For physicians

Information for Physicians

We are a woman-centred, not-for profit clinic offering women’s reproductive health care services including pregnancy terminations, compassionate and timely spontaneous abortion management, IUD insertions, STI screening and Pap testing. We provide professional interpreters for surgical abortion and spontaneous abortion patients who require this assistance. We also have contraceptive  resources in Chinese, Punjabi and other languages.
We appreciate your referrals for our services. If you would like more information about how Everywoman’s can assist your patients please contact our business line at 604-322-6576. The appointment booking line for patients is 604-322-6692.

You can download our clinic brochure here.

We would appreciate if your office could use our physician referral form.

IUD Insertion Referral Information

Pre-medication with IUD insertion
Ibuprofen 400-600 mg orally at least one hour prior to the appointment is suggested for everyone able to tolerate NSAIDs. It helps especially with cramping post insertion.The alternative is Tylenol ES 2 tablet PO. Most women will not require any other medication.
Percocet 1 tablet orally one hour prior to the appointment is suggested for women known to have a lower pain threshold (e.g endometriosis/pelvic pain syndrome with Mirena IUS insertion) and those who specifically request extra pain medication.
Misoprostol 400 mcg orally two hours prior to the appointment is suggested for young nulliparous women and those with a history of a “difficult” cervix (previous insertion difficult or failed).

IV Conscious Sedation
We have the capacity to offer IV sedation in extenuating circumstances where IUD insertion would otherwise not be possible. This service is reserved for carefully screened women and is rarely necessary.

Management of IUD Complications
For the few patients who experience complications post-insertion we strongly prefer to manage these cases here as we have the expertise and can often avoid an unnecessary removal.

Asthma Screening for Abortion Patients

We are only able to see women for an abortion whose asthma is considered stable. This means daytime symptoms requiring a bronchodilator no more than three times per week, no nighttime symptoms, no hospitalization within the previous six months and able to participate in regular activities. Women not meeting the above criteria need to be stabilized before they will be seen at our facility. The alternative is referral to the CARE program at BC Women’s Hospital

Post Abortion Medical Care and Follow-up

Most women have an uneventful recovery after visiting our clinic and do not require follow-up. Those women presenting with prolonged or heavy bleeding and/or any unusual pain will need to be assessed for a possible complication. We monitor our complications diligently and would appreciate knowing if you treat any of our patients for a post abortion complication. We are obliged to report any hospital admissions occurring within 28 days of a visit to our facility and would appreciate if you could inform us of those.

Bleeding
Various amounts of bleeding may last up to the first menses. Hemorrhaging is defined as soaking two pads in an hour for two consecutive hours, in which case an emergency room or clinic evaluation may be necessary. Please call the clinic 604-322-6576 for direction. Most episodes of bleeding can be handled easily and without surgical intervention.

Self-limited heavier bleeding that normally occurs on days 3 to 6 after an abortion is likely due to subinvolution. The diagnosis is one of exclusion; infection, retained POC or other immediate complications must be ruled out. Treatment includes rest and possibly a uterine contractile agent such as misoprostol 200 micrograms TID for three days.
If bleeding persists beyond the first menses or if it is excessively heavy, ordering an ultrasound will be helpful. If minimal, retained clots/tissue can be evacuated using misoprostol (in the above dosage schedule).

Fever
Evidence supports the use of prophylactic antibiotics in all women undergoing surgical abortion and we use them routinely in our clients. Should a woman present with a tender but firm uterus, a closed os with no tissue seen, and a temperature under 39 degrees C, the diagnosis is uncomplicated endometritis. Doxycycline 100 mg BID for 10-14 days is the treatment of choice. Alternatively, Metronidazole 500 mg BID plus Ofoxacin 300 mg BID for 10 days may be used.

If the presentation is complicated by a boggy, enlarged uterus, an opened os, a temperature greater than 39 C or any other sign of sepsis, the infection is considered serious and should be managed accordingly.

Cramping
Cramping after an abortion is normal. Helpful measures include rest, Ibuprofen and a heating pad. With severe and progressive cramping after an uncomplicated procedure, it is important to rule out post-abortal uterine atony (incidence 1 to 2 in 1000). The uterus will be tender, hard and larger than just before the procedure. Vaginal bleeding will be minimal. Re-aspiration of the uterus provides immediate relief.

Positive pregnancy test
It may take six weeks or more for BhCG to wash out of circulation following termination of pregnancy.

Psychological issues
Sadness is not unusual in the weeks following an abortion. Understanding that these feelings are normal and talking about them will help with coping. We offer post abortion counselling to women who feel they need it and this is also available to those who have had abortions in facilities other than ours. Patients can call 604-322-6692 to book an appointment for this service. The incidence of psychiatric illness is lower after an abortion than after childbirth.