Contraception & Termination of Pregnancy

Every sexual intercourse has the chance of resulting in a pregnancy. That is fine if you are ready to be parents and want to have a child. If not, you should not take chances but practice contraception. There are many contraceptive methods in use today. Each has its own advantages and disadvantages with varying effectiveness.

1. Oral contraceptive pill - a synthetic hormone pills, many varieties are available in the market to suit different women. Women on this method take one tablet everyday for most or all of each month. It is very effective and is safe and acceptable to most women.
2. Contraceptive plaster (Evra) – The coolest invention in 2002. Contraceptives delivered in plaster form and last for 1 week. Patient uses 3 plaster in a month. Effectiveness is 99%. The advantage is that it has better compliance for patients and not easily to forget.
3. Contraceptive injection - this is an injection form of synthetic hormone. The injection is given every two or three months depending on the type of manufacture. It is almost 100% effective, long-acting, easy to use and safe.
4. Contraceptive implants - another synthetic hormones contained in a set of capsules called Norplant. The capsules are inserted by a doctor under the skin of the woman's arm under local anaesthesia. It is almost 100% effective, long-acting lasting for 5 years and safe.
5. Condom - a thin sheath of rubber worn over the erect penis during sexual intercourse. Ejaculated semen is trapped in it and so prevented from entering the vagina. It offers good protection (75%) if the man uses it correctly and consistently. Effectiveness is increased if used together with a spermicide (90%).
6. Intra-uterine Device (IUD) - a small device which is inserted into the womb. It is inserted by a doctor. The effectiveness is 97%-98%. It can be left in the womb for 2-5 years depending on the type of IUD.
7. Spermicide - chemicals that kill sperms, available in the form of a vaginal foam, jelly, cream, pessary, tablet or aerosol. It is not very effective on its own (70%). Should be used with the condom.
8. Diaphragm - a flexible cup-shaped device made of rubber. It is out of fashion and not available in the local market.
9. Rhythm methods of safe periods - there are two rhythm methods of birth control - calendar and temperature. In both the woman abstains from intercourse for between 10th to 18th days of each menstrual cycle so as to avoid intercourse on the days when she is most likely to conceive. This method is unreliable. It depends on the regularity of the menstrual periods of the women.
10. Sterilization - this consists of an operation on the fallopian tubes to prevent eggs passing from the ovaries to the womb. It is a day surgery using laparoscope. It does not affect health or sexual relations. It is very effective and also would enhance sexual life as there is no need to worry about unwanted pregnancies. This is considered as a permanent method though failure does occur (1 in 500 cases) and rejoining of the tubes are possible using microscopic surgical technique.

Abortion is not a contraceptive method. It is often a controversial and emotional issue. Always practice family planning if you are not ready to start having a child. Prevention is better than cure. Once a woman decide to terminate the pregnancy, time becomes important.

Termination of Pregnancy

Abortion is the most widely used method of birth control in the world. It has been estimated that nearly 1 in 4 pregnancies are terminated, many illegally. There has been a gradual liberalization of abortion laws, and today well over 75% of the world's population live in countries where abortion is to a greater or lesser extent legal. Different countries have different laws. The limit of abortion varies from 20 to 24 weeks in various countries. In Singapore, abortion is legalised on socio-medical ground. The legal limit is 24 weeks pregnancy.

There are four types of abortion:

1. Menstrual regulation - also known as interception, and menstrual suction. This is a preemptive abortion technique, meaning that it can be performed for up to 2 weeks after a missed period, even before a pregnancy can be positively confirmed. This term was used in the seventies when the status fo missed period was not known. With modern easily available diagnostic pregnancy test and ultrasound, it is replaced by Suction Aspiration.
2. Suction aspiration - also called vacuum curettage, suction abortion, or STOP (suction termination of pregnancy). Sometimes it is done with the procedure called D & C (dilation and curettage). This is similar to the above but using a bigger suction machine. It is meant for pregnancies less than 14 weeks. This is one of the safest and simplest method in surgical procedure.
3. Prostagladins - this is a medication to induce early labour as suction is not easy to perform for bigger pregnancies. It can be used till 24 weeks, the legal limit in Singapore.
4. Hysterotomy - this is used in cases where prostagladin method fails. The fetus is surgically removed in a process similar to Caesarean section. This is not often done as the above method usually works well.

Illegal Abortion

"Back-street" and self-induced abortions are still present - worldwide they cause 30-50% of all maternal deaths from pregnancy and childbirth. With the improvement of childbirth, this figure may be even higher. The complications arise mainly from unhygienic and unskillful abortions resulting in infection, injuries and hemorrhage.

Procedure for an abortion

1. Please bring with you your identity card (IC) or passport to the clinic. The clinic is legalised for abortion. Please make an appointment at 6736-3331.
2. After seeing the doctor, you will be counselled for the procedure with the viewing of the counselling tape.
3. After counselling, you can go through the procedure after 48 hours for citizens. Non-citizen do not have to wait.
4. The procedure of TOP takes about 10-15 minutes and patient will rest for 1-2 hours after the procedure for observation and for recovery from the sedation.
5. You are recommended to have a post operation examination in 1 week and 4 weeks when you should experience a new menstrual cycle. However , a scan will be done after the procedure if you are unable to return for follow up. The urine will take 2-3 weeks to turn negative.
6. Please come to the A & E of the Mt Elizabeth Hospital (Tel: 67312218) should you have an emergency or call Answering Service at 6535-8833. The doctor will attend to you. You may also call the clinic at 6736-3331 during office hours for any help.

[Copyright 2005]
Lien Clinic for Women
Mount Elizabeth Medical Centre, 3 Mount Elizabeth #05-03, Singapore 228510
Telephone: (65) 6736 3331, E-mail: lien@lienclinic.com