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Americanrtl.orgthe abortion pill by W. David Hager, M.D.
A positive pregnancy test is one of the most life-changing moments for a woman. Never is it more important to base your decisions on accurate information. Try to think beyond the pressures you face right now and consider the long-term impact of your choices. You may have considered —or someone around you may have suggested—having an abortion. Don't let anyone rush you into a medical decision before you understand the risks and consider all your choices. One of your options is to take the abortion pill to cause what is called a medical abortion. The following pages contain answers to some questions you might be asking.
When can a medical How is a medical abortion done? abortion be done? According to the official safety guidelines issued by the U.S. Food and Drug Administration (FDA), a medical abortion • This method of abortion is only approved requires three office visits: for use if it's been 49 days or less since the first day of your last menstrual period. 1. At the first doctor visit: You will take three mifepristone
Doctors call this "LMP." pills, also known by the brand name Mifeprex®. These pills contain a drug that cuts off the supply of blood and • When did your last period begin? nutrients to the developing embryo. 2. Two days later: You will return to the doctor to take
• How many days has it been since then? another drug, misoprostol, also called Cytotec®. This causes your uterus to contract and expel the embryo. You may also be given some antibiotics. 3. Two weeks later: You'll have a third visit to the doctor
to confirm that the abortion is complete.
You should know . .
You should know . .
Some abortion providers give patients If an abortion provider doesn't follow the safety the abortion pill as late as 63 days guidelines required by the FDA, you should LMP—but this is not recommended consider seeking medical care elsewhere. by the FDA and it could make a medical abortion less safe for you. Are there potential side effects from expect afterwards? taking these medications? • You should expect to have vaginal According to the data collected by Micromedex, here's what women bleeding or spotting for an average who've taken these medications have experienced: of 9 to 16 days. • Up to 8 percent of women may • headache (up to 44%) • diarrhea (12–40%) experience some bleeding for • nausea (43–61%) • fatigue (10%) 30 days or more. • vomiting (18–26%) • cramping & pain (96%) Are there health conditions I need You should know . .
to tell my doctor about? Your follow-up visit is an important step in ensuring you are healthy and that the Yes—make sure to tell your healthcare professional about any of these medication has worked correctly. conditions, because a medical abortion is not safe for people who have: • high blood pressure • heart disease • uncontrolled diabetes • bleeding problems • an IUD in place What kind of track record does What warning signs the abortion pill have? should I watch for? • The abortion pill is used in about 25% of early abortions, according Within the first 24 hours after taking to the Guttmacher Institute.
mifepristone and misoprostol, contact • For 1 to 4 percent of women, the abortion pill won't result in a your healthcare professional right away complete abortion and they will still need a surgical abortion to if you experience: terminate the pregnancy. • The FDA collects information about the drugs they approve to • heavy bleeding that soaks through two help people understand some of the risks they face in choosing thick, full-size sanitary pads per hour certain treatments. • persistent stomach pain or discomfort You should know . .
Since September 2000, the FDA has tracked complications following medical • diarrhea, with or without fever abortions in the United States. In 2011, • fever of 100.4° or higher for more than they reported: These symptoms, even without a fever, • Ectopic pregnancies–58 may indicate a serious and possibly fatal • Blood loss requiring transfusions–339 blood infection.
• Severe infections–48 • Deaths–8 Are there some safety tips I should follow? It's very important • Get an ultrasound to make sure that the pregnancy is in your uterus because the abortion pill doesn't work safety guidelines if you have an ectopic pregnancy.
• Take the misoprostol pill orally, not vaginally.
The FDA report also says that eight • Take the misoprostol only at the healthcare professional's women died from a severe bacterial office—do not take it at home.
infection in their bloodstream. • Go for a follow-up visit after the abortion is complete to make sure you are healthy. • Seven of these women had the misoprostol inserted in their vagina and one let the pill dissolve in her mouth, instead of swallowing the • Use this method of abortion if it's been more than pills as the safety guidelines require. 49 days LMP.
• Each of these women became ill • Sign any paperwork that says that it's been less than very quickly and died from a 49 days LMP if you know it's been longer—even if the fast-growing infection. abortion provider asks you to.
• None who swallowed the misoprostol • Order the abortion pill online—you don't know what pill have died from an infection.
• Go to an abortion provider who lacks immediate access to a surgical facility in case you need an emergency surgical abortion.
What's an ectopic pregnancy? Female Reproductive System • This is when the embryo is growing outside of your uterus, usually in your fallopian tube.
• If the embryo is in the fallopian tube, the abortion pill won't end your pregnancy and the embryo will continue to grow and could cause the • Here's the danger: The cramping and abdominal pain that are normal
after the use of the abortion pill are a lot like the symptoms of an ectopic pregnancy. You might not realize until it's too late that you need to seek emergency care—and this puts your life at risk.
• If you have little or no bleeding after taking misoprostol, it could also be a warning sign for ectopic pregnancy. • An ectopic pregnancy is an emergency—don't delay in contacting your doctor or the emergency room at the hospital. • Better yet—get an ultrasound before having a medical abortion.
Here's why it's important • If the embryo is growing in your fallopian tube, the abortion pill won't You should know . .
end your pregnancy.
The abortion pill will not end an ectopic pregnancy, • The embryo would continue to grow, possibly causing your fallopian which could put your life at risk. An ultrasound can tube to burst (rupture), which might put your life at risk.
help your provider detect such a pregnancy. • An ultrasound could help your provider detect an ectopic pregnancy, which could save your life.
Thoughts from a doctor… Despite its known risks, the abortion pill has been called a major medical breakthrough. In fact, some groups go so far as to say that it's a real step forward for the health of women, even that it "saves lives." You should know . .
This is just not true. As an obstetrician, I can tell you that an incredibly "An incredibly special and completely special and completely unique person is growing inside of every unique person is growing inside of every pregnant woman." You can see for yourself, at the Mayo Clinic's website, that just six weeks after your last period, your baby's heart has already begun beating and he or she has the beginning of arms, legs, mouth and eyes. Visit mayoclinic.org and search for "fetal development—first trimester."
Take time to consider all your options and get counseling from someone
who does not have a financial or personal stake in your decision.
Then choose well.
Author NoteDr. W. David Hager is a board-certified obstetrician gynecologist curr ently practicing gynecology at Baptist Health Woman's Care in Lexington, Ky. Things to ask your doctor Things I want to ask my doctor 1. Will you do an ultrasound to make sure my pregnancy is not ectopic? 2. If it's been more than 49 days since my last menstrual period began, will you do a surgical abortion? 3. If the abortion pill doesn't end my pregnancy, do you have admitting privileges at a local hospital in case I need an emergency surgical abortion? 4. How do you give the second drug, misoprostol—vaginally or orally? 5. Will I have a follow-up visit to make sure the abortion is complete and that I have no infection? Do you know the difference? The U.S. Food and Drug Administration
Sometimes these pills get confused. • Medication Guide: Mifeprex®• Drug Label Information for Mifeprex®• Drug Safety: Mifeprex Questions and Answers• Postmarket Drug Safety Information for Patients and Providers: Mifeprex® The Abortion Pill:
The Morning-After Pill:
U.S. National Library of Medicine and the
A method used to prevent National Institutes of Health
An abortion method used to pregnancy. It may cause a very Drug Information: Mifepristone (nlm.nih.gov) terminate an early pregnancy.
early abortion if fertilization has already occurred.
Guttmacher Institute: Induced Abortion in the
Medications are Mifeprex® Medication is Plan B® One-Step United States. (guttmacher.org) (mifepristone) and Cytotec® Must be taken within 49 days Must be taken within 72 hours of when your last menstrual after unprotected sex.
Pills must be prescribed by a healthcare professional. At least Available without prescription.
three visits to your provider are needed, possibly more.
Will not prevent sexually Will not prevent sexually transmitted infections transmitted infections or diseases.
3 Physicians Resource Council 2010, 2014 Focus on the Family.
All models were used for illustrative purposes only.
GalanterKrishnan25 4/6/2004 12:19 PM "Bread for the Poor": Access to Justice and the Rights of the Needy in India† Marc Galanter* & Jayanth K. Krishnan** India is rightly acclaimed for achieving a flourishing constitutional order, presided over by an inventive and activist judiciary, aided by a proficient bar, supported by the state and cherished by the public. At the same time, the courts and tribunals where ordinary Indians might go for remedy and protection are beset with massive problems of delay, cost, and ineffectiveness. Potential users avoid the courts; in spite of a long-standing reputation for litigiousness, existing evidence suggests that Indi-ans avail themselves of the courts at a low rate and the rate seems to be falling.1 Still, the courts remain gridlocked.2 There is wide agreement that
February 17, 2009 In this Issue. advocates pushing the doctrine beyond its intended bounds, the doctrine has generated a great deal of confusion. recently, in Gantler v. Stephens, the Delaware supreme Court, in an effort "[t]o restore coherence and clarity" to the doctrine of stockholder ratification, held that the doctrine "must be limited to its so-cal ed ‘classic' form; that