She should not use tampons but hygienic pads in case of blood
loss. In certain cases this advice will have to be mitigated:
A patient is advised not to use tampons. She states
that she must resume work the next day. Her work is naked dancing in
a night club and she does not fancy this with a hygienic pad. We
compromise that she uses a tampon during her performance only and
that she chooses a sterile tampon which can be brought in without
touching it with the hands.
Advice the patient about contraception. Explain that her next
period may be somewhat delayed, she can expect it after four to six
weeks, but that she may become pregnant again before the period,
since the ovulation occurs first. Advice her that she may start
taking the pill the same evening or a day later. This will ensure her
next period to come in time (after she finished the first pack) and
that she is regulated and protected against a pregnancy from the
beginning. Although an IUD or sterilization may be done immediately
following the abortion it may be wise not to do it. An IUD may cause
infection and the abortion will be blamed. A decision to be
sterilized may be taken too easily after the abortion and later
regretted. If a woman refuses to use contraception, mostly worded
that she is certain never to have intercourse again, do not insist.
Tell her that the MAP exists
[Chapter 6]. It may be handy
for such cases to have a few MAP packages available.
Always tell her that in rare cases the termination does not
succeed and the pregnancy remains in tact. This phenomenon is
discussed in [Chapter 13]. Tell
her that although we do the utmost to prevent it the possibility can
not always be completely excluded. The patient should preferably come
back for a checkup examination after two weeks or be examined by
another doctor. If she wants to do a pregnancy test to make sure she
must not do that within three weeks to avoid a false positive result.
If her period stays out after six weeks she must be reexamined.
Never make the mistake to threaten her that she will not be
treated again if she fails to take contraception. She will simply go
to another clinic or, worse, she may lose faith and rely on some
backstreet abortionist.
Be aware that certain women regret fervently that they have
become pregnant. They will blame the man who impregnated her and all
other men. The first person to take the blame is the doctor who does
the abortion, particularly if he is a man. In a way this is the
normal fate of a doctor so don't react indignantly if the patient
shows a lack of gratitude or keeps complaining while you have the
impression that the procedure went flawless. Invariably she will
consider her own case different from the other women. She suffers the
misfortune to have become pregnant although she did not want it and
now she is forced to undergo a termination against her conscience.
The other women in the clinic just lack moral standards. They enjoy
sexual intercourse and prevent their rightful punishment by
terminating their pregnancy.
In a hospital in the Netherlands the sister of a
Roman Catholic bishop had a termination. When she learned that a
fifteen year old girl in the next bed came for the same she made a
terrible row about the fact that the hospital allowed such girls a
termination.
Never ridicule an antiabortion fanatic that she became pregnant.
She sees her case as different. It is her misfortune that she became
pregnant and now she is forced to undergo an abortion against her
conscience while the other women apparently don't mind. She is
genuinely distressed and there is nothing to be gained by explaining
that she is not different from other women. After the termination she
will if possible become more fervently against abortion then before.
It is a good practice to install a complaint procedure. Give
every woman when she leaves the clinic a questionnaire with the
request to send it back after two weeks. This gives a general idea
about the results and possible complications of the clinic. Besides
questions about the course after treatment she should be asked if she
has any complaints. She should be given a confidential address where
she can lodge her complaints if she does not want to contact the
clinic. See Appendix 9.
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