Modernising Abortion

Services…………….
Nurse/Midwife Led Provision

Alison Jones, Consultant Nurse Sexual Health & Teenage Pregnancy

Pontypridd & Rhondda NHS Trust
28 June 2007
Objectives

z Introduction

z Developing nurse/midwife roles

z Opportunities & challenges

Globally
„ Over ¼ of worlds population live in countries where
abortion is strictly prohibited

„ 19,000,000 Women have unsafe abortions annually

„ 70,000 Women die each year from unsafe abortions

„ 1 in 3 British Women will have an abortion

In Wales, England & Scotland abortion can be carried out
providing that 2 registered medical practitioners agree that:
(i) Up to 24 weeks:
The continuance of the pregnancy would involve risk greater than if the
pregnancy were terminated to the physical or mental health of the
pregnant woman or any existing children in her family

(ii) With no gestational limit:

„ If termination is necessary to prevent grave permanent injury to the
mental or physical health of the pregnant woman
„ There is a risk to the life of the pregnant woman greater than if the
pregnancy were terminated
„ There is substantial risk that if the child were born it would suffer
from such physical or mental abnormalities as to be seriously
handicapped
(Abortion Act 1967, amended by the Human Fertilisation & Embryology Act 1990)
Note:

„ Parliamentary debate July 2005 upheld the

24 week gestational limit.

„ Doctors attending the BMA conference June

2005 supported maintaining the limit by 3:1.
Statistics (Wales & Eng)
„ Abortions increased by 0.4% 2004-05

„ Teenage abortion rates unchanged

„ 89% of abortions carried out under 13wks, less

than 2% over 20 weeks (unchanged for 10 years)

„ 84% abortions were funded/carried out by the NHS

(fpa fact sheet, August 2006, publisher: Sexual Health Direct, London)
Modernising abortion services -
national policy context

z All Wales Sexual Health Strategy 2006

z Designed to Deliver (Wanless, 2000)

z RCOG Guidelines
Modernising abortion services locally
z Working together: multi professional, multi-organisation

z Identifying the need for change

z Organisational support

z Risk assessment, professional & legal liability

z Clearly specified purpose, roles & responsibilities

Principles of Nurse / Midwife Role
Development

&focused on empowering nurses/midwives to develop

knowledge & skills for the benefit of patient care.

'avoiding ad hoc acquisition of technical skills or

inappropriate delegation of unpleasant/unwanted
tasks by other professional groups.
Nurse/Midwives Responsibilities

Nurses work within the Abortion Act when they

accept delegated instructions from a registered
medical practitioner & carry out treatment in
accordance with his/her directions
Areas of nurse/midwife role development

z Ultrasound assessment of gestational age

z Pre & post abortion counselling
z Administration of abortificants
z Discharging patients
z Vaginal/speculum examination
z Assessment for & provision of contraception
z Obtaining consent for abortion procedures
Obtaining consent for abortion procedures
……..exceptions

„ Under 16 unaccompanied by an adult with

parental responsibility
„ The woman does not understand the procedures
„ The woman is unsure
„ The woman has bleeding / pelvic pain
„ A medical condition that is contraindicated
„ The nurse/midwife deems it unsafe
Areas of nurse/midwife role development
…….. Competency Framework

„ Identifies qualifications, experience & training

Registered Nurses & Midwives require to enable
competent safe practice

„ Provides methodology to quality assure through

assessment & audit
Modernisation….. developing a dedicated service:
„ Specified referral process
„ Developing & enhancing expertise
„ Responsive to individual needs
„ Easily accessible for ongoing care
„ ‘One stop shop’ / community settings
„ Speedier initial consultation
„ One to one holistic assessment
„ ‘sexual health’ perspective
„ High levels patient satisfaction
„ Positive effects on other services
Challenges…….

ƒPrimary legislation
ƒInterface between primary & secondary care
ƒ‘Cutting edge’. Expect the unexpected ……..
ƒSustainability
Checklist for service development
„ Working together!
„ Clear identification of need
„ Policy statement, protocols & procedures
„ Education & training package
„ Assessment – theoretical & practical
„ Audit
„ Identifying & acting on clinical incidents
„ Maintenance of competence
„ Identifying opportunity for continued development
 Thank you
Alison Jones
Pontypridd & Rhondda NHS Trust

Alison-g.jones@pr-tr.wales.nhs.uk
01443 443443 ext 4246