Here follows the procedure which has been developed in one of the author's clinics in the Netherlands. The aim is to make the total procedure a smooth one, so that every patient gets the utmost care and consideration, even if there many patients. Although each procedure takes roughly the same time which seldom exceeds fifteen minutes, a complication may arise which disrupts clinic routine. Ideally a spare treatment room is available and at least two doctors. While the junior doctor works on the list, the senior doctor keeps himself available to deal with sudden problems. He may take over the treatment while the junior continues with the next patient in a free theatre.

1. Appointing patients.

2. Reception and administration.

3. Counselling.

4. Preparation of the patient.

5. Anamnesis and examination.

6. Performing the abortion.

7. Bed rest.

8. Post-abortion examination and counselling.


Dependent on the number of patients the different tasks may be done by more or less staff. In a small setting the doctor with a receptionist and an assistant must do the lot, if the number of patients rises more staff will be necessary. It is a good thing if all staff are able to do all tasks so that they may alternate tasks, and absence of a staff member does not impair the routine.

1. Appointing patients. In almost all cases this will be done by telephone. Appointments should be made in a way which avoids overcrowding, so that the list can be handled smoothly with ample time for every patient. Time must be kept available for unforeseen problems. The exact date of last menstrual period (LMP) should be asked to schedule the patient according to the age of the pregnancy. Further advanced pregnancies take more time and have a greater possibility of complications.

Patients also tend to stay longer in the clinic. Therefore advanced pregnancies should be scheduled at the end of the session, young pregnancies in the beginning. If the LMP is unknown or not certain or if the patient is not sure about her pregnancy she is told that treatment is subject to the result of the examination in the clinic. These patients are appointed at the beginning of the day and examined first.

While the regular list is started the clinic reception can schedule them in if they can be treated, or try to find another solution for them.

The patient should be advised about the price and further conditions, told to bring a night gown, towel, extra slips and some hygienic pads, and told not to eat for six hours prior to the procedure (general anaesthesia) or have a light breakfast only (local anaesthesia). She should be encouraged to come for examination and counselling if she is not sure whether she wants to finish her pregnancy or not. It is a good policy for a clinic to grant this pre-exam and counselling free of charge and state in advance that a patient will not be persuaded to have an abortion done. A patient should feel free to decide at any moment to keep her pregnancy, even when she is already on the operation table (which occasionally happens). Patients should be urged to phone if they will not keep their appointment or if they will be late.

2. Reception. On arrival the patients name and address and date of birth is taken down and a treatment form is filled in. Payment is made and the patient is given an outline of the procedure. The receptionist should already find out if there is a reason for preliminary examination, for instance if the pregnancy is not certain or if it may be too far advanced.

3. Counselling. Ideally one or more counsellors are available who speak with every patient individually.

This topic is discussed in some detail in chapter 14


4. Preparation of the patient. Here again to prevent a useless time consuming session, the first thing is to find out if a preliminary examination is necessary. It is also the counsellor's task to deal with patients who are not admitted for treatment after examination.

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revised spring 2010