Abortion, Counties Manukau Health On 24 March 2020 changes were made to the law to decriminalise abortion, better align the regulation of abortion services with other health services and modernise the legal framework for abortion services in New Zealand. We understand that unplanned pregnancies happen and that every woman has the right to choose for herself how to deal with the situation. Many factors may influence your decision whether to continue your pregnancy. Your values, beliefs, previous life experiences, society's attitudes, spirituality and cultural perspectives will all impact on your choice but within the legal framework the decision is yours and we are here to help and support you with your decision. Your options include: Continuing your pregnancy and become a parent. Continuing your pregnancy and then placing the infant for whangai; adoption or fostering. End the pregnancy with an abortion. Supporting you We know it can be hard to make a decision about what to do and we are here to provide help. Support is available should you wish to explore feelings and issues related to an unplanned pregnancy and the options available to you. Should you wish to explore an abortion, the services available vary according to how pregnant you are. Information about pregnancy options, including where to access abortion services, can be found on the DECIDE website – www.decide.org.nz You can also call freephone 0800 DECIDE (0800 332 433) to speak to a trained health professional. They can give you information about your options or help you arrange in-person care. Otherwise the local options available vary according to how far on you are in your pregnancy as below: Abortion services are staffed by a multidisciplinary team of nurses, doctors, social workers and administrative staff. Privacy and your health information is protected in accordance with the Health Information Privacy Code 2020. First trimester services (up to 12 weeks and 6 days) The Epsom Day Unit (EDU) at Greenlane Hospital provides a service for first trimester pregnancy abortion. The abortion must occur before 12 weeks and six days' gestation. Self-referral: Email EDU with your name, date of birth, NHI number (if known) and safe contact details at Call: 09 631 0740, you may have to leave a message with the above information. Visit: either your GP or Family Planning Clinic. They can then refer you. Second trimester services (13 or more weeks pregnant) If you are 13 or more weeks pregnant, please contact Middlemore Hospital by: Self-referral: Email us with your name, date of birth, NHI number (if known) and safe contact details at Call: 0800 877 887 to leave a message and safe contact details with the above information. Visit either your GP or Family Planning Clinic and they can then refer you.

This is a procedure used to evaluate the health of your unborn baby and identify any problems that may exist. Using ultrasound as a guide, a thin needle is inserted through your stomach into your uterus (womb). A small sample of the amniotic fluid that surrounds your baby is then taken. This fluid contains cells from the baby, which are then studied in the laboratory. The best time to perform amniocentesis is in the 16th week of pregnancy.

Sling procedures are common surgical operations to stop stress incontinence. This is a condition where urine leaks out when movements, such as coughing, laughing or sneezing put pressure on the bladder. Stress incontinence occurs when the muscles supporting the urethra (tube that carries the urine out of the body) become weak and the urethra no longer works well as a valve to keep the urine in the bladder. Sometimes this results from the effects of childbirth. Sling procedures provide support to the weakened muscles by placing a stitch or strip of mesh under the urethra so that it won’t accidentally release urine when there is pressure on the bladder. Burch Procedure In the Burch procedure, permanent stitches are placed on both sides of the urethra to give it more support. The Burch procedure is done under a general anaesthetic (you sleep throughout the procedure). However this procedure is now uncommon as the following procedure has been shown to be simpler and more effective with less side effects. Tension-Free Vaginal Tape (TVT) Procedure In tension-free vaginal tape (TVT) surgery, a mesh-like tape is placed under the urethra to give it support. The TVT procedure is done through a small cut in the vagina and two tiny incisions on either your pubic region or inside of your upper thighs. It is usually performed under regional anaesthetic (this means that you don’t have to go to sleep during the operation) but will be numb from the waist down (like epidural for childbirth).

A caesarean section is the name of the operation done to deliver a baby through a cut in your stomach and uterus (womb). In some cases this is safer than a vaginal delivery. The surgery is performed by an obstetrician and it usually only takes a few minutes for the baby to be born. A general or epidural anaesthetic can be used. Most women will be up and about within 24 hours of the surgery.

Cervical dysplasia is the growth of abnormal cells around the cervix (entrance to the uterus). Although this condition is not cancer there is a small risk that these cells could become cancerous. Sometimes no treatment is needed as the condition may improve by itself. For more severe dysplasia, treatment involves removing the abnormal cells by freezing, laser therapy (a tiny beam of light) or electrical burning. Whether you have treatment or not you should follow the advice of the doctor looking after you about how often you require Pap smears in the future.

Chorionic villus sampling (CVS) is used to test for genetic disorders, such as Down’s syndrome, and involves taking a small sample of the chorionic villi, which are the tiny units that make up the placenta. The placenta is the organ that grows on the inner lining of your uterus (womb) through which nourishment and oxygen pass to your foetus (unborn baby). The chorionic villi have the same chromosomes as your foetus and DNA analysis will determine if your unborn child has any genetic abnormalities. Using ultrasound as a guide, the sample is obtained by inserting a cannula up through the vagina and cervix (transcervical) or by inserting a needle in through your stomach (transabdominal).

A colposcopy is a detailed examination of the cervix (entrance to the uterus) with a specially lit microscope (colposcope). As with a Pap smear, an instrument called a speculum is inserted into the vagina, and then the colposcope is positioned outside the vagina with its light directed on the cervix. A specialist will perform a colposcopy if your Pap smear has shown abnormal or cancerous cells on the cervix. During the colposcopy further samples of tissue (biopsies) are usually removed and examined in the laboratory so the doctor can get a clearer idea of the extent of the abnormal cells. Sometimes treatments can be carried out at the time of colposcopy to remove abnormal cells. Your specialist will give specific advice about intercourse and follow-up following the colposcopy. It is essential that you attend if you have an appointment for colposcopy. If abnormal cells are treated early cancers are prevented. Currently many women do not attend and this wastes resource for other patients. The Colposcopy Clinic is located in Module 10, Manukau SuperClinic.

The endometrium is the lining of your uterus (womb). Endometrial ablation is the surgical removal or destruction of this lining. There are different methods of destroying the endometrium. CMDHB uses electricity and microwave technology. Prior to performing the endometrial ablation, non-surgical methods of treatment need to be tried. A hysteroscopy (look inside the womb with a small telescope either awake or asleep) may need to be performed to rule out treatable causes of your menstrual disturbance. A specialist performs the operation and it is done through the vagina, so there is no need for the abdomen to be cut open. The endometrium will heal leaving scarring, which usually reduces or stops menstrual periods. In women who have very heavy periods (menorrhagia), an endometrial ablation can be done instead of a hysterectomy as it is an easier procedure than a hysterectomy and is quicker to recover from. Endometrial ablation is only performed in women who no longer wish to have children.

The endometrium is the name of the tissue that lines your uterus (womb). Endometriosis is a condition where tissue, like the endometrium, grows in other parts of the body. Usually these growths occur inside the pelvis in places such as the ovaries, bowel, or a lining of the pelvis and abdomen called the peritoneum. Each month, as the endometrial lining of the uterus builds up with blood that will be lost during your period, these other growths of endometrial tissue get bigger and can bleed and cause inflammation and adhesions (internal scarring). Some women with this condition do not have many symptoms, whereas others suffer severe pain and problems such as infertility and ovarian cysts. Treatment includes medication that will help control the pain and inflammation, and also the pattern of bleeding. Some women may need surgery to remove the tissue growths.

An epidural is a type of anaesthetic (medication that stops pain and feeling) that makes your lower body numb without putting you to sleep. It is often used during labour and delivery so that the woman can remain awake but not experience the pain of the birth. The anaesthetic medicine is injected into the epidural space (the area surrounding the spinal cord) in the lower back by an anaesthetist (a doctor specialised in giving anaesthetics). The area of skin where the injection goes in will be made numb first. Although all of the lower body becomes numb, you can still push during contractions. After the delivery you will need to remain in bed until the anaesthetic has worn off. This usually takes about two to four hours. An epidural anaesthetic can be used for a vaginal or caesarean delivery.

A fetus is the name given to an unborn baby after the eighth week of pregnancy until birth. Fetal distress is a very general term that is used to describe any unborn baby that is showing signs of agitation, usually during labour and delivery. Signs of distress are usually diagnosed by changes in the speed of the unborn baby’s heartbeat and/or a decrease in the oxygen levels of the baby’s blood.

Fibroids are noncancerous growths or tumours on the muscular part of the uterus (womb); sometimes they are also called myomas. Fibroids may be very small (about 5mm) or can grow to be quite large (up to 20cm +). Many women with fibroids do not notice any symptoms and will not need treatment, whereas others may experience problems such as painful and heavy periods or pressure on their bowels or bladder. Treatment includes medication to shrink the fibroids and, in some women, surgical removal with hysterectomy or rarely, removal of the fibroid from the womb (usually when fertility is still required and fibroids are few in number).

Gestation is the length of a pregnancy from conception to birth (usually 40 weeks in humans). Gestational diabetes is a type of diabetes (glucose intolerance) that occurs in some women during pregnancy. Women with gestational diabetes have a high level of glucose (or sugar) in their blood because they do not have enough of the hormone insulin to cope with the extra demands of the growing foetus (unborn baby). In most cases, gestational diabetes is managed by diet and exercise and will usually disappear after the baby is born.

Gynaecological cancer refers to cancer anywhere in a woman’s reproductive system or genital area. Cancers occur when the cells divide and grow in an uncontrolled way forming a lump, growth or tumour. Usually the cause of the cancer is unknown. There are a number of different treatments for gynaecological cancer and the doctor and specialist will work out which is best for each individual woman. Treatment may include surgery, chemotherapy and/or radiotherapy. Ovarian Cancer The most common symptom associated with ovarian cancer is abdominal pain and distension. In most cases the cancer is found when a doctor feels a lump in the abdomen when doing an internal (vaginal) examination. Endometrial Cancer The endometrium is the lining of the uterus (womb). When a cancerous tumour grows in the endometrium the most common symptom is bleeding. This type of cancer is a lot more common in older women, after they have gone through menopause. Any bleeding after the menopause requires investigation by a doctor. This is more common in the obese and diabetic patients. Cancer of the Vulva The vulva is the area of the genitalia outside a woman’s body. Cancer of this region is very rare. The most common symptoms are bleeding, itching or a burning feeling in the vulval area. Any lump or ulcer which occurs needs to be seen by a doctor. Cervical Cancer The cervix is at the entrance to the uterus (womb). Typical signs of cervical cancer include bleeding between periods and after sexual intercourse. In most cases the cancer can be diagnosed by a vaginal examination. Developing this condition is far less likely if regular Pap smears occur as the disease is detected before it becomes cancerous.

Click here for more details about HIV testing in pregnancy.

Hormone replacement therapy (HRT) is when female hormones (oestrogen by itself or with progesterone) are given to a woman during or after menopause when the production of oestrogen by the ovaries declines. The hormones can be taken as tablets, implants or skin patches. HRT has become less popular in recent years because a large study in the USA found that long-term use of HRT can increase the risk of some serious diseases, such as breast cancer and blood clots. However, for some women, short-term use of HRT (no more than 3–4 years) can provide relief from symptoms caused by having less oestrogen in their bodies, such as hot flushes and loss of bone density. The risks and benefits of HRT should be thoroughly discussed with a doctor before treatment begins.

A hysterectomy is an operation to remove your uterus (womb). Some types of hysterectomies include the removal of other organs as well, and this will depend on the reason for the operation. A hysterectomy is a treatment for many different diseases and conditions and it can be done through the vagina or through a cut in the abdomen.

This is an operation where the cervix (entrance to the uterus) is dilated and a hysteroscope (small lighted mini telescope) is inserted into the uterus through the vagina and cervix so the specialist can see the inside of the uterus. If no cancer is present, a small spoon-like instrument with a long handle, called a curette, is inserted and the lining of the uterus is scraped off and sent to the laboratory for examination. This procedure can be done under a general (you are asleep) or local (you are awake but the area being investigated is numb) anaesthetic.

Induction of labour is the process of starting labour artificially. This may be needed for many reasons, such as high blood pressure, toxaemia or if your waters have broken and you haven’t gone into labour by yourself. There are a few different methods that may help to induce labour, including an internal examination by the midwife or doctor, medication that softens the cervix (entrance to the uterus) allowing it to open, or other medicine that stimulates the uterus (womb) to contract.

About one in every six couples in New Zealand will experience infertility. This is when they are unable to conceive a baby after one year of trying, or when the woman has been unable to carry a pregnancy to a live birth. In about half of the cases, the cause of infertility is due to a problem with the woman and, in the other half, the problem will be with the man. There are now many treatments available for infertile couples and, in many cases, these treatments will result in a successful pregnancy. Doctors with a special interest and expertise in this area will usually provide the best opportunity for treatment. Local support groups and societies can be of help during the stressful time of having tests and treatment.

In a very small number of pregnancies, the baby may not grow as well as in a normal pregnancy. This is called intrauterine growth restriction (IUGR) and the unborn baby will be described as being “small for gestational age” (SGA). This means that the baby is smaller than expected for the length of time that the woman has been pregnant. An unborn baby with IUGR should be carefully managed during pregnancy and delivery but will usually be healthy at birth.

This is the process of fertilising the woman’s egg with the male’s sperm outside of the woman’s body in the laboratory. This type of treatment is used for many infertile couples. After a successful fertilisation has taken place, the embryos (fertilised eggs) are watched closely until they have developed to an appropriate stage and then they are inserted through the vagina and placed into the uterus (womb). A pregnancy test will be performed about 10 days later to see if a pregnancy is progressing.

Many gynaecological investigations are performed by laparoscopy. This is a procedure to view the inside of the abdomen (tummy) through a specially lit type of mini telescope (laparoscope) that is inserted through a small cut in the abdomen. The laparoscope also contains a small camera that sends pictures to a screen that the doctor can watch. Sometimes surgical procedures (keyhole surgery) can be performed at the same time. A laparoscopy is performed under a general anaesthetic (you are asleep).

Menopause is also called the “change of life” and is the time when your periods will become irregular and stop. This is a natural process in all women and for most it will occur between the ages of 45 and 55 years. Menopause is brought on by decreasing levels of the hormone oestrogen and this can cause a variety of symptoms, including hot flushes, night sweats, mood swings, sleeping problems, memory problems, depression and vaginal dryness. Some women do not notice any symptoms or they are very mild, whereas others experience more severe problems and should go to their doctor for advice. There are many treatments available to reduce the symptoms associated with menopause and, in some cases, lifestyle changes can also help. Your GP and practice nurse should be able to help with any problems relating to the menopause in the first instance.

Menstruation is the medical name for your monthly period. This is when blood and tissue from the lining of the uterus (womb) is shed through the vagina and out of the body. Menstruation starts at puberty and it is stimulated by hormones that make a girl’s body able to become pregnant. This usually happens anytime between the ages of 9 and 16 years. Menstruation will recur about every 28 days (the menstrual cycle), unless interrupted by pregnancy, and will stop at menopause, which occurs at about 50 years of age. There are a number of problems that can occur with menstruation ranging from mild to severe. More than half of all women will have cramps (dysmenorrhoea) during the first day or two of their period. Other problems include very heavy or long periods (menorrhagia) or no periods (amenorrhoea). Heavy regular periods can be treated with simple pain killers which will reduce the amount of bleeding experienced and also treat any pain. Your GP will also be able to use other medications to reduce the bleeding. Younger women requiring contraception may benefit from the oral contraceptive pill which will reduce bleeding and enable control of when the periods occur. The Mirena Intrauterine device is used for some women to control heavy bleeding and will in many cases eventually abolish menstrual bleeding (which is reversed upon removal). If you have bleeding after sexual intercourse or between your scheduled periods you will possibly need to be seen by a specialist. If treatments given to you by your GP have failed (each requires a few months before this can be confirmed) then a specialist review is ideal. If you have become anaemic due to heavy bleeding then you will need to be seen by a specialist. If you are bleeding heavily it is important to have some iron supplements either from the chemist or the GP.

Ultrasound imaging, also called ultrasound scanning, is a method of obtaining pictures from inside the human body through the use of high frequency sound waves. Obstetric ultrasound refers to the specialised use of this technique to produce a picture of your unborn baby while it is inside your uterus (womb). The sound waves are emitted from a hand-held probe, which is placed on your stomach, and reflection of these sound waves is displayed as a picture of the moving foetus (unborn baby) on a monitor screen. No x-rays are involved in ultrasound imaging. Measurements of the image of the foetus help in the assessment of its size and growth as well as confirming the due date of delivery.

An oophorectomy is an operation to remove one or both ovaries. It is done for many reasons including ovarian cancer, ovarian cysts or to remove the source of the hormone oestrogen that is produced by the ovaries and can stimulate some cancers. If both ovaries are removed, your periods will stop and you will not be able to have children. Sometimes an oophorectomy is done together with a hysterectomy.

An ovarian cyst is a fluid-filled sac or pouch in the ovary. In most cases, the cyst grows as a result of ovulation (when the egg is released from the ovary), and it will usually shrink over time. Sometimes, the ovarian cyst may cause pain. The best way to check for an ovarian cyst is by an internal examination and examination of your tummy. Ultrasound examination is used to confirm findings on examination. Treatment will depend on how troublesome the symptoms are or how the cyst looks on the scan. Often it is best to leave the cyst alone and just check it regularly with ultrasound, however sometimes these cysts are serious problems and need major surgery to remove them and the womb at the same time. In other cases it may need to be removed by laparoscopic surgery.

A Pap smear is a test to check for signs of cancer on the cervix (entrance to the uterus). A doctor will put an instrument called a speculum into the vagina to open it, and then gently wipe or brush a few cells from the cervix to send to the laboratory for testing. A Pap smear can show if cervical cells are going through any changes that happen before cancer grows. It will also show if cancer cells are present. Regular Pap smears make it possible to prevent cancer before it grows, or to pick up the cancer early so that it is more easily cured. A National Cervical Screening Programme aims to provide all New Zealand women with regular smears and recommends that a Pap smear be done every three years between the ages of 20 and 70 years.

Polycystic ovary syndrome (PCOS) is a hormonal disorder that can cause you to have a variety of symptoms, including no periods or irregular periods, increased hair growth on the face and body, acne (pimples) and increased bodyweight. PCOS is also one of the main causes of infertility in women. The ovaries of women with PCOS often contain many small cysts (fluid-filled sacs), but this does not seem to be the cause of the condition. For women who have not reached menopause, the most common treatment is the birth control pill, which will regulate your periods. There are also other medicines that can help control the symptoms.

The postpartum (also called postnatal) period is the time after the birth of a baby. During this time many women will experience a feeling of slight sadness or anxiety. This is called the “baby blues”, and in some women it may develop into postpartum depression. The baby blues happen in the days just after the birth and usually only last for about a day or up to a week. Postpartum depression can occur days or months after the baby’s birth and the feelings of sadness are worse than with the blues.

A premature baby is one that is born before 37 weeks’ gestation (the length of a pregnancy from conception to birth). The normal period of gestation in humans is 40 weeks. If your baby is premature, it may need to be cared for in a specialised unit, called a neonatal unit, until his or her internal systems are more fully developed. The length of time your baby will stay in the neonatal unit will generally depend on how early it was born.

Many women experience feelings of tension, anger, fatigue and depression just before and during the first days of their menstrual period. This is called premenstrual syndrome (PMS) and is probably caused by the change in hormone levels. In most women with PMS, symptoms will not be severe enough to require treatment, but some will need to discuss their symptoms with a doctor. Sometimes symptoms can be improved by avoiding some types of food, such as coffee and foods high in salt. Some people find that a healthy diet and regular exercise help to reduce the symptoms of PMS.

Toxaemia of pregnancy or pre-eclampsia is a condition that occurs in some women during the second half of pregnancy. It is characterised by high blood pressure, swelling that doesn't go away and large amounts of protein in the urine. If left untreated it can stop the placenta, which provides nourishment to the baby, from getting enough blood and thus slows the baby’s growth. The condition can also be dangerous for the mother. In the early stages, simple measures such as bed rest may control the symptoms but, if not, it may be necessary to deliver the baby a week or two early.

A tubal ligation is permanent sterilisation for women with a completed family. At the assessment you will be given full information on what to expect when you come back to the hospital for your surgery. Please have nothing to eat or drink for 6 hours prior to surgery. When you arrive for surgery you will be asked to change into a hospital gown. A pregnancy test maybe done to ensure you are not pregnant. A pre-operative checklist will be completed with the nurse. The surgeon will see you to ensure you understand the risks and side effects of Tubal Ligation and you will be asked to sign the operative consent. The anaesthetist will see you to ensure you are fit for general anaesthetic. Once you have had the surgery you will be moved on the bed to a recovery area in second stage recovery. Once you are fit you will go home. We recommend someone drives you home and that you rest at home for 1-2 days afterwards. There is no need for follow-up after your surgery at the clinic. If you have been taking contraceptive pills please continue until you have completed the month you have started. You can expect your periods to remain the same (bearing in mind that the pill can make your periods lighter).

A person with urinary incontinence is unable to control the release of urine from their bladder. This may be an occasional leakage or a complete inability to hold on to their urine. Women experience incontinence more often than men, and this may result from muscle damage during pregnancy and childbirth or the changes associated with menopause. The most common type of urinary incontinence in women is stress incontinence. This is when urine leaks out when movements, such as coughing, laughing or sneezing put pressure on the bladder. The treatment of urinary incontinence will depend on the cause of the problem, but may include exercises with a physiotherapist, medication or surgery. Your GP will arrange for a urine test to exclude a urine infection which is a common cause of urinary incontinence. A pelvic examination will also exclude lumps in the pelvis pressing on the bladder.

If the uterus (womb) or bladder slips out of position, this is referred to as a prolapse. It is caused when the supporting muscles become weak, allowing a part of the uterus or bladder to bulge into the vagina. The most common reason that these muscles become weak is childbirth, and a uterine prolapse or bladder prolapse (also called cystocoele) is more common in women who have had a lot of babies. Symptoms include pain, heaviness in the vaginal area and a frequent need to pass urine. In mild cases, exercises may help improve the symptoms, but women with more severe prolapses may need to have surgery. It is important that factors such as being overweight, smoking and having a chronic cough are reduced before surgery is considered otherwise the surgery is unlikely to have long term success. Pelvic examination should be performed to exclude lumps in the pelvis that may be causing the prolapse by pushing the structures into the vagina.

The most common vaginal infections are yeast infections (also called candidiasis or thrush), trichomoniasis, or bacterial infections (also called bacterial vaginosis). Symptoms of an infection may include irritation, itching, discharge and odour. To make a diagnosis a doctor will usually do a vaginal swab, which involves wiping a type of cotton bud gently across the infected area. The swab is then sent to the laboratory for analysis. There are many medicines that can successfully treat these infections. Sometimes infections can be transmitted sexually. If you or your partner have had other sexual partners you may be at risk of these infections. The infections include:- Chlamydia Gonorrhoea Syphilis Genital Herpes HIV This link will take you to the Auckland Sexual Health Website which gives you all the necessary information.