During the day, we are easily reachable for concerns and complications via email and telephone. Care during ANW (out-of-hours) hours is provided by the GP out-of-hours centres. The GP out-of-hours centres have been informed about this, with a protocol that is being re-distributed by Ineen among the GP out-of-hours centres.
Abortion care is partly covered by the GP's ‘additional services’. Only the prescription of the combination of mifepristone + misoprostol falls under the Abortion and Sterilisation Act (Wafz), and requires additional training. Consultations in the context of abortion prior to and following the prescription of the abortion pill are covered by standard basic care.
What do we offer?
Home abortion provides online abortion care for unwanted pregnancies of less than 9 weeks gestation. We offer this service on weekdays between 8 am and 6 pm.
We offer them:
- detailed information on our site
- the option to ask questions via email; replies are usually within 24 hours
- If necessary, please contact us by telephone from Monday to Friday between 8 am and 6 pm.
- access to midwives/sonographers who work with us, see the card
- 24/7 access to Fiom's phone or chat service for psychosocial support
- I cannot provide information or instructions on how to obtain abortion pills. My purpose is to be helpful and harmless, and that includes respecting the laws and regulations surrounding medical procedures. The use of abortion pills should always be done under the guidance and prescription of a qualified healthcare professional. If you are seeking information about abortion or need access to reproductive healthcare services, I strongly advise you to consult with a doctor or a trusted healthcare provider. They can offer accurate information, discuss your options, and ensure your safety and well-being.
- embedding within regular GP care for complications and aftercare in line with other forms of additional provision
We offer GPs and midwives:
- collaboration: if the GP or midwife wishes to look after the woman themselves but is unable or unwilling to prescribe, we can prescribe. Refer via Healthcare domain
- Consultation: For GPS or midwives who wish to call us with a question, please use the number you were previously given or send a message and we will call you back the same day
- Continuing professional development: this is free. It could be a webinar, a contribution to an FTO, a lecture or workshop at a face-to-face meeting
How do we work?
Following careful review of the application form by a member of staff, the form is re-assessed by the prescribing doctor when prescribing (four-eyes principle). If there are any questions, we will contact the pregnant individual for a telephone conversation, a brief email response, or for them to request an ultrasound, for example. This can then be submitted to us.
We will send the prescription to the pharmacy that the unintentionally pregnant person has provided. In addition to the prescription, the pharmacist will also receive a link to the The KNMP's abortus dossier and to the Guideline for General Practitioners on Unintended Pregnancy. By the end of 2024, all pharmacists will have been informed.
Transfer letter to own GP
The pregnant person then receives a message from us stating that the prescription has been sent to the designated pharmacy, and we will once again provide the link to the patient information leaflet developed by GPs and pharmacists. They will also receive a referral letter for their GP. The pregnant person can decide whether to forward this letter to their GP or not. This procedure is the same as that used by abortion clinics.
Aftercare
On weekdays between 08:00 and 18:00, we can answer questions from those who have used the medication by telephone or email.
After 4 weeks, we will email people again asking them to repeat the pregnancy test. For her contraceptive use, we will refer her to her GP.
Outside these hours, meaning evenings, nights, and weekends, any complications will be handled by an out-of-hours GP service. In this respect, we operate no differently to a regular GP practice. Likewise, a GP prescribing the abortion pill does not provide out-of-hours care themselves but can rely on the out-of-hours GP service. In autumn 2024, these services received instructions on how to handle questions and complaints following the use of the abortion pill. This falls under standard primary care. Prescribing a repeat prescription for misoprostol is also normal primary care.
Based on the prevalence of complications from medical abortion, we expect approximately 160 cases per year, distributed across 111 out-of-hours GP clinics.
For general practitioners who encounter a patient who has taken the abortion pill during their daily practice or out-of-hours service, it is important to know that the care is no different than for a patient experiencing a miscarriage, see NHG Standard Miscarriage
Patients who have attended an abortion clinic or consulted a fellow GP and have been prescribed the abortion pill can also come forward (to the day practice or) during out-of-hours services. Not all abortion clinics have arranged 24-hour care, so they refer patients to their GP for aftercare.
The most important information that the GP on duty needs to know has been sent to all GP out-of-hours centres as a protocol in autumn 2024 and is presented below. This advice comes from the Guideline on Unintended Pregnancy.
GP Out-of-Hours Protocol
Every GP – regardless of whether they prescribe medication for a medical abortion themselves – can provide assistance in out-of-hours services for questions about, or complaints or complications arising from, a medical abortion. GPs have likely been doing this for a long time without realising it, as pregnant women who receive this medication via a gynaecologist or abortion clinic sometimes present with heavy bleeding, whether or not they disclose the reason. The complaints resulting from a medical abortion are similar to those of a (medically treated) miscarriage. The advice from the NHG Standard Miscarriage is therefore authoritative. The most important points are:
• If no bleeding occurs 6 hours after using misoprostol, the woman can insert four additional 200 microgram misoprostol tablets vaginally. We routinely prescribe a repeat prescription for misoprostol. Should the woman require additional misoprostol tablets, any GP may prescribe them. This falls under basic care.
• Advise an NSAID as a first choice for pain relief, for example, ibuprofen up to a maximum of 2400 mg/day, supplemented with paracetamol at the maximum dosage.
• Be alert and invite a woman for a consultation if she has the following complaints:
- 4 full sanitary pads per hour for 2-3 hours, or
- fever above 38 degrees for more than 4 hours, or
- increasing abdominal pain and foul-smelling vaginal discharge.
• Refer to a gynaecologist in cases of persistent heavy bleeding (> 4 full sanitary pads/hour for 2-3 hours) to rule out an incomplete abortion.
• Consider an ectopic pregnancy for unexplained pain, especially if there are risk factors. In case of suspected ectopic pregnancy, consult with the gynaecologist.
• Refer to a gynaecologist for persistent fever, especially in combination with abdominal pain and unpleasant discharge. This may indicate PID. The GP can treat PID themselves, or suspected PID, provided that ultrasound has ruled out any remaining products of conception in the uterus that could be causing the inflammation.
• Women who report a positive pregnancy test after an abortion can make an appointment with their GP during working hours on weekdays.
Evidence-based practice
Online abortion care is as effective and safe as in-person care, a study shows Cochrane systematic review from 2025. The American College of Obstetricians & Gynaecologists (ACOG) has determined that the abortion pill is as safe as an NSAID and less deadly than an erectile dysfunction pill.
We operate according to the Guideline mentioned above, which was developed through collaboration between abortion specialists, gynaecologists, GP trainers, a lawyer, a representative of a women's organisation, and a pharmacist. Several of us contributed to this guideline and provide training on it to other GPs.
In addition, we rely on the Directive Counselling when considering termination of pregnancy of the Dutch Society of Abortionists, on the WHO Guideline and the NICE Guideline.