Terminating a pregnancy for medical reasons (TFMR)

If tests show that your baby has a serious genetic or structural condition (not growing in the normal way), you may be offered a termination for medical reasons (an abortion) to end your pregnancy. This is the most common reason for a medical termination during pregnancy.

You may also be offered a termination if you have any pregnancy complications that pose a significant threat to your life or your baby’s if you continue the pregnancy.

Many women and couples told us they dislike the use of the word termination to describe their experience because of it's association with termination of unwanted pregnancies. They also feel it implies that they had more choice than they realistically had. Try to remember that it is just a medical term.

The feelings you will have if you think you need to end a pregnancy are as strong and painful as any other type of baby loss in pregnancy. 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 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.

When might a serious medical condition be found in pregnancy?

During your pregnancy you’ll be offered tests, called 'screening tests', to check your baby’s development. These will include ultrasound scans and other screening and diagnostic tests.

When screening tests show that you or your baby have an increased chance of a serious condition you’ll be offered diagnostic tests to find out more.

These are sometimes done at the nearest fetal medicine unit. This is a specialist service for women and their partners who are expecting a baby with a higher chance of not developing as expected.

What the diagnosis might mean

Depending on what the diagnosis is, it may be possible to treat the condition while you’re pregnant or after the baby is born. Other medical conditions found in babies may cause some disabilities, but they will be able to have a good quality of life with the right care.

However, some conditions found in babies (sometimes referred to as fetal anomalies, abnormalities, congenital disorders or birth defects) may cause chronic illness, serious disability or even stillbirth or neonatal death. Some rare pregnancy complications can also pose a threat to a mother’s life or health if she continues the pregnancy.

It can sometimes be very hard for doctors to predict how the condition might affect you or the baby or how it will progress.

The offer of termination

You are likely to be offered a termination if the baby has been diagnosed with a condition that can cause death or serious disability. You may also be offered a termination if a pregnancy complication poses a threat to your life.

You should not feel under pressure to end your pregnancy. Whatever is diagnosed, it is your choice and your healthcare professionals will support you whatever decision you make.

When termination isn’t offered

Sometimes a fetal anomaly is diagnosed but your doctor does not offer to end the pregnancy because they don’t believe the baby is at risk of severe disability.

If the diagnosis is made before 24 weeks, you can have a termination under Ground C of the Abortion Act 1967. This states that you can end a pregnancy if the risk to your physical or mental health is greater than if you continued with the pregnancy.

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 access one.

If the diagnosis is made after 24 weeks and your doctor does not support a termination, you should be referred for a second opinion. If you’re still not offered one after a second opinion, you should be offered counselling.

An individual decision

Whether you have a termination to end a pregnancy or not is your decision. You’ll probably go through range of emotions as you try to make sense of what’s happening and think about what would be best for you and your family. You may feel devastated at the loss of the healthy baby you had hoped for and distress for the baby you are carrying. You may also feel very anxious about making the right decision or guilt about even thinking about the possibility of ending your pregnancy.

This can be a very painful and difficult decision, so it’s very important that you feel you have all the information you need before you decide.

Your doctor should tell you as much as they can about the diagnosis and what this means for the baby and for you. If the prognosis (how a medical condition will progress) is very difficult to predict, you can ask to speak to other medical specialists, such as a paediatrician, paediatric surgeon, geneticist or fetal medicine specialist to get more information. However, sometimes outcomes are very difficult to predict. There may also be condition-specific support organisations that can give you information about what it can be like to live with the condition the baby has. Ask your doctor if they can give you the details of any organisations that can tell you more.

Take the time you need

In most cases, you should be able to take the time you need to make your decision. You are likely to be feeling very shocked and upset, so it can be hard trying to take in all the information you’re given. Take your time and don’t be afraid to ask any questions, even if you think you’ve asked them before. If there’s anything you don’t understand, ask your healthcare professional to explain again. They are there to support you and help you explore your options.

It can be very distressing when you’re trying to cope with some very difficult news and are anxious to make the right decision. If possible, you could try writing some questions down before any appointments. You could also ask someone to go with you and make notes for you as you’re talking to your doctors.

You may want to ask why this has happened. Complications in pregnancy occasionally have a suspected cause, for example an infection in pregnancy or family history. But unfortunately, about half of fetal abnormalities can’t be linked to a specific cause, so it may be very difficult for doctors to answer this question.

Most people will be able to take their time to decide how to move forward. However, if you’re nearly 24 weeks pregnant you may need to reach a decision earlier.After 24 weeks, doctors must decide whether the anomaly diagnosed fits the criteria of Ground E of the Abortion Act (substantial risk the child would be born with serious disabilities).

Getting more support

Our midwives are available to answer any questions you might have or even just to chat if you need to talk through your decision. Our support line is open Monday-Friday, 9am-5pm – call us on 0800 014 7800. Or you can email [email protected]

The charity Antenatal Results and Choices offers non-directive information and specialised support for people who have received a diagnosis after antenatal testing. They can help you make sense of what you’ve been told, gather the information you might need and support you to make a decision that feels right for you and your family. Its helpline is answered by trained staff:

• Monday-Friday, 10am-5.30pm
• on 0845 077 2290 (or 020 7713 7487 from a mobile)
• [email protected]

If you decide to continue your pregnancy

If you decide to continue your pregnancy, your care will be managed at the fetal medicine unit or by a midwife alongside a specialist doctor (obstetrician).

When a fatal condition has been diagnosed, palliative care should be arranged for your baby after you give birth. This will help make sure the baby is as comfortable as possible.

If your baby’s condition is complex, they will need to be born in a centre with immediate access to specialist support.

Your midwife should also arrange appropriate antenatal care, which may include one-to-one antenatal sessions tailored to your specific needs. You may also be given contact details for any relevant support organisations.

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 method would be safer for you. Your doctor should clearly explain what your options are so you can decide about your treatment. Don’t be afraid to ask as many questions as you need to, so you feel as comfortable as possible. You could ask:

• 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?
• Is the procedure painful? If so, what pain relief can I have?
• Are there any risks to the procedure?
• What should I bring with me if I need to stay in hospital overnight? 

Medical termination

This involves taking medicine to end the pregnancy and it can be used at any stage of pregnancy. Two doses of medicine are taken 48 hours apart. A medical termination can be managed at home, but if you are more than 10 weeks pregnant, you’re more likely to need to stay in hospital.

You will be awake and aware of the process, and you may see the pregnancy come away. Your healthcare professional can explain what this might involve 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 overnight. Occasionally, the placenta doesn’t come away after you give birth, and a small operation is needed to remove it.

Seeing and holding your baby

Some people decide that they would like to name or see or hold their baby after a medical termination. There is no right or wrong thing to do – it is about what you feel able to cope with. If you don’t want to see the baby, you can ask hospital staff to take a photograph or hand and footprints. You don’t have to make a firm decision. Some people see how they feel at the time.

Surgical termination

Surgical termination will be performed in one of two ways depending on how far along you are in your pregnancy. In both cases, you will have a general anaesthetic which means you’ll be asleep or conscious sedation where you’ll be relaxed, but awake.

You will not be able to see or hold your baby or have a photograph taken if you have a surgical termination.

Vacuum or suction aspiration

This can be used up to 15 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 women go home a few hours later.

Dilatation and evacuation (D&E)

This is used from around 15 weeks of pregnancy. It involves inserting special instruments called forceps through the cervix and into the womb to remove the pregnancy. The baby is not removed intact.

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 such as British Pregnancy Advisory Service (BPAS) can provide D&E until 24 weeks. BPAS have developed a pathway for women using their services to end a wanted pregnancy after a prenatal diagnosis.

If your termination takes place after 21 weeks + 6 days

If you are 21 weeks pregnant or more, you will be offered a procedure which is referred to medically as feticide. This is an injection to stop the fetal heartbeat, so the baby is not born alive. Some women may decide not to have the injection if the 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.

Your medical team will be able to talk to you about your options and how the procedure will be managed.

After ending the pregnancy

Whatever type of termination you had, your hospital should arrange a follow-up appointment about six weeks after. They will check how you are doing 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 the baby’s abnormalities. Some tests can also be done after a surgical termination. A post-mortem will not be done without your permission (consent).

Tests can be done after a medical or surgical termination to see if the baby was carrying a genetic condition. This can help your doctors determine whether there is the chance of the same thing happening again in a future pregnancy.

Having just been through a painful loss, this can be a very difficult conversation. You may be feeling very anxious about what this means for future pregnancies or you may not want to think about this at all right now.

Your doctor will be able to talk to you about how you will be cared for if you do get pregnant again, but you don’t have to make any decisions at this point.

Having a funeral

All babies, regardless of the stage of pregnancy or the circumstances of their birth, can have a funeral. You don’t have to have a funeral for your baby, but some parents find that although a funeral can be distressing and painful, it is also an opportunity to acknowledge their baby’s short life and say goodbye.

You can talk to your midwife or the hospital chaplain about what they offer (usually a cremation) 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’s remains, you should tell them before your procedure.

We have more information about planning a funeral for your baby.

You can also talk to the doctor or nurse at your hospital about your options.

Telling friends and family

Whether you tell family or friends that you ended your pregnancy is entirely your decision.

If you do decide to tell people, how much you tell them is entirely up to you. You may want to talk about everything that happened or only that you lost your baby. You are the best judge of what you are comfortable with sharing with others, so take the time you need to think about it and tell people when you feel ready.

Most people will try to be supportive or say something comforting when someone they know has lost a baby. Their support can be invaluable, but unfortunately, some people’s reactions may not always be helpful or they may unintentionally say the wrong thing.

Some women have told us that after giving people the news, they were asked questions that they found intrusive or simply too painful to answer. Don’t be afraid to stop the conversation at any time if you feel uncomfortable. Telling people that you don’t want to talk about it anymore is okay.

Talking to other people with similar experiences

If you don’t want to tell your family and friends, or they find it difficult to understand what you're going through, it might be helpful to contact others 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 feel ready, our Tommy's Support Group is here for you. 

Our Tommy’s Support Group is a safe destination for all members of the baby loss community. As part of the terms of joining the group, our members agree to help us maintain our supportive environment without judgement, as this is a place for everyone.

Antenatal Results and Choices 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 all shared similar experiences.

Healthtalk.org has video interviews with women talking about their decision to end their pregnancy because of medical problems.

Counselling

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 will be able to refer you to a local counselling service or if you are able, you can pay for a private service. You should be aware that some counselling services that offer ‘post abortion support’ have an anti-abortion agenda. Antenatal Results and Choices can help you find an appropriate 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 doctors who cared for you through a medical termination should be able to give you advice about your physical health.

Your mental health during another pregnancy

If you do become pregnant again, you may feel a huge mix of emotions. You may feel happy or relieved, sad about the baby you lost and anxious about this baby’s health. This is all 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 women, 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 difficult to come to terms with a traumatic event, but PTSD is treatable. The important thing is to seek help.

You may want to spend some time thinking about how you want 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 on Tommy’s free Pregnancy Line 0800 0147 800, open 9am-5pm, Monday-Friday. The midwives on the line have received training in bereavement care and welcome calls from parents who have lost a baby.

We also have an online forum where you can connect with other people who have lost a baby.

Antenatal Results and Choices (ARC) provide specialised support services to women, couples and families who have had a termination for fetal anomaly.

The Child Bereavement Trust has support groups, offers counselling and lots of online resources. They can also help siblings through a bereavement.

Twins Trust is the Twins and Multiple Births Association for support with losing a multiple birth baby.

Peer support

A very supportive community has built up over the last few years around pregnancy loss. The page below lists a number of blogs and social accounts from people who have suffered pregnancy loss/es or preterm birth.

"When my son was stillborn, I couldn’t find anything to read about the mum’s personal experiences and what to expect... I needed something real, something I could relate to." Hannah Pontillo

All write movingly about their experiences of loss, life after loss and, in some cases, pregnancy and pregnancy/parenting after loss.

Online communities supporting those who have gone through baby loss or preterm birth