a step-by-step guide to safe medical abortion

  • A home abortion involves taking two pills, mifepristone and misoprostol, to end a pregnancy.
  • You take the first medicine by mouth and 24-48 hours later dissolve the second tablet in your mouth.
  • If you are eight weeks or less pregnant, a medical abortion is 94-98% effective.

While many people think of abortions as procedures performed in a clinic, medical abortions, also known as “home” abortions, are less invasive and take place in the comfort of your own home. All it takes is two drugs, which are FDA-approved for pregnancies up to 10 weeks.

It is estimated that medical abortions are now more common than in-office procedures, accounting for 54% of abortions in the United States. Here’s what you need to know about how home abortions work, the steps to take the medications, and aftercare.

What is a home abortion?

Having an abortion at home means using drugs as a safe way to end an early pregnancy, says Dr. Kate White, OB-GYN and associate professor of OB-GYN at Boston University School of Medicine. The specific drugs you use are mifepristone and misoprostol.

When you take these pills, the pregnancy sac detaches from the walls of the uterus. After that, the bleeding and cramping cause any pregnancy tissue to drain out of the uterus, White says.

Mifepristone and misoprostol are very effective in terminating pregnancies. However, your chances depend on how far along the pregnancy is.

  • If you are eight weeks pregnant or less, a medical abortion is 94% to 98% effective
  • If you are eight to nine weeks pregnant, a medical abortion is 94% to 96% effective
  • If you are 9 to 10 weeks pregnant, a medical abortion is 91% to 93% effective

White says if you’re past nine weeks, you may need to take an extra dose of the second drug, misoprostol, to make sure the process is successful. If you are 9-10 weeks pregnant and take an extra dose, the success rate is 99%.

Although the FDA has approved medical abortion up to 10 weeks pregnant, some people may have one a little later. If you are 10 to 11 weeks pregnant, the success rate of a home abortion is 87%. However, if you take an extra dose, your chances increase to 98%.

If a second dose still does not completely terminate the pregnancy, an in-clinic abortion is required.

How to get medication for abortion

Depending on your personal situation, there are two ways to obtain mifepristone and misoprostol for an at-home abortion.

White says you can go through a doctor or clinic and receive the drugs in-office, where you’ll likely swallow the first pill (mifepristone) and take the second drug (mifepristone) home to complete the process.

Alternatively, in more difficult situations where you don’t live near a clinic or it’s not legal in your state, White says you can order these medications online and they will be shipped to you. From there, you follow the same instructions as if you were to go through the medical system.

A step by step guide to a home from home

It is important to follow the correct steps to ensure that your home abortion goes smoothly.

Step 1: Take mifepristone

First, you’re taking mifepristone, which is a progesterone antagonist, meaning it blocks the hormone progesterone, says Dr. Stacey Leigh Rubin, obstetrician-gynecologist specializing in complex family planning and advocacy. at the DuPont Clinic.

This helps start the abortion process since progesterone is needed for a pregnancy to develop and grow, Rubin says.

Although this medicine is working, you probably won’t feel any major changes in your body. “People often don’t feel any effect from this first medication, although spotting or light bleeding may start that day,” White says.

Step 2: Prepare to take misoprostol

Since misoprostol causes cramping and bleeding, you should make sure you have:

  • A supply of sanitary napkins or reusable sanitary pads on hand to manage the bleeding. “Tampons or menstrual cups are not recommended during this time because blood needs to flow freely from your body to prevent infection,” says White.
  • An over-the-counter pain reliever such as ibuprofen or acetaminophen, which you can take before misoprostol to relieve some of the pain that comes with cramping.

Step 3: Take misoprostol

Misoprostol is the second medication, which you usually take about 24 to 48 hours after ingesting mifepristone.

Rather than simply swallowing pills, misoprostol is better absorbed by letting the pills dissolve and pass through mucous membranes. You let the pills dissolve. Rubin says there are three ways to take it:

  • Oral: You place the pills between the cheeks and the gums
  • Sublingual: You place the pills under the tongue
  • Vaginally: You insert the pills into the vagina

Misoprostol causes uterine contractions and bleeding, allowing pregnancy tissue to extrude out of the uterus, and eventually through the vagina, Rubin says.

Step 4: Bleeding Management

Within an hour of taking misoprostol, you will experience intense cramping and heavy bleeding, including clots, which signal the passage of pregnancy tissue. In most cases, the pregnancy tissue will pass after four or five hours, and you can expect the worst cramping and bleeding to last for a maximum of six hours, easing after the pregnancy ends, Rubin says. .

In addition to cramping and bleeding, you may also experience symptoms such as:

  • Diarrhea
  • Dizziness
  • Mild fever
  • Nausea
  • Vomiting
  • Fatigue

During this process, some things can make you feel a little more comfortable. White recommends:

  • Stay near a bathroom for easy access
  • Take a hot shower or bath
  • Using a heating pad or hot water bottle on your abdomen

When to See a Doctor Immediately

Medical abortions are safe, but it is important to monitor yourself for any complications. Rubin says the red flags to watch out for are:

  • Heavy bleeding including clots for more than six hours after taking the second medication (especially if the clots are larger than a golf ball).
  • Soak an entire pad every half hour for more than two hours anytime after taking the second medication.
  • Fever or gastrointestinal problems more than 24 hours after taking misoprostol, which could be a sign of infection.

In these cases, you should immediately consult a doctor.

Abortion Aftercare Instructions

During the first few days after the abortion, the cramps will subside and the bleeding will slow down. White says it’s normal to bleed over the next two weeks, with less and less bleeding over time.

After two weeks, you should take a pregnancy test to confirm that you are no longer pregnant.

Since everyone’s body is different, there is a wide range of what is “normal” after an abortion. Rubin says it can range from very light spotting to more period-like bleeding throughout this period.

Avoid straining for a few days after your abortion, as this can cause more cramping and bleeding. You should refrain from intense physical exercises for a week.

Remember that it is completely normal to experience a wide range of emotions after an abortion. Confiding in a trusted loved one and seeking support during this time can be very comforting.

Also, you can ovulate within two weeks of having an abortion, which means you can get pregnant again if you have unprotected sex. If you don’t want to get pregnant again, Rubin recommends starting some form of birth control as soon as possible.

Insider’s Takeaways

A home or medical abortion involves taking two drugs, mifepristone and misoprostol, to end a pregnancy and expel the contents of the uterus. This is a safe and effective option if you don’t want to get pregnant and prefer to avoid a surgical abortion.

Be sure to follow the instructions carefully and monitor yourself during and after the abortion to make sure there are no complications. If at any time you notice any red flags, do not hesitate to consult a doctor.

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