Linda Grung Ertzeid, RN, Ingrid Økland, RN, Line Bjørge, MD, Ragnhild Tveit Sekse, RN, Mette Løkeland, MD
Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
Background: Worldwide most late first trimester abortions are achieved surgically by vacuum aspiration. As the first hospital in Norway, medical abortion between 9 and 12 weeks of gestation was introduced at the Department of Obstetrics and Genecology, Haukeland University hospital, Bergen, Norway. in October 2005. Data from the implementation period has been analysed in detail, and shows that it is an effective and acceptable method for this gestational age (1). When the procedure was introduced women were given the choice between medical or surgical methods for termination of pregnancy. In June 2007 the medical abortion procedure became the method of choice for late first trimester abortions at the Department. The treatment and follow-up requires a close collaboration between different groups of health care providers. The nurses play a central role in treatment and follow-up of this patient group by administrating the medications, monitoring the patients clinically, confirming the terminations and
providing mental support as well as giving information about the procedure.
Method: A multi-competence team consisting of nurses and doctors with special interest was established. Its role was to develop treatment protocols and information materials and to enlighten and motivate the health care providergroups to use the new treatment alternative. At the first consultation at the outpatient clinic the doctor determined the gestational age and the choice of method were decided. The nurses informed the women about the treatment procedures, administrate mifepristone medication, governed misoprostol and pain killers, monitored bleeding, provided mental support and confirmed the termination by visual inspection. They were also responsible for contacting the women if further follow-up were needed. To build nursing competence structured training was made compulsory and given to all the nurses. They needed more knowledge about why conservative treatment should be preferred to surgical, and also be acquainted with the new procedures so they could be able to give a proper information and support to women.
Results: From October 2005 to April 2007 55% (254) of the women requesting abortion with gestational age 63 to 90 days chose medical termination. Initially many nurses found it hard to handle the new procedures, especially to verify the abortion by visual inspection to see that both fetus and placenta had been passed. To master this it was essential and important to give the nurses time for debriefing and for discussions, - like how to motivate each other and how to cope with different emotional reactions. Routines have also been made for new nurses. They were never left alone with this patient group until they felt secure with the procedures. This was important for a successful outcome of the implement of the new method.
Conclusion: Late first trimester medical abortion is an effective and acceptable method for termination of pregnancies. During the study period the numbers of procedures performed has increased and today more than 75% of all the abortions performed at this gestational age are performed medically. The key factors for the successful implementation were planning, delegation of treatment responsibility and motivation and follow-up of the nurses. Interdisciplinary cooperation on procedures and methods and increased knowledge has given the nurses professional confidence, competence and more responsibility for patient care provided for the women who choose abortion.