Chemical abortion
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A chemical abortion is a type of abortion in which a drug is used to induce the abortion, rather than a surgical procedure. Chemical abortions occur after the embryo has implanted itself in the uterus. The implantation in the uterus is when a fertilized egg becomes a pregnancy.
Three Steps to a Medical Abortion
There are three steps to a medical abortion is performed. First, a clinician will administer an injection of methotrexate or the patient will be given a dose of mifepristone in tablet form. Second, the patient will be given a second dose of misoprostol in tablet form that should be taken within 72 hours of the previous medication. As a final step, the patient will need to return to the clinic for a follow-up check up to make sure the abortion was complete.
Misoprostol causes the uterus to contract and empty which is how the abortion is completed. With methotrexate about fifty percent of women have the abortion that same day they take the misoprostol tablet. The other thirty-five to forty percent will have the abortion take place in about a week, though the entire process can take up to two weeks. With mifepristone about ten percent of the women will have the abortion before they take misoprostol and most other patients will have the abortion in about 4 hours after taking the first pill. Most patients will not start bleeding until twenty four hours after taking the medication, and the whole process can take up to a week. Though both medications are similar methotrexate is about ninety percent effective and mifepristone is from ninety-two to ninety-five percent effective.
Pre-Procedure Tasks
When a woman decides to have a medical abortion there are a few pre-procedure tasks the patient needs to complete. First the patient needs to contact an institution that performs abortions; they then need to sign up for an appointment. Clinics prefer to have a pre-counseling session to talk to the women about what is going to take place and how she is feeling about her decision to have an abortion. The counselor will also discuss with the patient how she came to the decision to obtain an abortion. Next, the patient will have to sign a consent form and have several laboratory tests. These tests can include blood tests, STD test, and an ultrasound to confirm pregnancy.
After all the necessary pre-procedures are done, the patient is then given the first dose medicine and the second dose is then taken at home. After the doses of medicine are given there can be a few side effects. These include strong cramps, nausea or vomiting, diarrhea and temporary abdominal pain. Over the counter medicines such as Tylenol or Excedrin are given to help ease the pain. Most patients who receive medical abortion feel more like it is an early miscarriage. After the abortion is complete the patient will need to return back to the clinic to have a post-procedure check up. To prepare for the follow-up visit the patient should not take aspirin, drink alcohol, take an anti-coagulant, or take a vitamin with folic acid. Another ultrasound will be given at the follow-up appointment to insure that the medical abortion has been completed. If the ultra sound comes up negative, the patient will then have their normal menstrual cycle in around four to six weeks and is no longer pregnant.
Though it is uncommon, a medical abortion is sometimes unsuccessful. Success rates decline about eighty percent in the ninth week of pregnancy. When the medical abortion does not work, surgical abortion is then needed to carry out the procedure. Surgical abortion is a more common method that is performed by manual vacuum aspiration. Manual vacuum aspiration is when the embryo is removed by using a manual syringe. Surgical abortion has also been called “partial-birth” abortion.
The most common drug, called Mifepristone (RU-486), blocks progesterone, which is a hormone required for a pregnancy to continue. Administered correctly, it has a high rate of success. Advocates of chemical abortion claim that it is easier emotionally for the women and that it is safe. However, some critics believe that chemical abortions are unsafe, and might even cause death. While available in most European countries, chemical abortion has met great controversy in Canada and the United States.
When a women comes to the decision to have a medical abortion there are a few different places this procedure can be performed. In the US, the patient can either call a women’s health care center, a private clinician, or a Planned Parenthood. The cost for medical abortion can depend on a few factors; as there are a number of multiple tests and exams that are given, in the USA the price can range from about $350 to $575. The cost can vary either up or down depending on whether the patient needs further testing and additional tests. Further, mifepristone, misoprostol, and methotrexate are giving pregnant women a new alternative to abortion.
Mifepristone was first licensed in France in 1988. After this medication was licensed in France, medical abortion has been approved in nearly thirty countries. These countries include Austria, Belgium, China, Denmark, Great Britain, Israel, Norway, Russia, South Africa, Sweden, and Taiwan. In 1993 President Clinton signed an executive order to encourage testing, licensing, and manufacturing of mifepristone in the United States. Finally in 2000 the US Food and Drug Administration (FDA) approved the use of mifepristone to be used for medical abortion in the United States.
It is currently possible to get Mifepristone (the most common drug used in combination with prostaglandin to have a chemical abortion with) in 60 clinics/centers in the United States. If you do not live where it is generally available it is possible to order it or get information but the cost is very high ($450 US).
Clinical trials of RU486 are currently being done in Canada in the cities of Edmonton, Winnipeg, Ottawa, Toronto, Montreal, Halifax and St. John's Newfoundland. Chemical abortions are not otherwise available in Canada and the drug can not be imported for personal use.
While there have been many rumours about the dangers of Chemical abortions the statistics on them show them to be quite safe. The last set of statistics were during a period when a particular prostaglandin was still in use that was found to increase the risk of using RU486. However even then the risks of a chemical abortion were similar to a vacuum abortion (both have a rate of death of 1: 200,000). It should be kept in mind that the risk of death from child birth is 1: 14,300.
References
- www.plannedparenthood.com
- Ellertson, Charlotte and James Trussell. “Estimation the Efficacy of Medical Abortion.” 60(1999)
- Cabezas,. “Medical versus Surgical Abortion.” International Journal of Gynecology & Obstetrics 63 (1998)