Self-managed abortion can carry different meanings depending on where you live. A self-managed abortion in the United States normally refers to a medical abortion in which medication is used to end a pregnancy. A woman obtains the medication online or through the mail and takes the drugs with little to no medical supervision.
There can be a lot of unknowns when looking into a self-administered medication abortion. Different laws and regulations exist in different areas. Medication abortion pills can be purchased online throughout the United States, but you should be informed about:
- the specific laws and regulations for your location
- your own health and how a self-managed abortion could affect your health
- when to take the medication
Should I see a doctor before an at-home medication abortion?
Yes. It is always best to have a medical professional review your health before self-administering a medication.
Why should I see a doctor before a medical abortion?
When a medical abortion is managed by a physician, the patient undergoes a physical exam and an ultrasound. It is important for the doctor to know how far along the pregnancy is, to check the heartbeat, and to be sure the pregnancy is in the uterus. If the pregnancy is 70 days or less, the doctor will approve a medical abortion and give the first pill to take in the office. This pill blocks a hormone that is needed for the pregnancy to continue. A second pill is sent home to be taken 24 to 48 hours later.
How do abortion pills work?
The first pill, mifepristone, blocks a hormone called progesterone which is necessary for the pregnancy to continue. This cuts off oxygen and nutrients from the fetus, causing the fetus to detach from the uterus wall and stop growing, ending the pregnancy.
The second pill is Misoprostol. This is taken 24-48 hours after the first pill. It causes the uterus to contract and expel the uterine lining and pregnancy tissues. The patient should expect severe cramping and bleeding which is likely to be much heavier than a normal period.
A medical abortion cannot be performed if:
- the pregnancy is too far along
- the patient has an allergy to the medications used
- there may be an ectopic pregnancy
- the patient is taking blood thinners
- Certain medical conditions such as severe kidney, liver, or lung disease, certain heart or blood vessel diseases, or an uncontrolled seizure disorder are present
- the patient has an IUD (intrauterine device)
Can I get an abortion without a doctor visit?
When Covid hit two years ago, many doctor visits were canceled or done virtually. There was a push by abortion providers and advocates to allow medical abortions to be done virtually.
The Food and Drug Administration (FDA) requires mifepristone – one of two medications typically prescribed for a medical abortion – to be closely monitored due to serious safety concerns. But in April of 2021, the FDA relaxed restrictions on the management of mifepristone.
As a result, women seeking an abortion are now able to receive the abortion pill through the mail following a virtual visit with an abortion clinic. Prior to this decision by the FDA, mifepristone could only be prescribed after an in-person exam with a certified physician.
Is self-managed abortion without a doctor visit safe?
Self-managed abortion raises several concerns.
- No Physical Exam – Without a physical exam, the doctor is not able to check for masses or a possible ectopic pregnancy. If the pregnancy is ectopic (meaning it is not in the uterus) it creates a dangerous, even life-threatening, situation for the patient. An undiagnosed ectopic pregnancy growing outside of the uterus can rupture, causing internal bleeding. This can result in the need for surgical repair, loss of fertility, or even death. It is very important to have a physical exam before completing a medical abortion.
- No Ultrasound – Without an ultrasound, it’s impossible to know exactly how far along the pregnancy is, whether the pregnancy is growing in the right place and whether the pregnancy is viable.
- 10 Week Effectiveness – Medication abortions are only effective up to about 70 days or 10 weeks. If the pregnancy is further along, the medication will not effectively end the pregnancy. It’s very important to have an ultrasound and know the age of the pregnancy before taking an abortion pill.
- Natural Miscarriage – If the pregnancy is not viable – meaning it will not survive on its own – an abortion is not necessary. About 30 percent of early pregnancies end naturally in miscarriage.
During and after an abortion, it’s important for patients to have access to a medical provider for any problems, questions, or the need for emergency care.
A follow-up appointment post medical abortion includes a physical exam to make sure you are healing properly. The doctor will check bleeding and look for signs of infection. They might ask questions such as:
- How much bleeding have you had?
- Are you still bleeding?
- Do you still feel pregnant?
- Did you see the passing of the gestational sac or embryo?
What are the risks of a self-managed medical abortion?
The risks of a medical abortion include:
- Incomplete abortion – This means the medication was not completely effective and the patient will need a surgical procedure.
- Bleeding which is heavier than a normal period and lasts longer
- Infection
- Complications could result in problems with getting pregnant in the future
Common Questions About self-managed Abortion
Every patient is different, so seeking professional advice and counseling is extremely important. Below we have compiled a few of the most common questions about medication abortion.
How old do you have to be to purchase the medication for a self-managed abortion?
To purchase the medication for an abortion you need to be at least 18 years old. In Pennsylvania, you’ll need a parent or legal guardian to purchase abortion pills. This is due to state laws. Ordering abortion pills online will require someone over 18 and in many states, it can be illegal to self-administer the abortion drugs after a certain date. You can protect yourself from legal persecution by knowing for certain the age of the pregnancy. A simple ultrasound can determine the age or gestation of the pregnancy. Jewel Women’s Center offers pregnancy confirmation ultrasounds to patients at no cost. If you are under 18 it is vital that you communicate with your legal guardian about being pregnant.
How long does the self-administered abortion medication take?
According to some studies, most women feel the abortion was completed by three weeks after they had taken the medication. Some felt contractions occurred within a few days of taking the medication.
How does a self-administered abortion feel?
Throughout the three weeks, women reported they felt a lot of pain, a lot of contractions, and heavy bleeding.
Essentially the small fetus (a term used before a baby reaches 10 weeks in the uterus) passes as a normal menstrual cycle. Since the fertilized egg has drastically increased in size, the pain and contractions will be more intense than regular period cramps and the bleeding is more severe because there is more tissue to expel than a normal period.
What does the law say about abortion in Pennsylvania?
In Pennsylvania, it is illegal for women who are 24 or more weeks pregnant to have an abortion. This is measured from the first day of a woman’s last period until the current date. The law makes an exception if the doctor says that an abortion is necessary to prevent the woman’s death or is necessary to prevent the substantial and irreversible damage to a woman’s major bodily function.
A healthy option at no cost to you
Jewel Women’s Center offers no-cost preabortion screenings that will answer important questions such as:
- Am I really pregnant?
- Is the pregnancy viable?
- How far along am I?
Your health is important and we are here to help. No cost. No pressure. Contact Jewel today for a preabortion screening.