Module 3: Early surgical abortion theory

1. Learning objectives and module overview

Learning objectives

The objectives of this course are to provide the necessary theoretical knowledge to provide high quality early surgical abortions using vacuum aspiration. Participants will learn how to provide early surgical abortions that:

1. Are culturally safe and patient-centred
2. Manage patient pain using analgesia and/or sedation
3. Prevent infection through the use of sterile equipment, a “no touch” technique and antibiotic prophylaxis
4. Are safe, with knowledge and plans in place for the management of any complications.

Following completion of this course, trainees need to observe an experienced abortion provider before completing a minimum of 40 early surgical abortions with a competency-based assessment under supervision in order to become an early surgical abortion provider.

Module overview

This module describes the equipment, steps and skills required to provide early surgical abortion using vacuum aspiration. In contrast to an early medical abortion, which most commonly occurs in the person’s home environment, provision of early surgical abortion requires that the provider has the assistance of an additional qualified health practitioner(s), access to specialist equipment and suitable premises. The NZCSRH supports the provision of early surgical abortion by qualified health practitioners including nurses, midwives, non-specialist doctors and specialist doctors, and this is also recommended in the World Health Organization 2022 Abortion care guidelines.

It is essential that early surgical abortion trainees are aware of the safety plans in place to manage any potential complications in the service prior to providing early surgical abortions. Examples of plans that can be used as templates are within this module. We recommend developing support networks with local whakatahe abortion providers as they are the specialists in abortion care. You should also connect with local gynaecology services to enable referral for complications. You should be familiar with the available support services in your area including specific services for Māori, Pacific peoples and rangatahi (young people).

Before beginning this course, it is expected that participants will have completed the online NZCSRH Abortion Training Module 1: Consultation – communication and decision making module. Qualified health practitioners who intend to provide early surgical abortion must also:

• Hold a current practising certificate with their Aotearoa New Zealand professional body
• Hold a minimum of NZ Resuscitation Council CORE immediate certificate
• Have competence to provide contraceptive counselling
• Have completed long-acting reversible contraception (LARC) training and be able to fit LARC competently as per the New Zealand LARC standards (this can be done during early surgical abortion training)
• Be competent to provide the analgesia/sedation used according to The Australian and New Zealand College of Anaesthetists (ANZCA) PS09 guideline. Many hospital sites will have processes for sedation accreditation and training. One online training option for safe sedation training alongside the clinical training is available at safesedationtraining.com. Please contact the NZCSRH if you are interested in further sedation training as we may provide this in future if there is sufficient demand.