by Christa Brown RN, Abortion Pill Rescue (APR) Coordinator/Medical Specialist
‘‘I didn’t want the baby, but I also didn’t want to have the abortion,’’ a young woman in her early 20s just beginning her nursing career said. ‘‘I just wanted it all to not exist, which is kind of what the pill allows a woman to think can happen.’’[1]
Taking a couple pills seems easy enough. But can this “easy fix” make a living baby nonexistent?
Another woman stated, “I seem to change my mind every five minutes. I'm booked for an abortion in two weeks. My head tells me it is the right decision, but my heart tells me not to do it.”
It can be the most difficult decision a woman will ever have to make. The promise of an easy fix is enticing. And there are often time, relational, and financial pressures that move the choice forward quickly.
Growing in popularity and availability, chemical abortions (often referred to as medical abortion or abortion pill) account for 31% of all nonhospital abortions and 45% of nonhospital abortions before 9 weeks' gestation in the United States in 2014. At Planned Parenthood clinics in the United States, medical abortions accounted for 32% of first trimester abortions in 2008, 35% of all abortions in 2010, and 43% of all abortions in 2014. Some women prefer chemical abortion to surgical abortion, as it seems less invasive and can be completed at home.[2] But it is not without physical and emotional risks, and for many a lot of regret.
In 2016 the FDA updated its protocol to a regimen that uses less medication, has a longer time span during which it can be used (up to 70 days after a patient’s last menstrual period) and requires fewer visits to the provider. Twice as many abortion patients are eligible for chemical abortion following the 2016 FDA label change. The overall number of U.S. abortions continues to decline, while the number of chemical abortions continues to increase. [3]
The most common chemical abortion regimen in the United States involves the use of two different medications: Mifepristone, sold under the brand name Mifeprex, and misoprostol, sold under the brand name Cytotec.
Mifepristone is a progesterone receptor antagonist. Mifepristone and Progesterone have similar cellular structures and are able to enter progesterone receptors like a key into a lock. However, mifepristone can’t turn the lock, it just sits in the lock and prevents progesterone from going into the receptor. Mifepristone causes the separation of the decidua basalis from the trophoblast. This separation decreases the oxygen and nutrients that can be delivered to the embryo or fetus and make it difficult for the pregnancy to thrive.[4]
Misoprostol, taken 24-48 hours later, works to empty the uterus by causing cramping and bleeding. A follow-up visit is usually scheduled a week or two later to confirm the pregnancy was terminated via ultrasound or blood test. [5]
But what happens when indecision continues and a woman changes her mind after beginning a chemical abortion? Is it possible to choose again?
Prescribing bio-identical progesterone can reverse the effects of mifepristone and is successful in 64-68% of the cases. This reversal treatment works by outcompeting mifepristone for the progesterone receptor sites until the mifepristone is no longer in the system. [6]
Progesterone is a natural female hormone. It stimulates the growth of the uterus, causes maturation of the endometrium, inhibits myometrial contractions, builds breast tissue and strengthens the cervix. Called “the pregnancy hormone,” it is essential before and during pregnancy. Following a successful implantation, progesterone helps maintain a supportive environment for the developing fetus. After 8 to 10 weeks of pregnancy, the placenta takes over progesterone production from the ovaries and substantially increases progesterone production.[7]
Progesterone has been safely used to support pregnancies for over 60 years. In a study conducted by the Pope Paul VI Institute 933 pregnant patients received progesterone during the course of their pregnancies. To date, this is the largest single study of its kind. The incidence of fetal abnormalities was actually lower in that population than it was in the population that did not receive progesterone. Their conclusion was “There is no credible evidence to suggest that its use to support pregnancy, whether that support be in the early days or months of pregnancy or later in pregnancy, is, in any way, teratogenic or responsible for any genital malformations. In fact, all of the available evidence strongly supports its safety when used in pregnancy.”[8]
In an observational case series of 754 patients who decided to attempt to reverse the medical abortion process after taking mifepristone but before misoprostol and were prescribed progesterone to support the pregnancy, the researchers concluded that “the reversal of the effects of mifepristone using progesterone is safe and effective.”[9]
Pregnancy Help Organizations exist to support, educate and empower women to make the best choices possible. Sometimes, there is regret after the initial decision is made by a client and we can offer the assistance they need to attempt to reverse the effects of the abortion pill. Here are some ways your center can help:
- Offer reversal information to clients considering abortion so they understand reversal is possible. This information can be included in referral sources:
“Abortion Pill Reversal is possible. Contact us for help.
https://optionline.org/
Call 1-877-558-0333
Text “HELPLINE” to 313131” - Follow up with clients who have begun the chemical abortion process and offer reversal as an option. Many still do not know reversal is available and your call, text, or email might be a welcome glimmer of hope to someone who is regretting their decision to abort.
- When a client presents at your center seeking reversal, have her call the APR Hotline to speak with a medical professional (877) 558-0333. Heartbeat International has Medical Professionals waiting to take her call, answer her questions, and connect her with a reversal provider in her area.
- Seek donors to help a client with the cost of Progesterone for reversal. After paying for the chemical abortion, some clients may not have enough to pay for the progesterone prescription. And even those with insurance sometimes face delays that could affect the outcome of the pregnancy. Having financial assistance available would allow them access to their prescription as soon as possible.
- Become an AP Rescue PMC (Pregnancy Medical Clinic) – These are Medical Clinics that are part of the APR Network and are consulting, counseling, and prescribing for abortion pill reversal. These PMC’s may also administer and follow up with abortion pill reversal clients.
- Become an AP Rescue PRC (Pregnancy Resource Center) – These are centers that are part of the APR Network and are consulting with clients regarding abortion pill reversal. These centers offer assistance such as education about reversal, financial assistance to pay for Progesterone, and ongoing support.
- Locate new AP Rescue Medical Practices in your community – These are private medical practices or pregnancy help medical clinics that might be able provide the protocol for abortion pill reversal and may offer continued care for abortion pill reversal clients.
To receive Abortion Pill Rescue brochure information and/or more information about how to become an AP Rescue PMC or PRC, email This email address is being protected from spambots. You need JavaScript enabled to view it..
[1] A New Front in the War. New York Times Magazine Web Site. https://www.nytimes.com/2017/07/18/magazine/a-new-front-in-the-war-over-reproductive-rights-abortion-pill-reversal.html. Published July 18. 2017. Retrieved July 11, 2018.
[2] Mindock, Clark International Business Times. Web Site. "Abortion Pill Statistics: Medication Pregnancy Termination Rivals Surgery Rates In The United States". Published October 31, 2016. Retrieved April 19, 2018.
[3] Medication Abortion. Guttmacher Web Site. https://www.guttmacher.org/evidence-you-can-use/medication-abortion. Published 2018. Retrieved July, 11, 2018.
[4] Delgado, G. M.D.,Condly, S. Ph.D., Davenport, M.M.D., M.S., Tinnakornsrisuphap, T. Ph.D., Mack, J. Ph.D., NP, RN, Khauv, J. B.S., and Zhou P., A Case Series Detailing the Successful Reversal of the Effects of Mifepristone Using Progesterone. Issues in Law & Medicine, Volume 33, Number 1, 2018.
[5] Medication Abortion. Henry J. Kaiser Family Foundation Web Site. https://www.kff.org/womens-health-policy/fact-sheet/medication-abortion/. Published June 01, 2018. Retrieved July 11, 2018.
[6] Delgado, G. M.D.,Condly, S. Ph.D., Davenport, M.M.D., M.S., Tinnakornsrisuphap, T. Ph.D., Mack, J. Ph.D., NP, RN, Khauv, J. B.S., and Zhou P., A Case Series Detailing the Successful Reversal of the Effects of Mifepristone Using Progesterone. Issues in Law & Medicine, Volume 33, Number 1, 2018.
[7] Progesterone and Pregnancy: A Vital Connection. Resolve Web Site. https://resolve.org/infertility-101/the-female-body/progesterone-pregnancy-vital-connection/. Published 2018. Retrieved July 11, 2018.
[8] Unleashing the power of a woman’s cycle: Progesterone Support in Pregnancy. NaPro Technology Web Site. https://www.naprotechnology.com/progesterone.htm. Retrieved July 11, 2018.
[9] Delgado, G. M.D.,Condly, S. Ph.D., Davenport, M.M.D., M.S., Tinnakornsrisuphap, T. Ph.D., Mack, J. Ph.D., NP, RN, Khauv, J. B.S., and Zhou P., A Case Series Detailing the Successful Reversal of the Effects of Mifepristone Using Progesterone. Issues in Law & Medicine, Volume 33, Number 1, 2018.
