A Descriptive Analysis of Abortion Clinics’ Aftercare Instructions Following Surgical Abortion [4G

Abstract

INTRODUCTION: Providing patient expectations after a planned procedure is an important component of the preoperative visit. However, recommendations after surgical abortion are often neither standardized nor evidence-based. METHODS: The aftercare instructions of 73 National Abortion Federation (NAF) clinics providing surgical abortion were reviewed by three different authors for consistency. Clinics were chosen that provided comprehensive written instructions. The answers to common patient questions were examined. RESULTS: Of the clinics, 7 (10%) were academic university affiliated. A follow-up appointment was recommended at 3 weeks by 45% of clinics. The most common behavioral recommendations were to abstain from sex, douching, and tampons for 2 weeks. The majority of clinics did not have recommendations regarding exercise, baths, or swimming. Recommendations for pain included Tylenol™ (60%), NSAIDs (78%), narcotics (22%), and a heating pad (49%). Emergency care was recommended for fever (88%) and excessive pain (81%). Majority (52%) of clinics described abnormal bleeding as soaking 1 pad/hr for 2 hours compared to 2 pads/hr for 2 hours (36%). Normal post-abortion bleeding was defined as irregular (86%) or spotting (44%) with return to menses by 8 weeks as the most common time frame. About half (53%) of clinics counseled regarding breast symptoms, of which 93% described discomfort and 66% described leaking. 77% of clinics mentioned post-abortion emotional reactions, of which 77% used normalizing language and 82% provided specific resources. CONCLUSION: While many recommendations will likely remain unsupported by formal evidence, a review of frequent recommendations by expert providers may help formalize surgical abortion aftercare instructions.