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Thursday, May 3, 2012

Abortion Pills: What we should all know about them

When discussing abortion with anti-choice people, it occurs to me that many of their arguments are formulated around surgical, not medical abortion.  A lot of their criticisms, and indeed a lot of the legal roadblocks they're trying to set up, fall apart when it comes to using the abortion pill.  That's why medical abortion is Public Enemy #1 for the anti-choice movement.  It's discreet, it mimics a natural miscarriage, a doctor cannot even tell the difference between a medical abortion and a natural miscarriage at all.  For people who want you to endure the shame of dealing with pictures of torn apart fetuses and recovery in a clinical setting, for people who have made it entirely too difficult to be humanely treated when seeking abortion, the invention of mifepristone was the worst day in their battle against choice.

While it's not a legal option, it's still possible to order mifepristone and misoprostol online, thus avoiding the waiting period, angry protestors with graphic signs, mandatory ultrasounds and unnecessary descriptive narratives of the fetus' development.  Sure, these women are taking a chance on the drugs they are buying online, but the anti-choice movement has made certain that these poor women, who were in a terrible situation anyway, are now in a desperate one.  Desperate women take chances and do desperate things, like buy drugs online and take them without the supervision of a doctor.

I'm not advocating this route, but I am saying that I understand why some women feel that they are being forced to take this chance.  It's not as scary as the coat-hanger abortions of the pre-Roe era, but internet-purchased medical abortions are the contemporary version of them.  It's still taking a chance with our health because of legal blockades set up by the anti-choice movement.

So what are these drugs?  Mifepristone, also called RU-486 or Mifeprex, is a pill designed to block progesterone to the fetus.  Progesterone is necessary to continue to sustain the uterine lining, and so blocking progesterone ends the pregnancy the majority of the time.  A dosage of 200-600 mg is recommended.   Mifepristone alone is effective at ending a pregnancy 60-80% of the time, and so it is recommended that it be taken in combination with misoprostol.

Misoprostol, also called cytotec, is the second part of the medical abortion equation.  In some circumstances, it can actually work all on its own, but it has been recommended that it be used in combination with Mifepristone if that is available, since the combination have fewer side effects and less discomfort than misoprostol alone.  Misoprostol is also prescribed for the prevention of gastric ulcers, so it may be easier to get a hold of than mifepristone in countries where abortion is illegal.

Misoprostol works by stimulating uterine contractions, thus expelling the products of conception.  dosages between 25 and 800 mcg are recommended depending on how far along the pregnancy is.

Wait, what?  You mean medical abortions can happen beyond the 49 days post-conception as recommended by the FDA?  In other countries, this happens all the time.  In the UK, the same method, mifepristone and misoprostol taken 48 hours apart, is routinely used up to 63 days after conception, and their abortion safety record is no worse off for it.  In fact, in some form or another, medically induced abortion (read: mifepristone/misoprostol abortion) can be used up to 24 weeks into the pregnancy.  To be sure, it is NOT as simple as just taking the two part pill regimen which is effective at 7 weeks, but in varying doses, medically induced abortion can be safely used FAR beyond what it has been approved for in the United States.  

In fact, recently an Idaho woman used pills purchased from the internet for her abortion which ended up terminating a pregnancy far more advanced than she had thought.  She was certainly lucky, as it should be understood that complications and side effects from a medical abortion are more likely the farther the pregnancy has progressed, and she would have been much safer under the supervision of a doctor, but who could blame her?  Desperate women do desperate things, and the anti-choice movement has forced us into desperate actions.

In my searches, I have come across sites (which I will not list here for fear that they will be shut down) with instructions for women in countries where abortions are illegal.  They have instructions on where 
to get the pills, as well as this warning:

Do not buy any pills from the website "" or "" or "". The medicines are not Mifepristone, Mifegyne or RU 486. The medicines that were sent to us did not contain the active ingredient Mifepristone!
Do not order from the website "" or "" either, the package never arrives!

They recommend the woman take the final dose and then sit in a hospital cafe so that when the bleeding starts, she can rush to the emergency room and claim to be having a miscarriage.  This way, she will be examined and can be certain that all products of conception are expelled in a non-judgemental manner, since no doctor can tell the difference between a medical abortion and a natural miscarriage.

I think this is good advice for anyone in a situation so hopeless that they've considered the illegal, abortion pills online method.  At least be near a hospital.  Do not be afraid to rush in there when you are bleeding so that you can be taken care of properly.  Understand that, unless you have an undissolved misoprostol pill in your vagina, there is no way any of the hospital staff will know you've started your own abortion unless you admit it to them.  Getting an examination afterwards is crucial to avoid infection or complications that may endanger your future fertility or your life.

Medical abortion is not a perfect solution.  There are many side effects including diarrhea, vomiting, abdominal cramping, nausea, vaginal bleeding, headache, fever, chills, and dizziness.  I have known several women who have experienced a medical abortion, and none have reported a pleasant experience.  However, it is important to note that it is considered very safe under the supervision of  doctor, and some ob/gyns will administer the pills in their own office, thus saving their patients from having to visit a freestanding abortion clinic (with the possibility of protesters and their shaming tactics.)


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