Tele-Abortion: Frequently Asked Questions
1. Will I be able to work during my medical abortion?
How you are feeling, and your ability to function, will depend on where you are at, during the medical abortion process.
After the FIRST step tablet, it is likely that you will be able to continue your normal life without feeling very different. However, you may start to bleed so it’s a good idea to wear a pad in your underwear. After the first step, you may feel less pregnant but otherwise, you should feel pretty normal.
However, on the day when you plan to take the SECOND step of the medical abortion, you will need to plan NOT to work. You will need to be somewhere safe and comfortable, and not make ANY plans for the whole day. This includes NOT working, NOT meeting people or looking after young children. We recommend you get support from someone who knows you and cares about you, as you will feel UNWELL and have limited ability to carry out normal activities.
You may also consider taking the following day off, after the day of taking the second step medication. We can give you a work certificate for these 2 days if you require one.
If you feel well enough on the third day after taking the 2nd Step medication, you can resume your normal schedule, though you may continue to bleed for up to 3 weeks after the medical abortion. If you have significant pain on the third day after taking the 2nd step tablets, you should seek medical attention locally.
2. How long will the medical abortion process take?
We will likely be in contact with you for approximately 3 to 7 days after you register, prior to you actually getting the pills for the medical abortion. This is so that we can make sure we have results and any information we need to safely guide you through the medical abortion process. The actual medical abortion ( miscarriage) itself, which has 2 steps, will take somewhere between 36 to 72 hours depending on your plan for taking the medication.
The first tablet can be taken at any time, preferably as soon as possible after you collect the prescription. Then between 24-48 hrs later you will take the second lot of tablets. This second step (of 4 tablets), should be taken in the morning after a light breakfast. This is Day 1 of the miscarriage. Make sure you are well hydrated by drinking plenty of water the day before. Its a good idea to take pain relief (and anti nausea pills) on Day 1, before taking the second step medication. The second step medication can cause you to vomit so by having pain relief already in your system, it will be working for you even if you vomit later.
About 30 mins after taking the second step tablets you will start to bleed and get cramps, which may be severe. For this reason, you should not make any plans to be anywhere other than at home or somewhere safe and familiar and be supported by someone who knows what is happening and who is able to care for you.
On Day 2, after the miscarriage, you will feel tired. You will still have bleeding and maybe some light cramps. You should plan to have a quiet day.
On Day 3 after the 2nd step tablets, you can resume your normal activities of daily living but don’t expect too much of yourself. You may continue to bleed for up to 3 weeks after the medical abortion. During this recovery time, you can go to work or study or look after others, but you should not have sexual intercourse until we have given you the all-clear that the medical abortion has been successful. This is to help prevent infection.
You will have a telehealth consultation with one of our clinicians approximately 1 week after the medical abortion to ensure that all is well. You will have an at home urine pregnancy test 4 weeks after the medical abortion to ensure the procedure was successful. If you wish to make contact with us after the medical abortion but before the scheduled follow-up please email us at email@example.com.
3. Will it be painful?
Yes, it will be painful. However, a woman’s experience of pain during medical abortion varies. Some women describe medical abortion as being like period pain, whereas others are in excruciating pain and need to be hospitalised (though this is unusual). Most women describe moderate to severe pain which subsides after a few hours of intensity.
4. What can I do to manage the pain?
Simple measures that you can take are to have a warm pack or hot water bottle available; be prepared to mobilise around your settings; keep moving. Being upright and able to sit on the toilet is useful.
We will usually prescribe strong pain-relieving tablets at the same time as the medical abortion pills. You will collect pain relief medication at the same time as when you collect your medical abortion pill prescription. Ibuprofen and paracetamol can be purchased in any supermarket and are useful to have on hand as well.
Note; The pain is usually at its worst for 6 to 7 hours after the second step tablets, and then should subside significantly. So, if you take the 2nd step tablets, in the morning you should be in a comfortable state by late afternoon and should be able to have a good night’s rest after the medication has worn off.
5. Why do I need to get the tests done urgently?
Medical abortion is licensed in Australia for pregnancies up to 63 days or 9 weeks. We cannot prescribe a medical abortion for you if your pregnancy is past this date. It is therefore very important that we get the information about your pregnancy as quickly as possible so that we can help you in a timely manner.
However, if the scan is done too early and nothing conclusive is showing in the uterus, you may end up having more tests including blood tests to confirm that you are suitable to proceed. We do not recommend that you have your scan before 6 weeks from your last menstrual period, in case it is too early .
If you are unsure about your dates, or suspect that you are further along than 6 weeks, you can get your scan as soon as possible.
If you are "too early", then you may go into a "holding pattern" of more tests until we can confidently exclude ectopic pregnancy and generate the prescription for your medical abortion drugs.
If your pregnancy is later than 63 days, then you can choose to have a surgical abortion (termination of pregnancy).
6. If I don’t go through with the medical abortion, or if there are complications, do I get a refund?
No. If you don't want to or are unable to proceed with the medical abortion, for whatever reason, there will be no refund. This also applies if there are complications and further treatment from a local health service provider is necessary. Although we try to keep costs to a minimum, we are unable to offer a refund to patients as there are costs involved in providing the service, even if you do not go ahead.
7. Is there a Medicare rebate for tele-abortion?
No. There is currently no Medicare rebate available for tele-abortion. The first consultation is privately billed to your credit card for $90 and the second consultation is privately billed for $250 before your appointment.
All follow-up and aftercare for medical abortion are free of charge, as it is covered by fees that you have already paid.
Gap fees for any investigations such as ultrasound or blood test will be payable by yourself to your local provider.
Costs of the medication will be born by yourself, and are payable to the pharmacy when you collect your medication. Costs of the medication will depend on whether you have a Medicare Card or Health Care Card.
If you do not hold a valid Medicare card, please contact us directly on firstname.lastname@example.org to discuss your circumstances.
8. Will you help me choose a good method of contraception?
Yes. All our clinicians are highly skilled in contraceptive counselling and will be able to help you make the right choice of contraception. This will help give you control and decide when to get pregnant.
Effective contraception will help prevent further unplanned pregnancies, but you need to find a contraceptive which suits you. It is likely that we will be able to include a contraceptive prescription at the same time as we provide you with the abortion pill prescription.
9. I don’t want anybody in my community to know that I am having a medical abortion. What can I do to maintain my privacy?
We understand your need for complete privacy. This is one of the advantages of tele-abortion, as it provides you with medical attention in the privacy of your own home. Concerns about privacy and confidentiality are especially important for women undergoing an abortion, due to the stigma that women who seek abortion often experience in their communities.
We will never share your information unless you request that we do so and/or give us your permission to do so.
However, we will advocate for you and support you in any way that we can. This includes liaising with other health professionals on your behalf.
For example; we will give you a choice of local dispensing pharmacies where you can collect your medication. This means that you can choose a pharmacy which is not in your local community if you wish.
Alternatively, we can courier the medications directly to a named person at your home or work. There is an additional $30 for "hand to hand" courier service. You can choose to have the package marked "Urgent medical supplies" which may help prioritise delivery.
10. How do I get my medical abortion pills and how much will they cost?
During the first video consultation, you can tell us your preference for pick up locally or if you prefer a courier to deliver "hand to hand". If you choose courier delivery, there will be an additional fee of $30 payable in advance of the second consultation for the courier. Courier delivery can take up to 4 days if you live in a rural area.
If you choose to have the medications couriered, you will need to pay up front for the medication at the time of the courier. The cost of for the medical abortion drugs are about $40 if you have a Medicare card and about $6 if you have a Health Care Card. Prescription painkillers are about $3 and anti nausea medications are about $10.
If you choose to collect the medication in person from a pharmacy, we will give you the details of a dispensing pharmacist where you can collect your prescription. We send you an "e-prescription" (which is a QR code) to your mobile phone or email. You take this to the pharmacy where it will be scanned and your medications dispensed, and you will pay the pharmacist directly.
Pharmacists are bound by professional confidentiality in the same way as doctors and nurses. Not all pharmacies dispense this medication, but we will help you find one, as near to you as possible, that does.
11. What happens if I have problems or my medical abortion doesn't work properly?
There is a 24 hr helpline available for women undergoing medical abortion The number for this is 1300 515 883.
During the second consultation, we will explain to you any worrisome signs to look out for and when to seek assistance if you have a complication.
We will give you an "emergency care letter" which you can show to a local provider if you need to seek help.
If you do need to seek assistance with your GP or at your local hospital, we will speak directly with the healthcare professionals as required.
12. What happens if I am treated badly by local health services because I chose to have an abortion?
During follow-up, if we find that there have been any incidents of unprofessional behaviour we will advocate for you, for example, by making a report to the Australian Health Professionals Registration Authority (AHPRA) or assisting you with a submission to the Health Care Complaint Commission (HCCC).
It is not acceptable for health professionals to discriminate or judge patients unfairly because they have had an abortion. Access to abortion care should be as easy as access to any other type of health care.
Doctors, nurses or anyone else involved in your journey have no right to judge you according to their own personal held beliefs.
13. What if I have a Rhesus negative blood type?
If you have a rhesus negative blood type, it is not considered necessary for you to have Anti D injection for early medical abortion (under 9 weeks).
If you have a surgical abortion or decide to continue the pregnancy, then Anti D injections may be offered to you.
14. Why is tele-abortion so expensive?
We pride ourselves on providing our clients with a high-quality service. We have a short turn around, so can provide you with excellent, discrete and timely, patient-centred care.
Nowsis is the not for profit organisation which manages this Teleabortion service. However, we have no funding to provide abortion care. We are passionate about providing women with access to safe and effective abortion care, and we need to cover the costs of providing the service.
Unfortunately, the costs of providing the service are high and therefore there is a gap of $340 which is payable by yourself. The government are not currently funding Teleabortion services unless they are delivered by your own local doctor, whom you have visited in person in the last 12 months. Most GPs do not offer this service.
15. I am financially disadvantaged. Can I have a discount?
If you are suffering genuine financial hardship and are struggling to find the money to pay for the tele-abortion, we will discuss your particular circumstances with you. Please alert us to your situation at the time of your registration appointment.
16. Can you send me the medications by Australia Post?
Pharmacy medications are sensitive to heat and cold and can be lost during delivery. By making contact with the pharmacist yourself, it will reduce the risk of loss or damage. Or, you can choose to have the medications delivered by "hand to hand" named delivery, by courier. We can organise the courier for you, for an additional $30 fee, which is payable before the second consultation .
17. What happens if there is a complication?
In about 5% of cases, medical abortion is not straightforward, though has a 98% success rate. Complications can include excessive bleeding, excessive pain, infection and failure of the medication to work partly or completely.
We may recommend that you have further treatment and/or investigations if you have a complication. There is no extra fee for our services for ongoing support and assistance.
We will help you if you are unlucky and have a complication. In about 1-2% of cases of medical abortion, a surgical procedure is required to complete the process.
Unfortunately, there is no refund of our $340 fee, if you experience a complication which requires further investigation or medical assistance. Additional services, such as hysteroscopy or D&C, may incur extra fees if undertaken privately in your local community.