1. The Question is HOW not if According to Best Practice Guidelines

2. The process First contact, setting the stage, the woman in control. Listen, affirm, screen & help her sort and plan first steps. First contact, setting the stage, the woman in control. Listen, affirm, screen & help her sort and plan first steps. Make appt. Make appt. Clarify health assessment data & do ultrasound Clarify health assessment data & do ultrasound Counsel to clarify decision re abortion & plan for follow up Counsel to clarify decision re abortion & plan for follow up [Early-late abortion; Medical or Surgical abortion options] Pre-op medication given Pre-op medication given The OR/Treatment room procedure: 5-15 min The OR/Treatment room procedure: 5-15 min Recovery: Physically and emotionally stable Recovery: Physically and emotionally stable Follow up in 2-4 wks. Follow up in 2-4 wks.

3. The Procedure Positioning on exam table Options for medication during Local freezing of cervix Cervix opened and cannula inserted Just enough suction Examine tissue: placental & fetal Walk to recovery, assess for 10-20 min Specialty consult needed??? Review plan for follow up

4. Guiding principles Woman centered; enhance woman’s health and reproductive control. Her choice, she in control. Woman centered; enhance woman’s health and reproductive control. Her choice, she in control. Do no harm!! Do no harm!! Delaying access, limiting info = Harm Delaying access, limiting info = Harm Recognize her social, cultural & family context Recognize her social, cultural & family context Confidentiality & privacy Confidentiality & privacy Trained and experienced staff Trained and experienced staff

5. The HOW Bringing the principles & the procedure together to do no harm and promote the health of women and families First contact critical. Quality of information provided! Community setting with access to specialty consult