Abortion Services in New Zealand

Wellington

Capital & Coast DHB

Kapiti Coast District (Paraparaumu, Waikanae and Paekakariki-Raumati Wards only), Porirua City, Wellington City

Licensed institutions

Wellington Hospital

Services provided

Te Mahoe Unit - Wellington Regional Hospital

Previously Level J Unit in the Grace Neill Block, the shift to Te Mahoe in the Wellington Regional Hospital took place on 13 February 2009.

Te Mahoe Unit provides an abortion service for the greater Wellington area (Capital & Coast and Hutt Valley DHB) and accepts referrals by arrangement from Mid Central, Whanganui, Nelson-Marlborough, Hawkes Bay and Tairawhiti.

Facilities

Te Mahoe Unit is a modern, purpose-built facility, part of the Women's Clinics in the Wellington Regional Hospital.The unit works within the context of the law to provide legal, safe abortions.

There are no childcare facilities in Te Mahoe Unit, so patients are strongly encouraged to arrange childcare for the entire day of the procedure. No children under 16 years are allowed in the Ward area under any circumstances.

Staff

The multi-disciplinary team within the unit is made up of nurses, midwives, social workers, doctors and administrative staff. Te Mahoe Unit staff are committed to providing the highest quality care and support for women through this often very stressful decision-making process, while protecting the privacy and security of clients.

Protestors

There may be anti-abortion protestors outside the hospital grounds. These people are not permitted to trespass on Capital & Coast Health campus and have no way of knowing who is coming to Te Mahoe Unit.

Te Mahoe Unit itself has a well-designed security system in place to protect clients and staff and security is alerted if protestors harass patients or enter hospital grounds.

Confidentiality

All staff members at Te Mahoe Unit uphold confidentiality as one of the most important aspects of service provision. All patient notes are held separately and are not integrated with a patient's main hospital notes. A secure computer system provides a high level of protection. Te Mahoe Unit does not release any information without the consent of the patient. All enquiries to Te Mahoe Unit can be made in total confidence.

Location and contact details

Te Mahoe Unit is part of the Women's Clinics and is located on Level 3 in the Wellington Regional Hospital, Riddiford Street, Newtown, Wellington.

Parking is available in the basement of the hospital. Parking is $8.00 per day.

Phone: (04) 806 0761
Facsimile: (04) 806 0323
Public transport (Wellington)

There is a bus stop located directly outside the main hospital and buses operate frequently to the hospital. Volunteer drivers may be available for women in the Wellington area. This requires advance notice.

Public transport (out of town patients)

Te Mahoe Unit does not provide or fund transport for out of town patients. The social worker assisting with the referral will help arrange appropriate transport for women, if needed.

Accommodation options

For patients who wish to stay close to the hospital there are a range of hotels available in Newtown. Accommodation can be arranged at the Riddiford Street Hostel or Te Pehi Parata Whānau Whare at reasonable fees. Please work with the referring general practitioner (GP) and social worker to arrange accommodation well in advance of your appointment.

Te Mahoe Unit Services

Pre-decision/pregnancy options counselling

Te Mahoe Unit provides pre-decision counselling as part of its pregnancy options counselling and termination services. If women are unsure of their options or require support while making the decision, they can make an appointment with Te Mahoe Unit. This does not require a referral.

Women who decide to continue their pregnancy can be assisted to access antenatal care and support.

Women who decide to continue with the termination process will need to see their GP or other health care provider for a referral if they have not already done so.

Termination prcedures at Te Mahoe Unit:
Surgical termination from 6-14 weeks of pregnancy

This operation is performed in Te Mahoe Unit under local anaesthetic (LA) with conscious sedation.

Surgical termination up to 19 weeks of pregnancy

This is done in Main Theatre under general anaesthesia (GA). For women over 16 weeks this is a 2 day procedure.

Early medical termination up to 63 days with Mifegyne® and misoprostol

This is a 2 day procedure with a 24 hour interval between the two medicines.

Induction of Labour from 16-19 weeks with Mifegyne® and misoprostol

This is 2-3 day procedure with a 48 hour interval between the two medicines.

Post-abortion counselling

Post-abortion counselling is available to all women, their partners and family/whānau, should they require further support after the termination.

General Information

Information required from the referrer

All patients requesting a termination must see a health care provider who will refer them to the unit. This can be any GP, or Family Planning Clinic.

Te Mahoe Unit will need the following information from referring agencies:

Non-New Zealand residents

Non-residents may have to pay for their procedure. Te Mahoe Unit can advise on eligibility criteria and fees or refer to www.moh.govt.nz/eligibility for complete guidelines. The patient's passport needs to be seen by the unit to confirm residency status.

Fees (current to June 2011)
Interpreters

To comply with our legal responsibilities and to ensure that clients make informed choices/decisions:

Te Mahoe staff will arrange a professional interpreter from a reputable service when it is felt that the woman does not have the language skills to clearly understand all aspects of the procedure and consent process. Information on contraception and the procedures are available in several languages.

If a woman is not eligible for free health care in New Zealand, she will be required to pay for interpreting services.

A Chinese social worker is available onsite to provide service to our Mandarin and Cantonese speaking clients.

Contraception

Contraception can be arranged at Te Mahoe Unit, whether it is a prescription, the insertion of an IUCD, a Depo-Provera injection or the insertion of an implant (Jadelle). Encouraging safe sexual practice and pregnancy prevention will be emphasised at each contact ie: social workers, doctors, nurses/midwives. This is to ensure that all patients understand how to use their chosen method of contraception, what to do if it fails and how to stay healthy and safe. Sterilisation requests should be made by your GP during your referral visit or your post-termination visit.

Sexual health services

Te Mahoe Unit has close ties to Sexual Health clinics and has the ability to treat undiagnosed sexually transmitted infections (STIs) at the time of visit to Te Mahoe Unit.

Sexual health promotion is an integral function of the Unit and all members of the multi-disciplinary team are trained in contraception and sexual health issues.

Medical certificates

If an employer or school requires a medical certificate, we can provide one for the days of all appointments at Te Mahoe Unit. The medical certificates are generic to Wellington Hospital and do not identify the nature of the visit.

Referral to other services

From time to time clients come to the unit with other significant issues and may need support and/or referral to other social services. We are happy to make referrals to other agencies, including Women's Refuge, Mental Health Services, Relationship Services and government agencies.

Wait Times

For a Day One appointment the expected wait time is between one day and two weeks from date of referral. Expect to be at the unit for approximately 3 hours for counselling and the medical assessment.

Day One and Day Two are not consecutive days.

The procedure day or Day Two appointment will be booked generally 2-10 days after the Day One visit. Expect to be at the unit for about three hours for a local anesthetic or early medical procedure and all day for a general anesthetic or second trimester medical procedure.

Women being referred from out of the Wellington area who have arranged counselling in their district of origin, will usually be booked for Day Two only. This can be discussed with the social worker assisting in the referral.

Support

Te Mahoe Unit encourages women to have adequate support by family and friends during their visit, especially on Day Two. However, due to limited space, only two support persons are admitted into the ward area, and no support persons are admitted into theatre. It is Te Mahoe policy that women are seen alone initially for counselling and medical assessments. Once initial assessments have been done, she can request outside support be invited to the session.

Māori Health Unit/Pacific Island Health Services

All clients who identify themselves as Māori or Pacific Islanders are provided information regarding accessing services within these units.

Chaplaincy Services

Patients are offered information about the chaplaincy service available in the hospital.

Out of town patients

If women are travelling from out of the Capital and Coast area, most find it more convenient to have counselling and one certificate done in their own communities, if possible. For a list of Social Workers in other areas that can assist with the process, contact Te Mahoe Unit.

History & team values

History

The Wellington Hospital Board set up the stand-alone Parkview Clinic in 1980 following the passing of the Contraception, Sterilisation, and Abortion Act (1977). The clinic serviced women requiring first trimester (under 12 weeks) abortions. In 2000, the service moved into the Grace Neill Block, WellingtonWomen's Hospital and became the Level J Unit, providing counselling and termination of pregnancy services for women in a safe and comfortable environment.

During the early years of the clinic's existence there was much controversy and harassment of women and staff by anti-choice/anti-abortion protestors. However there has always been strong community support for the clinic.


With the building of the new Wellington Regional Hospital Level J Unit was moved on 13 February 2009 into the new premises on Level 3 as part of the Women's Clinics. The name was changed to Te Mahoe Unit.

Te Mahoe Unit is staffed by a dedicated multi disciplinary team who is committed to providing a safe, legal, ethical abortion service for women from the greater Wellington area and other contracted areas.

Team Values

The Te Mahoe team acknowledges the importance of the following values and agrees to work to them in all business dealings.

Mission Statement and Values
To provide safe, legal and ethical services

Dignity
We respect the individuality, cultural perspective and dignity of all people

Professional Health Care
We are committed to quality care and will work with integrity in our practice in the future

Teamwork
We will work together recognising the contribution of each team member.

Abortion process at Te Mahoe Unit

Day One

Counselling

Day One counselling gives you the opportunity to fully explore your options within an environment of practical and emotional support and can also provide clarification of any conflict involved in your decision making (e.g. relationship, religious, cultural, spiritual or moral issues).

Certification

Te Mahoe Unit offers women on site certification in terms of the Crimes Act 1961 and the Contraception, Sterilisation, and Abortion Act 1977.

The Day One consultant will go through a medical assessment to include a medical history and a physical examination. Swabs and bloods may be taken if the referring doctor has not done so already. This medical assessment looks at the suitability of the woman for the procedure and helps to determine which procedure is most appropriate. The doctor will discuss the decision to have a termination and will answer any medical questions. When a woman is certain about her decision to terminate her pregnancy and the doctor agrees that she fits the criteria as stated in the law, the first certificate is signed.

Contraception is also discussed and arranged, as required, as well as medication for any untreated sexually transmitted infections.

Booking Nurse

After the consultation with the Day One certifier, the Booking Nurse arranges the time and date for the procedure. The nurse will also go over what preparations are required before the day of the procedure and go over contraception use, if required. The entire Day One process takes about 3-4 hours.

Day Two - Procedure Day

Second certifier

A second doctor reviews the decision to terminate with the woman, and will sign the second certificate, again, if she is certain of her decision and provided she meets the legal criteria. Informed consent will be carefully reviewed with each patient by the certifying doctor. Prior to the procedure, the following will need to be signed. All women must feel confident that:

The procedure

Once the second certifying consultant has signed the certificate and all informed consent has been signed, a support nurse/midwife who follows each woman through the Day Two process will be introduced. Here the support nurse will begin pre termination preparation.

For surgical abortions:

Local Anaesthetic (LA) Procedures
Patients will go through to the Te Mahoe Unit on-site theatre.

General Anaesthetic (GA) Procedures
Patients will be transported into the main hospital's theatre.

For women over 16 weeks undergoing a GA procedure, it will be a 2 day process. Depending on certain criteria some women may be given Mifegyne® or Laminaria 24 hours prior to the TOP.

Primiparous women: 14-16+6 Mifegyne® 24 hrs pre-op

                                  17 wks+ Laminaria 24 hrs pre-op

Multiparous women: 15 wks+ Mifegyne® 24 hrs pre-op

Laminaria may be inserted into the cervix to begin slowly and safely to dilate the cervix. This takes about 10 minutes after which the woman can go home and return the following day. This is considered the beginning of the termination and once inserted, the procedure must be completed within 24 hours.

All women are given misoprostol tablets for priming the cervix (neck of the womb) approximately one hour prior to surgery. The time in theatre for the surgical procedure is approximately 15 minutes. There is a one-hour post-surgical observation to ensure no complications have arisen. Once the support nurse/midwife is satisfied with the recovery, the woman is discharged. The support nurse/midwife will then write a discharge letter to be faxed through to the referring doctor.

Expect to be in hospital on Day Two for 3-4 hours (LA procedures) and all day for GA procedures.

For medical terminations:

Women will begin the first course of medicine (Mifegyne®) on Day One and return 24-48 hours later for the second medications. The medicine begins the process of miscarriage. In the first trimester of pregnancy, it may take anywhere from 2-3 hours to complete up to several days. If termination is not completed by the end of the day, women are advised of the necessary follow up required to ensure completion and the referring doctor is informed.

Once the (Mifegyne®) is administered, the woman must return within 24-48 hours for the misoprostol.

Many women choose to go home and complete the process at home, the Te Mahoe staff being in contact with them trhoughout the day via the phone. However there are some women who need to remain in Te Mahoe if for example they do not have adequate support during the day.

If the pregnancy is 16 weeks or greater, the Day Two process can take anywhere from 1-3 days. Most women complete on the first day, but it is possible to be admitted for a 1-2 night stay in hospital. Adequate childcare must be arranged in advance to allow for an extended stay if needed.

Follow up

A follow-up appointment is recommended with the referring provider. We suggest making an appointment with the referring provider for 10-12 days post abortion for a follow up visit. Please check with your doctor for cost information.

Second trimester abortion services for fetal anomaly are provided by the Maternal Fetal Medicine Team in Ward 4 North of the Wellington Regional Hospital in conjunction with Te Mahoe.

This service is available for all women in the wider Wellington region as well as women from Whanganui, Hawke's Bay, MidCentral and Nelson-Marlborough District Health Board areas. In some of these areas only women with more complicated problems and more advanced pregnancies are referred.

Appointments
Preferred contact: Maternal Fetal Medicine Coordinator
Phone: To be advised
Facsimile: To be advised

A phone call should be followed by a faxed letter with full information. Women will be seen within seven days for Maternal Fetal Medicine referrals.

Information required from the referrer

Demographic data, including NHI number, gravida and parity, LMP, antenatal bloods and full information regarding the anomaly including films of USS if performed.

Certification

Certification will be provided by the MFM Team consultant, and the second certificate by another member of the team. This usually does not require the woman to be interviewed by more than one certifying consultant.

Counselling

Counselling is provided by the Maternal Fetal Medicine Team consisting of the obstetrician and midwife. If appropriate, further counselling can be accessed from the experienced Te Mahoe Unit counsellors.

The procedure

The method used is a medical induction of labour, using mifepristone (Mifegyne®) and misoprostol (Cytotec®). The protocol recommends the Mifegyne® be given 24-48 hours before the misoprostol. Women then return for the induction with misoprostol tablets. This usually only takes one day but will extend to a second or even third day for some women. Admission for misoprostol may be to Te Mahoe Unit or another Ward.

Accommodation can be found near to the hospital for the interim 2 nights. Partners are able to stay in the ward during the induction period. Women will always have a single room and are cared for during the process by experienced midwives under the care of the Maternal Fetal Medicine Team and Te Mahoe Unit. In Te Mahoe Unit no children under 16 years are allowed into the Ward area.

Follow-up

Follow-up is provided by MFM team although if women chose not to return to Wellington they can be seen by their referring obstetricians. However, if there is a genetic abnormality they will be referred to the geneticists who provide out-reach clinics in Wanganui, Hawke's Bay, Masterton and Nelson. Counselling is available in Te Mahoe either pre or post termination for those women/family desiring it.

Cost

The service is free for eligible patients. The charge for non-NZ-residents is at the usual cost for in-patient hospital treatment.

DHB responsibilities

All District Health Boards are required to provide termination of pregnancy services "for those women who meet the criteria provided by the Crimes Act 1961 and the Contraception, Sterilisation, and Abortion Act 1977". See Ministry of Health. However they may not necessarily provide the services themselves. Accessing accurate, up-to-date and informative details about how individual District Health Boards provide these services, has been extremely difficult. The information provided here is the best that we have been able to obtain for this district to date. We will continue to update the website as we obtain further information.

Last Updated: 10 June 2011