last menstrual period. You can also use an online pregnancy calculator.

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Counseling and Assessment

Virtual “No Touch” Abortion
·      A “no-touch” abortion is a medication abortion that may be helpful for those patients who face barriers[LF12]  accessing care close to home .
·      You will be required to complete a 10-minute questionnaire via myHealthRecord prior to your first appointment.
·      You will be booked for a video visit with a physician or Nurse Practitioner
·      The doctor or Nurse Practitioner will fax a prescription to the pharmacy for the medicine you will need to take. They will then book follow up virtual visits, usually at 1 week and 4 weeks after you complete the medication abortion.
Please note that a virtual abortion may not be the best course of care for some patients – a clinician will work with patients to ensure they receive the type of abortion care that meets their healthcare needs.
For further information on low/no touch abortions, visit this page.
Surgical Abortion
·      A surgical abortion is a procedure during which a pregnancy or pregnancy tissue is removed from the uterus.
·      It can be done for any pregnancy starting at 42 days (6 weeks) after the first day of your last menstrual period, through to 25 weeks.
·      If you contact the Bay Centre for a surgical abortion, you will be booked for a pre-operative assessment at the Bay Centre. During this appointment you will see a nurse and a physician. You will also have an ultrasound to confirm the gestational age (i.e. number of weeks), and blood work. Once this appointment is completed, you will be booked for a surgical abortion. You will be welcome to ask any questions during your appointment
·      We will offer an appointment with our social worker for additional counseling or to assist with additional concerns related to your abortion or pregnancy options care.
·      Our surgical abortions are currently offered 1-2 times per week. We work with a team of gynecologists and family doctors who provide the procedure. You will meet them the morning of your procedure and have a chance to ask any additional questions.
·      Patients who undergo surgical abortions at WCH are fully asleep.The anesthetist will discuss with you the options on the day of your procedure.
 
Types of Surgical Abortion available at WCH
 
[MS13] Suction Dilatation and Curettage
This is a type of surgical abortion that can be done up to 14 weeks and 3 days of pregnancy.  It is done in the operating room, and in general for surgical abortions at WCH, patients are fully asleep for the procedure. However, you can request to have no[MS14]  anesthesia, mild anesthesia, or to be fully asleep for the procedure. The anaesthetist will discuss with you the options on the day of your procedure. A machine applies suction to help empty the uterus and a spoon-like instrument (curettage) is used to remove any remaining tissue along the lining of the uterus. This procedure can take up to 15 minutes. The procedure is very safe; at least two visits are required.
If the pregnancy is beyond 12  weeks, you may need an extra appointment to insert a cervical dilator. A dilator is a small firm rod that is placed inside the cervix several hours[MS15] [CA16]  before your procedure. It swells and helps to open, or dilate, the cervix. It is also often referred to as a cervical tent, or cervical dilator[LF17] .
Dilatation and Evacuation [MS18] 
This is a type of surgical abortion that can be done between 14 weeks and 4 days, and 24 weeks and 6 days  of pregnancy. This procedure is very safe. It usually involves 2 to 3 appointments. If you are coming from out of town, please be mindful that you might need to find a place to stay for two or three nights. Blood work, a physical exam an infection check and an ultrasound will need to be completed during your first d visit.
The day before your procedure, you will be required to meet the doctor who will be performing your procedure and completing yourcervical preparation. Cervical preparation involves using cervical dilators such as laminaria and Dilapan-S to help open the cervix. This will make it safer and easier to enter the uterus at the time of the surgery. A local anesthetic is used around the cervix to numb the  area and help with any mild pain. For abortions between 20 and 24 weeks and 6 days, additional preparation could include taking medication in advance of the procedure and receiving an injection. [MS19] [CA20] 
At Women’s College Hospital, this procedure is currently available up to 24 weeks and 6 days gestational age and is done in an operating room. You are given a sedative to ensure that you are asleep during the procedure. . An oxygen mask, an airway called a “laryngeal mask airway” or full intubation “endotracheal airway” may be required. You will meet with an  anesthesiologist to discuss your anaesthetic plan prior to your procedure.
Other clinics offering  dilatation and evacuation procedures in Toronto include:
·      Cabbagetown Women’s Clinic[MS21] [LF22] 
·      Morgentaler Clinic
·      Bloor West Village Women’s Clinic
If you do not live in Toronto, or want to learn about other clinics, please visit www.choiceconnect.ca.
If you are over 24 weeks and 6 days gestational age please contact Action Canada[OM23]  for Sexual Health and Rights
 Abortion Care Questions and Concerns [MS24] [OM25] 
General
This pregnancy was a miscarriage. Why is it called an abortion?
Abortion is the medical term used to describe emptying the uterus of a pregnancy. It applies to therapeutic abortions, when an abortion is done intentionally, and to spontaneous abortions, often called miscarriage.[CA26] 
Do I need parent consent if I am a youth?
No, you do not need consent from your parents if you are a youth. Consent is based on capacity, not age. If the physician and healthcare team feel you understand the procedure and its risks, you may consent to medical care.
Do I need a doctor’s referral to book an appointment?
No, you do not need a doctor’s referral to make an appointment. You can make the appointment at your own convenience. If you were accessing care prior to your appointment and you have recent test results for blood work, ultrasound and/or genetic testing, it would be helpful to have a doctor refer you so that information can be included in your appointment.
Medical
What are the risks of medication abortion?
Known side effects of the medications include nausea, vomiting, diarrhea, and fevers. These side effects are temporary. You will be counselled on these and how to manage them. A medication abortion will lead to a few hours of heavy bleeding and pain. Ongoing heavy bleeding or hemorrhage is a risk and may require a visit to the emergency department. There is a risk of failure (2 to 5% of cases) or of retained tissue requiring further intervention with a procedure or more medications to fully empty the uterus
How successful are medication abortions?
A medication abortion, when using the regimen Mifegymiso (mifepristone plus misoprostol) is up to 99%t effective if less than or equal to 63 days pregnant and up to 95%  effective if up to 70 days pregnant.
Is a medication abortion painful?
People having a medication abortion will experience cramps that can be quite strong when the abortion is happening. Your doctor will prescribe you some pain medications to take to help with this. Warm compresses like a hot water bottle, or gentle back massage, can help as well. The pain improves immediately after the abortion is complete.
Surgical
What are the risks of surgical abortion?
Some period-like bleeding and pain is common after a surgical abortion. The risks of surgical abortion include infection, hemorrhage/heavy bleeding, retained tissue, and incomplete procedure (i.e. you remain pregnant). The likelihood of any of these risks are less than 1 per cent. Rarer risks include hematometra (trapped blood in the uterus), cervical trauma, and uterine perforation (a complication during the surgery itself where a hole is accidentally pierced through the wall of the uterus or womb).
Will I be in pain during my abortion procedure?
[MS27] . If you are having a dilatation and curettage (DC), you will be given a sedative to ensure that you are asleep during the procedure.This means you will not see, feel or hear anything at the time of the procedure. You will wake up when the procedure is done.
[CA28] 
How successful are surgical abortions?
Surgical abortions in the 1st trimester (up to 14 weeks) are 98 per cent successful. This means that up to 2 per cent of the time you might need a repeat procedure or to take medications like misoprostol in order to fully empty the uterus.[CA29] 
I am having a surgical abortion. How long does it take?
The surgical abortion requires multiple hospital visits. The first visit is a pre-op assessment where you will meet with a nurse, sonographer and doctor or nurse practitioner. This appointment requires counseling, an ultrasound, a physical exam and infection testing and blood work. When you have your abortion at Women’s College Hospital, you are scheduled to arrive 2 hours before your procedure,  and stay up to 2 hours after for monitoring. Although the actual procedure is short (10-15 minutes), the total time you will spend at the hospital is generally around 3-5 hours.  Sometimes you may be asked to arrive more than 2 hours before the procedure, depending on whether you need to have any extra preparation.
I am having a surgical abortion. Can I bring a support person with me?[MS30] 
You are welcomed to bring a support person to your appointment. They can wait in the waiting area while you are undergoing your procedure. Support persons will not allowed to be at the bedside at the time of procedure or while you are in recovery.  You can use your mobile device to connect with them remotely during the counselling portion of your care and while you are in the waiting area for your procedure.
I am having a surgical abortion. What do I bring with me?
Please bring your health card, Interim Federal Health paperwork or proof of insurance and photo identification if you do not have medical coverage,  If your phone battery drains quickly, it can be helpful to bring a phone charger. Bringing warm[CA31]  socks usually helps to keep you more comfortable. You might want to bring a book, headphones, or something else you can do to keep busy while waiting. If you are planning to start an IUD,contraceptive implant or injection at the time of your procedure, please remember to fill the prescription and bring the device/medication with you. Please try to limit the number of valuables you bring to the clinic.
Decision-Making
What is complex decision-making and how do I decide what’s right for me?
When a pregnancy is unplanned or unwanted, people sometimes feel overwhelmed by their emotions and alone. They may fear judgment from their family members, partner and peers.  Some people are certain they want an abortion. Others struggle to make this decision in a short time frame. This can be hard when some people need time to process emotions, think through decisions, and seek support from others.  It is important to seek support in making an informed choice that’s right for you. At the Bay Centre we offer pregnancy options counselling and psychological counselling. You can book an abortion assessment or social work appointment at the Bay Centre without knowing if you want to proceed with an abortion[LF32] . For more information or to get support, contact 416-351-3700.
Is there an alternative option to abortion between 14 weeks + 3 days and 24weeks + 6 days?
Yes, it is called an induction of labour. It requires admission to a hospital [LF33] and can take 24 hours to 4 days to be completed. In Canada it is currently much harder to access. In general, it is considered safer to have a surgical abortion, as it is quicker, does not require a hospital stay, has a lower rate of retained tissue or retained placenta, and a lower risk of infection. People who need thetissue [CA34] of the pregnancy examined with an autopsy or genetic testing may be counselled for an induction of labour as there is less damage to the tissue.
I have a counseling and abortion assessment appointment. How long will it take?
In general, an abortion assessment at the Bay Centre is roughly 3 hours long. That’s because we review your pregnancy options, your health history, do a physical exam, and ensure there is time to discuss your feelings about your decision, and answer any questions you have. This also includes the time required for bloodwork and an ultrasound, which are done to ensure your abortion is as safe for you as possible.
Will having an abortion affect my ability to have children later on?
It is very unlikely for a surgical abortion to affect your future fertility. Some people worry about a condition called Asherman’s Syndrome, which is when scar tissue forms in the uterus leading to menstrual issues and fertility problems. This condition is rare, but is more likely to occur when there are complications after a vaginal delivery, miscarriage, medication abortion or surgical abortion, such as an infection. Most individuals who have an abortion go on to have normal pregnancies later in life (if they want to).
It is important to remember that there are many factors that affect fertility. The most important factor can be age. Infertility is defined as the inability to conceive after 1 year of trying. If someone is experiencing difficulties in conceiving after 1 year, or after 6 months if they are over the age of 35, we recommend they seek the opinion of a gynecologist and/or fertility specialist.
I do not live in Toronto, and I am not sure I can afford to travel there. What are my options?
National agencies such as the National Abortion Federation of Canada and Action Canada for Sexual Health and Rights have 24-hour Canada-wide toll-free access hotlines that can help direct you in terms of where your closest options are for abortion care. They also have small emergency funds that can help individuals address the challenges they may face in accessing care.
Action Canada can often help navigate other barriers to accessing care, such as when people do not have passports and may need to travel to the United States of America or have legal challenges that impact their ability to travel outside of their region. For more information, please visit their websites.
Post- Abortion Support
What can I expect after my abortion?
Bleeding is common and will continue for up to 3-4 weeks afterwards. This can vary especially if you are starting a new contraceptive method. Cramps are also common and get better with time. Over-the-counter medication such as acetaminophen and ibuprofen and non-pharmaceutical alternatives like heating pads , are often used to help reduce the pain. People with pregnancies over 18 weeks may experience breast discharge, which is normal and will also get better with time.[MS35] 
Is it normal to experience grief and sadness after an abortion? How do I know if I need further counselling and support?
After an abortion many individuals feel a sense of relief, but it is also normal to experience guilt, shame, isolation, regret and sadness – all emotions encompassed by grief and loss, and due to a shift in hormones from the pregnancy.


It is important to give yourself permission and the space to grieve. One struggle with abortion is that it is a disenfranchised loss, meaning it is a loss that society doesn’t always validate or recognize.  This means people don’t feel they have the same right to grieve the loss because it was their choice or because of the judgment and stigma around abortion.  It is important to remember that, though this loss is not identical to other losses, that does not mean it is not a valid loss.  It is an experience that you have the right to grieve.  It is part of you and your story, and you can feel, process, and integrate the complicated emotions that come with that.

The sadness of any type of grief can become overwhelming at times, despite being normal and a natural part of the process. However, if after several weeks you find that your emotions are overwhelming, you are not able to stop thinking about the pregnancy or abortion, and you are unable to return to your routine, it may be a good idea to seek professional support.
Part of your care at the Bay Centre is access to counselling post-abortion. For more information or to speak with the social worker on staff contact 416-351-3700. Appointments with the Bay Centre social worker are offered both in-person and over the telephone/video. You may also choose to speak to a therapist or counsellor of your choice in the community.[MS36] 

 [CA1]or who no longer wants to be pregnant?
 [OM2]Due date calculator – Pregnancy Info
 [MS3]We need to change this to a different calculator
 [TD4]what if we embedded a due date calculator like choice  connect does?
 [OM5]Something similar to EPIC, build it in ourselves??
 [OM6]Abortion Options Comparison | Women’s College Hospital
 [MS7]This needs to be fully overhauled
 [LF8]can this be emphasized?
 [MS9]physician or NP
 [MS10]We should add something about follow up bloodwork to ensure successful procedure
 [LF11]most patients have to pay out of pocket first, then be reimbursed by private insurance
 [LF12]more specific? patients outside of toronto?
 [MS13]Should we remove this from the website since we aren’t offering MVAs?
 [MS14]Does this ever actually happen? Will anaesthesia do the procedure without any sedation?
 [MS15]Should we keep “laminaria” or say dilapan instead? Or maybe just “cervical dilator”
 [CA16]I think we should switch to cervical dilator
 [LF17]do we need to add cervical dilator again?
 [MS18]Should we add info re cost for non OHIP
 [MS19]Do we want to add anything about dig here?
 [CA20]we could say patients need to receive an injection?
 [MS21]Should we add a blurb about Action Canada here as a resource for folks?
 [LF22]yes, like “if you require assistance with accommodations, please consult/ contact Action Canada”?
 [OM23]Action Canada | Action Canada for Sexual Health and Rights
 [MS24]I think we should format this differently- have the questions broken up into topics/sections- medical/surgical/decision making/post support etc
 [OM25]FAQ video?
 [CA26]This question may not need to be included since we don’t patient’s experiencing a fetal demise?
 [MS27]Update this info as we do not do MVA here
 [CA28]Removed and added to the medical abortion section
 [CA29]Could we check the statistics on this? I was under the impression that the D&C surgery was 99% effective. Most of the FSC websites also quote 99% effectiveness?
 [MS30]This needs to be updated.
 [CA31]too colloquial?
 [LF32]book an assessment appointment or social work appointment
 [LF33]reference Mt Sinai?
 [CA34]language changed out of consideration for people undergoing genetic terminations
 [MS35]Should we add a note re cabergoline
 [MS36]Should we ask Leanne for more resources that we could link to?