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Chemical abortion methods

Pharmaceutical abortion, also known as chemical or medical abortion, is a method to chemically induce abortion early in pregnancy.

It is typically done using two drugs. The first is mifepristone, also known as RU-486, and the second is misoprostol. The drugs are taken orally over three days, although the abortion itself may take much longer to complete.

In 2000 the U.S. Food and Drug Administration authorized the use of mifepristone for abortions up to 49 days of pregnancy. By 2011, chemical abortions accounted for 28.5% of all U.S. abortions at or before eight weeks. 

A chemical abortion causes a serious reaction in a woman’s body in order to cause it to interrupt and expel the pregnancy. It normally causes several hours of bleeding and cramps ranging from mild to severe, and side effects may include nausea, vomiting, diarrhea and shivering. Infection and hemorrhage requiring emergency care are known risks. 

The abortion may end in about 4 to 5 hours, but in some cases takes as long as two weeks to complete. According to Marie Stopes, bleeding and cramps following chemical abortion can last several weeks.

There have been fourteen women known to have died in the U.S. between 2000 and 2011 due to complications following this method. 

How Mifepristone Works

Mifepristone is an antiprogestin: it works by blocking the pregnancy hormone progesterone. Progesterone is “pro-gestation,” as the name suggests, and makes the nutrients in the uterine lining available to the newly-conceived fetus as it arrives from the fallopian tube.

When progesterone is blocked by mifepristone, the lining of the uterus softens and breaks down. Taken in pill form, mifepristone alone will cause abortion in 70% of early pregnancies. (1)

Misoprostol is then taken to help ensure expulsion, two days later in the U.S. FDA-approved regimen or as early as 6 hours later in the UK. Misoprostol is a hormone-like compound (prostaglandin) that produces uterine contractions to expel the dead baby and placenta.

Danco Laboratories, the U.S. manufacturer of the mifepristone brand Mifeprex, states that the two-pill regimen is 92 to 95 percent effective in completing an abortion.

If the drugs fail to end a pregnancy, surgical abortion may be performed.

FDA Guidelines for Chemical Abortions

The FDA-approved pharmaceutical abortion protocol is for pregnancies up to 49 days gestation and follows this regimen:

  • Day 1: three 200 mg mifepristone tablets orally in one dose.
  • Day 3: two 200 mcg misoprostol tablets orally in one dose at a provider’s office.
  • Day 14: The patient must return to confirm that a complete termination has occurred.  If not, surgical termination is recommended. 

Bleeding and cramping can begin after either the first or second set of pills.

Unlike surgical abortions, in which abortion staff immediately remove products of conception, medical abortions usually take place at home and in solitude. Women and experts have said the gestational sac and embryo is sometimes intact and can be seen after it is expelled during these abortions, especially if the pregnancy is relatively late. (2) For some, this could be distressing.

The medication guide for Mifeprex includes an agreement to be signed by patient and provider, in which the patient assents that “I believe I am no more than 49 days (7 weeks) pregnant,” and “I will take [this guide] with me when I visit an emergency room or a provider who did not give me Mifeprex.”

The mifepristone label indicates that bleeding or spotting will likely continue for an average of 9-16 days, and possibly last up to 30 days. 

The FDA lists 2,207 adverse events in women who used mifepristone between 2000 and 2011. Beyond 14 deaths and 612 hospitalizations, the most frequently occurring complications were hemorrhage requiring transfusion (339) and infection (256).

Second Trimester Chemical Abortions

Mifepristone and misoprostol are sometimes also used to end pregnancy in the second trimester. This off-label alternative induces labor by the use of both drugs or of misoprostol alone.

When mifepristone is followed by misoprostol 48 hours later, one study found that the time to fetal expulsion was about 7 1/2 hours. (3)

Retained placenta is the most common complication for second trimester pharmaceutical abortion, and may happen for as many as 50% of women. Hemorrhage requiring transfusion and infection are the next most frequent complications. 

Reversible

Women who change their minds and want to keep the baby after starting a medical abortion in the first trimester may be able to do so up to 72 hours after taking the first pill, mifepristone.  This is done by progesterone treatments with a claimed survival rate for the pregnancy of 60%.

“By giving extra progesterone, we hope to outnumber and outcompete the mifepristone in order to reverse the effects of mifepristone,” say the founders of AbortionPillReversal.com, which refers women to doctors providing the progesterone treatment. 

Although the Mifeprex guide suggests birth defects could affect a child born after failed chemical abortion, the American College of Obstetricians and Gynecologists reports that “No evidence exists to date of a teratogenic [birth defect] effect of mifepristone.” 

In fact, babies born after the progesterone treatment have not shown birth defects due to mifepristone. AbortionPillReversal.com reports that 89 babies have been born after progesterone treatment. Aside from one minor and unrelated birthmark, all were without birth defects. 

 

(adapted from abortionis.com

 

Footnotes:

1. Sam Rowlands, ed., Abortion Care (Cambridge University Press, 2014), 63.

2. (2011-08-24). Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care (Kindle Location 6159). Wiley. Kindle Edition.

3. (2011-08-24). Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care (Kindle Locations 8873-8874). Wiley. Kindle Edition.

 

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