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Medical Abortion Procedure

This Page Outlines the Clinics Medical Abortion Process

Representing one of the most significant advances in women’s reproductive heath and choice in decades, on September 28, 2000, the Food and Drug Administration (FDA) approved the drug mifepristone (organically known as RU 486 and pronounced miff-a-PRIS-tone) for the termination of very early pregnancy. Mifepristone is distributed under the brand name Mifeprex. Using Mifeprex to terminate early pregnancy without primary surgical intervention is referred to as a medical abortion.

Mifeprex gives women a new choice for abortion-a safe, private method of terminating a very early pregnancy that is non-invasive (no surgery) and does not require anesthesia. Mifeprex can only be used during the first 10 weeks or 70 days after a woman’s last menstrual period. This means that it can only be used during the first three to five weeks after a woman first misses a menstrual period, which is typically when she discovers that she is pregnant.

Please be Sure to Check the Following Additional Resources:

Requirements and Precautions to Qualify for a Safe Medical Abortion

Abortion Frequently Asked Questions

Instructions for Inserting the CYTOTEC (MISOPROSTOL) Tablets

Summary of Medication Intake

How to Manage Possible Side Effects of Misoprostol

What to Expect From Your First Visit

You will be given patient information sheets to fill out.

The nurse will then take you to the lab where the lab technician will prick your finger to do a blood test for the RH factor and anemia. Your blood pressure, pulse, and temperature will also be taken. If you are extremely anemic (hematocrit below 30%), you may not be able to have a medical abortion. A surgical abortion is the safer option for women who are extremely anemic.

Rh- If you have Rh negative type blood, you must consent or sign a waiver explaining why you do not want the Rhogam shot. The Rhogam shot prevents heart or brain damage in any future pregnancies due to Rh negative blood. There is an additional cost for Rhogam.

You will then be taken to an exam room where the technician will perform your ultrasound to determine your gestational age and make sure that you are not over 10 weeks pregnant. There is a possibility that the technician will have to do a vaginal ultrasound in which a small probe is inserted into the vagina to be able to perform the ultrasound. This may cause some discomfort, but is not painful. This method allows the physician to get a more accurate measurement. State Law requires that you wait at least 48 hours prior to having the abortion. The physician or qualified person will provide you with the state required material “Right to Know”. You will also be given the opportunity to view the ultrasound and a video prepared by the state. You are not required to read the material or view the ultrasound. You will receive your patient information counseling that will explain the pros and cons of medical and surgical abortion and how they are performed.

After your ultrasound you will go to the business office where your first day fee will be collected. Patients receiving 48 hour state required literature by mail must make payment in full on the day of the abortion.

What to Expect From Your Second Visit

The balance of the charge for the abortion will be collected.

You will be called by a counselor who will answer any questions you have, ask which procedure you have chosen, and attend to any concerns you may have. In the counseling session, you will also see a video that explains the abortion process, go over each item on the informed consent form, and sign them with the counselor. Birth control options will be offered as well.

Then you will go to an exam room to take the Mifepristone pill, which interrupts the growth of the pregnancy and begins the abortion process. You will also receive pills, Misoprostol to take home with you. You will be instructed to insert 2 tablets on each side of your mouth between your cheek and gum at anytime the next day. Using Misoprostol at home has been found to be safe, effective, and acceptable to women. Women in studies preferred to take their Misoprostol at home because of privacy, convenience, control, and comfort among other reasons. Most women reported that the bleeding and cramping following Misoprostol were managed at home comfortably and conveniently. Once the Mifepristone has had enough time to work, the Misoprostol causes the uterus to contract and usually produces a miscarriage. So, that is the start of the abortion process, and once started, you must complete the abortion.

After you have received all your instructions and received your follow-up appointment date and time then you will be ready to go home.

Instructions for taking the CYTOTEC (MISOPROSTOL) Tablets

Have something to eat prior to taking the Misoprostol. If you wish, you may use pain reliever approximately 30 minutes before letting the tablets disolve. You should have your pain RX filled prior to taking Misoprostol.

1.    Take the 4 tablets from the bottle labeled Cyctotec or Mifepristone and insert 2 tablets on the inside of your mouth between your cheek and gum. The tablet may not dissolve completely. Swallow any remaining tablets after 30 minutes.

2.    Expect cramping and bleeding for the next 1-10 hours.

3.    Get up slowly from a sitting or lying down position…Misoprostol can cause dizziness.

4.    Eat lightly and drink plenty of fluids. Avoid alcohol and caffeine.

5.    Continue to use pain reliever as directed for cramping.

6.    Monitor your bleeding.

7.    Contact the clinic for excessive bleeding, pain, concerns, or questions.

Summary of Medication Intake

Day 1    Mifepristone Pills (RU-486): This is the start of the abortion process.

Day 2    Misoprostol (Cytotec)

Day 9 or Day 10    Return to West Alabama Women’s Center if a miscarriage has NOT occurred, you may need more Misoprostol pills or have a surgical abortion. The physician will discuss both options but the method chosen will be at physician’s discretion. If miscarriage occurs your follow up visit will be scheduled to return in 3 weeks.

Managing Possible Side Effects of Misoprostol

Drink plenty of fluids and eat lightly the day before and the day you take the Misoprostol pills. Misoprostol may cause nausea, vomiting, and diarrhea, so you need to drink lots of fluids. Spicy or fried foods worsen the distress.

If the vomiting and diarrhea are more than you can tolerate, call West Alabama Women’s Center at 800-616-2383 and if it is after 5 p.m. you will be directed to our answering service who will contact the medical personnel on call.

If Cramping Should Occur:

The cramps may be quite strong. Cramps are worse when your stomach is empty. Be sure to eat lightly and drink fluids.

Take the pain pills we prescribed a half hour before you insert the misoprostol pills.

Take as directed for pain relief.

You may use a heating pad or hot water bottle if bleeding is not heavy.

You do not need to call to tell us you are having pain, because it is a normal part of the process.

You may also take 600-800 mg of Ibuprofen every 4 hours in addition to the pain pills.

Do not take aspirin, as it can increase your bleeding. Cramping becomes milder after the passage of pregnancy tissue, in most cases.

What to Expect From Your Third Visit

Three weeks from the 2nd clinic visit, you need to return to West Alabama Women’s Center for a 3rd appointment for an ultrasound and follow up visit. Remember the abortion is not complete until after the ultrasound on your final visit. Even if you had heavy bleeding, cramping, and passed clots, you can still be pregnant. There is not an extra fee for this ultrasound or your follow-up visit.

You can have someone drive you, or come alone on your 3rd visit, but if you need a surgical abortion, you will have to have a driver to receive sedation.

Remember, a mifepristone-misoprostol abortion has about a 2%-4% failure rate, and that these drugs can cause serious birth deformities if pregnancy is carried to term. It is absolutely necessary that you agree to have a surgical abortion if the medical abortion fails.

If the ultrasound on the final visit shows you are still pregnant, the physician will discuss with you whether you can take more misoprostol or whether a surgical abortion is best, depending on whether the pregnancy is still growing.

There is no extra charge for the ultrasound, additional Misoprostol pills, or surgical abortion at West Alabama Women’s Center. If you seek medical care from any other hospital, doctor, or clinic, those expenses are your responsibility.
Book An Appointment Online or for additional information please feel free to Contact us at anytime at 1-800-616-2383 or 205-556-2026.