Terminating a pregnancy for medical reasons (TFMR)
You may be offered a termination for medical reasons (TFMR) if tests show that your baby is not developing as expected. This may be due to a serious genetic or structural condition. You may also be offered a TFMR if you have pregnancy complications that risk your life or to your baby’s life.
Having a termination for medical reasons is a highly personal decision and only you can decide what is best for you. There is no right or wrong.
Many women and pregnant people tell us they dislike the use of the word termination to describe their experience because it makes them think of ending an unwanted pregnancy. They also feel it makes it sound like that they had more choice than they really had. Try to remember that it is a medical term. Some people prefer to call it ‘baby loss for medical reasons’ instead.
The feelings you have if you need to end a pregnancy for medical reasons are no less painful or valid than any other type of baby loss. Being told that you or your unborn baby are at risk is a painful and traumatic experience. Parents tell us that the guilt linked to making the decision can make it even harder.
You should be given clear, non-judgemental and supportive information from your healthcare professionals to help you decide what’s best for you and your partner, if you have one.
How a serious medical condition in your baby might be found
All pregnant people are offered screening tests during pregnancy to find any health conditions that could affect you or your baby.
If your screening tests show that your baby has a higher chance of a serious condition, or if you have a family history of a certain condition, you may be offered diagnostic tests. These tests tell you for certain whether you or your baby has the condition.
Diagnostic tests are sometimes done at your nearest fetal medicine unit. This is a specialist service for pregnant people who need specialist care.
What your diagnosis might mean
Depending on the diagnosis, it may sometimes be possible to treat you or your baby while you are pregnant, or after your baby is born.
But some conditions found in babies may cause chronic illness, disability, stillbirth or the death of a baby soon after birth (neonatal death). These conditions are sometimes referred to as fetal anomalies disorders or birth defects. Some rare pregnancy complications can risk your life or health if you continue the pregnancy.
Sometimes, it can be hard for healthcare professionals to know how some conditions might affect you or your baby and how things will progress.
When healthcare professionals might talk to you about the option of terminating your pregnancy
Your healthcare professional may talk to you about termination if your baby has been diagnosed with a condition that can cause death or serious disability or if a pregnancy complication puts you in danger.
You should not feel under pressure to end your pregnancy. This is your choice, and your healthcare professionals will support you whatever decision you make. However, if your life is at risk, they will strongly recommend that you agree to a termination.
When termination is not offered
Sometimes a fetal anomaly is diagnosed but your healthcare professional does not discuss ending your pregnancy with you. This is because they do not believe the condition they have found is serious enough to offer termination.
If your doctor does not offer a termination and you want one, you can ask for a second opinion or see your GP, who can help you get one if you are less that 23 weeks and 6 days’ pregnant.
If you are 24 weeks pregnant or more and your doctors do not support a termination, you should be referred for a second opinion.
At this stage, the law around termination becomes stricter. It can only be offered if 2 doctors agree that:
- it would prevent grave, permanent injury to your physical or mental health
- carrying on with your pregnancy involves risk to your life
- there is a substantial risk of your baby being born with serious disabilities.
If you are still not offered a termination after seeing a doctor for a second opinion, you should be offered counselling.
Coming to a decision
It is very important that you feel you have all the information you need to help you decide what is best for you.
You will probably go through a range of emotions, as you try to make sense of what is happening and think about how to move forward. People have told us that they felt devastated at the loss of the healthy baby they had hoped for. Others may feel very anxious about making the decision or guilty about even thinking about ending their pregnancy. There is no right or wrong way to feel about what you are going through.
Your healthcare team should tell you as much as they can about the diagnosis and what this means for you and your baby. Depending on the condition, you might want to speak to a range of specialists, such as a paediatrician, neonatalogist, paediatric surgeon, geneticist or fetal medicine specialist, to get more information. Sometimes it can be hard to predict how the diagnosis may affect your baby’s health.
There may be support organisations that can give you information about what it can be like to live with the condition your baby has. Ask your healthcare professional if they can give you the details of any organisations that can tell you more.
“When we went to our 20 weeks scan and found out our baby had not developed how he should have and that he would not survive after birth, we knew TFMR was the right thing to do for him, to protect him from any pain, regardless of how heart breaking it was for us.”
Taking the time you need
In most cases you should be able to take the time you need to make your choice. But it can be hard to take in all the information you are given.
Take it at your own pace. Ask questions, even if you think you have asked them before. If there is anything you do not understand, someone in your healthcare team explain again. They are there to support you and help you explore your options.
If possible, you could try writing some questions down before any appointments. It may also help to bring your partner, a friend or someone in your family to appointments so they can take notes for you.
It is common to want to ask why this has happened to you and your baby. Health professionals can sometimes suspect what has caused pregnancy complications. For example, an infection in pregnancy or a genetic problem. But it is often difficult to be sure of the exact cause, so it may be very hard for your doctors to answer this question. This can be very difficult to come to terms with and can lead to some people unnecessarily blaming themselves. But it is not your fault.
Most people will be given as long as they want to decide how to move forward. However, if you are nearly 24 weeks pregnant you may need to decide quicker. This is because the law around termination is stricter after 24 weeks.
“We made the heartbreaking decision to have a termination for medical reasons after finding out our baby boy had severe myelomeningocele spina bifida at our 20 week scan. Although there were many unknowns and no crystal ball to see into the future, after talking with multiple medical professionals, further scans and conducting our own research online, everything pointed to the reality that his life would be severely impacted forever, even with neonatal and lifelong medical intervention. Never did we imagine ourselves in this position and it's a decision no parent should have to make. But we took on a lifetime of pain so he didn't have to. Our decision came from pure love, love that we will carry with us forever. We think and talk about our baby boy everyday and hope one day to give him healthy siblings. We are forever grateful for the time we got to spend with our baby boy when he was born and to the maternity and medical team who cared for us.”
Getting more support
Our midwife helpline is available to help answer any questions you might have or even just to chat if you need to talk it through. It is open Monday-Friday, 9am-5pm – call us on 0800 014 7800. Or you can email [email protected].
The charity Antenatal Results and Choices aims to give you information and specialised support. They will not direct your decision, but they can help you make sense of what you have been told and gather the information you might need. ARC can help you make a decision that feels best for you and your family. Their helpline is answered by trained staff.
Call 020 7713 7486 (Monday-Friday, 10am-5.30pm) or email [email protected] to arrange an evening call (Tuesday and Thursday, 8pm-10pm).
If you decide to continue your pregnancy
Your healthcare team may recommend that you are cared for at a fetal medicine unit or by a midwife alongside a specialist doctor (obstetrician).
You may also be cared for by a specialist bereavement midwife if your baby is stillborn or dies soon after birth.
When your baby is diagnosed with a fatal condition (a condition that they cannot survive) specialist (palliative) care should be arranged for after you give birth. This will help make sure the baby is as comfortable and well cared for as possible.
If your baby’s condition is complex, they will need to be born in a hospital where they can receive specialist support straight away.
Your midwife should also arrange the right antenatal care for you.
Having a termination
There are 2 types of termination: medical and surgical. Before 24 weeks, you should be given a choice, unless there are medical reasons why one would be safer for you.
Your healthcare professional should clearly explain your options so you can decide which method you can best cope with. Do not be afraid to ask questions, so you feel you have all the information you need. You might wish to ask the following.
- Where will the procedure take place?
- Can my partner, family member or friend stay with me?
- Who will be looking after me?
- When will I be able to go home? Or will I be able to stay in the hospital if I want to?
- Will it be painful? If so, what pain relief can I have?
- Are there any risks involved?
- What should I bring with me if I need to stay in hospital?
Some people may want to see or hold their baby after the procedure. This will be possible if you have a medical termination, but not if you have surgery.
If you feel you need more information, the British Pregnancy Advice Service (BPAS) may also be able to help. It also has specialist care services for if you have decided to end your wanted pregnancy for medical reasons.
A medical termination involves taking medicine to end your pregnancy. It can be used at any stage of pregnancy. Two doses of medicine are taken 24 to 48 hours apart. You will likely experience abdominal (stomach) pains after taking the second dose of medication.
If you're over 10 weeks pregnant you need to take these tablets at hospital and you will stay there hospital to give birth to your baby and the placenta. This process can take several hours, and you should be offered pain relief to help cope with the pains.
You will be awake and aware of what is happening, you may see the baby after they have been born. Your healthcare professional can explain what this may be like, depending on how far along your pregnancy is.
When a medical termination is carried out after 10 weeks of pregnancy, you will usually need to stay in overnight. Occasionally, the placenta does not come away after you give birth, and you will need a surgical operation to remove it.
If your pregnancy is in the second trimester or onwards you might find this information about the physical effects of losing a late-term baby helpful.
Seeing and holding your baby after a medical termination
You may be asked if you want to see or hold your baby after a medical termination in hospital (although this is not always possible). Your wishes will be supported by your healthcare team, whatever you decide. You do not have to make a firm decision in advance – some people see how they feel at the time. You may want to talk to a trained professional, as well as your loved ones, about what feels best for you. If you choose not to see your baby, you can still ask hospital staff to take a photograph or hand and footprints, if you want to.
A surgical termination can be carried out in 1 of 2 ways depending on how far along you are in your pregnancy. In both cases, you will usually have a general anaesthetic, which means you will be asleep during the procedure.
Vacuum or suction aspiration
This can be used up to 14 weeks of pregnancy. The doctor uses a local anaesthetic to numb the entrance to the womb (the cervix). A tube is then inserted through the cervix and the pregnancy is removed using suction. Vacuum aspiration takes 5 to 10 minutes, and most people go home a few hours later.
Dilation and evacuation (D&E)
This is used from around 14 weeks of pregnancy. It involves inserting special tools called forceps through the cervix and into the womb to remove the pregnancy.
It normally takes 10 to 20 minutes, and you might be able to go home the same day. Very few NHS hospitals can offer D&E but independent providers (under NHS contract), such as British Pregnancy Advisory Service (BPAS) or can provide D&E until 24 weeks.
If termination takes place when you are 22 weeks pregnant or more
If you are having a termination on or after 22 weeks, you will be offered a procedure before your termination to stop your baby’s heartbeat.
It involves an injection through your tummy (abdomen), which stops your baby’s heart. This means that they will die before they are born. This can be another tough decision for you to make. Some people decide not to have the injection if their baby has been diagnosed with a condition that means they will die at or very near birth. However, some doctors may not agree to end the pregnancy without it.
This is carried out at a specialist fetal medicine centre. Your medical team will be able to talk to you about what it will involve.
Having a funeral
All babies, regardless of the stage of pregnancy or the circumstances of their birth, can have a funeral. But it is up to you if you do decide to have one. Some parents find that although a funeral can be distressing and painful, it is also a chance to acknowledge their baby’s short life and say goodbye.
Trusts and Health Boards have a responsibility to make sure you are offered choices about burial, cremation and funerals for their baby. Talk to your midwife or the hospital chaplain about your options. Your hospital will offer you choices or you can arrange and pay for the funeral yourself.
If you are having a surgical termination and you want to bury or cremate your baby, speak to your medical team before your surgery happens.
We have more information about planning a funeral for your baby after a stillbirth that you may find helpful.
After ending the pregnancy
Whatever type of termination you had, your hospital should arrange a follow-up appointment about 6 weeks after. They will check how you are physically and talk through what happened with you.
If you had a medical termination, the doctors may have been able to do a post-mortem examination to find out more about your baby’s condition. Some tests can also be done after a surgical termination. A post-mortem will not be done without your permission (consent), unless a coroner (procurator fiscal in Scotland), who is a legal official who investigates deaths, believes it is needed.
Tests can also be done after a medical or surgical termination to see if your baby’s condition was genetic. This can help your doctors assess how likely it could be that the same thing might happen again in a future pregnancy and what may be done to prevent this.
Again, you may have a mix of feelings. You may feel anxious about future pregnancies or you may not want to think beyond right now.
No matter how you are feeling, your doctor will be able to talk to you about how you will be cared for if you do get pregnant again. You do not have to decide anything at this point.
Telling friends and family
Whether you tell family or friends that you had a termination for medical reasons, and how much you tell them, is also entirely up to you.
You are the best judge of what you are okay with sharing. Take the time you need to think about it and tell people when you feel ready.
Most people will try to support you or say something comforting. This can be a huge comfort, but unfortunately, some people’s reactions may not always be helpful or they may say the wrong thing by mistake.
Some people have told us that they were asked questions that they found intrusive or simply too painful to answer. Do not be afraid to stop the conversation at any time if you feel you want to. It is okay to tell people that you do not want to talk about it anymore.
Talking to other people with similar experiences of loss
You may find it helpful to chat with other people who have had a similar experience.
We understand that it can be hard to tell your story, especially when you are not certain how it will be received. But if you are looking for support from peers the Tommy's Support Group is here for you.
Antenatal Results and Choices (ARC) specialise in support after a termination following a diagnosis of fetal anomaly. It has a password-protected online forum, where you can contact other people who have shared similar experiences.
Watch Healthtalk’s videos where people share their lived experience of ending a pregnancy because of medical problems.
Some people find it helpful to get some professional support. Counselling involves talking to a trained therapist who will listen to you and help you find ways to cope with your loss.
Your GP can refer you to a local counselling service, or if you are able, you can pay for a private service.
If you live in England and are aged 18 or over, you can refer yourself to NHS talking therapies services.
Some employee assistance programmes also offer free counselling. Ask your line manager or HR department what is available.
Be aware of counselling services that talk about ‘post abortion support’, as they can be anti-abortion organisations disguised as support. Antenatal Results and Choices can help you find a suitable counsellor or therapist in your area.
Getting pregnant again
It is a very personal decision if, or when, you want to have another baby. If you do, the healthcare professionals who cared for you through a medical termination should be able to give you advice about your health
Your mental health during another pregnancy
If you do become pregnant again you may feel a huge mix of emotions. This is completely understandable.
You can talk to your doctor and midwife about how you feel. Pregnancy can be emotionally challenging for anyone, but you have been through a distressing experience in your previous pregnancy, so you may need extra support.
For some, losing a baby can cause post-traumatic stress disorder (PTSD), which may lead to fear of childbirth in the next pregnancy. It can be very tough to come to terms with a traumatic event, but PTSD can be treated. The important thing is to seek help if you think you may have PTSD. Talk to your midwife or doctor, who will be there to support you.
You may want to spend some time thinking about how to manage any anxiety during this pregnancy. Some parents find it too difficult to go back to the same hospital, whereas others want to because the staff know their history. You may want to have more or fewer tests. Talk to your midwife or doctor about what your options are for how your pregnancy is managed.
More support and information
You can talk to our midwives for free on 0800 014 7800, which is open 9am-5pm, Monday-Friday.
There is also a Facebook forum, where you can connect with other people who have lost a baby.
Antenatal Results and Choices (ARC) provide specialised support services to those who have had a termination for medical reasons.
The Child Bereavement Trust has support groups and offers counselling as well as lots of online resources. They can also help siblings through a bereavement.
Twins Trust is a registered charity that has a bereavement group for support with losing a multiple birth baby.
Sands is the stillbirth and neonatal death charity supporting anyone affected by the death of a baby.
Petals provides and promote specialist counselling for parents across the UK following baby loss.