So you are having a miscarriage with medicine

In the wake of the leak that the Supreme Court is likely to overturn Roe v Wade, there has been a flurry of discussion around pro-Internet corners: You can't ban abortion, you just ban safe abortion. can. These social media posts are often accompanied by graphic images of coat hangers and gruesome statistics, such as the fact that abortion rates are 34 times higher in countries that have laws.

But in the United States in 2022, that is no longer the case. When it comes to self-managed abortion, drug-assisted abortion has changed the game. The two drug methods, mifepristone and misoprostol, are more than 95% effective in terminating pregnancy. And they're incredibly safe: major complications requiring hospitalization, surgery, or blood transfusions occur in only 0.3% of cases, making drug abortion safer than Tylenol.

Mifepristone and misoprostol are "the safest, least expensive, and most effective method of self-administered abortion," says Dr. Diane Horowth, co-founder and medical director of Abortion Care Partners. "They work beautifully together, and they work almost all the time," she says.

The use of these abortion pills has steadily increased over the past two decades, and now accounts for more than half of all abortions in the United States. Despite its prevalence, only one-fifth of adults (21%) and one-third of women between the ages of 18 and 49 (36%) have ever heard of a medical abortion.

Raising awareness about mifepristone and misoprostol is more important than ever, especially for anyone interested in reproductive rights - or activity with the uterus. Because access to abortion is endangered and restricted in many states, underground groups are working to help people seeking abortion connect with service providers in other states, or even pills. Send directly to people who need it.

If you need a medical abortion, either in partnership with the provider or arranged by you, here's what to expect.

How do tablets work?

First, you will take a 200 mg tablet of mifepristone, which inhibits the action of the hormone progesterone. Progesterone is needed to support the embryo implant by thickening the lining of the uterus to maintain early pregnancy. Stopping progesterone starts to separate the pregnancy from the wall and can stop the fetus from growing.

After 24 to 48 hours you will take Misoprostol - usually four 200 microgram tablets. The important thing is that you do not swallow mesoprostol. Let the tablets dissolve in the sac under your tongue or between your cheeks and gums.

Misoprostol belongs to a class of drugs called prostaglandins. Prostaglandins are also usually produced by the body (they are like hormones) and when you have menstrual cramps or cause uterine contractions during labor. When taken for abortion, misoprostol causes the cervix to open and the uterus to contract, leading to miscarriage.

How would it feel?

Although these drugs are very safe, they can cause unpleasant side effects like miscarriage, especially after misoprostol. You will feel pain and abdominal pain and experience vaginal bleeding. You may also have nausea, vomiting, and mild fever. These symptoms are all normal, but if they become severe or persist for a long time, you should seek medical attention.

Dr. Daniel Grossman, a professor of gynecology, gynecology and reproductive sciences at the University of California, Berkeley, says, "It's important for people to know what common side effects are and what the potential complications might be." San Francisco.

Are there any dangerous side effects?

Grossman says the things that need to be taken care of are pain which is severe and does not relieve painkillers like ibuprofen. There is so much bleeding that it soaks through the two menstrual pads for an hour or two in a row. And nausea, vomiting, or fever that lasts more than four hours or starts 24 hours after taking mesoprostol.

Symptoms of overdose or delay can be a sign of infection or hemorrhage and require immediate medical attention.

"The overall risk of a serious complication, such as hospitalization or the need for a blood transfusion or emergency surgery, is incredibly rare - less than half a percent," says Grossman. "It's definitely more common for people to be bleeding because they're worried about what needs to be diagnosed. In some studies, about 5% of people may go to the emergency department for a checkout. But most of them do not need treatment, they do not need blood transfusions, they are just observed and reassured. "

There are some situations in which these drugs are definitely less safe. The first is for people who have a bleeding disorder that makes them less likely to have a blood clot, or for those who are thinning their blood. People taking steroids should also avoid mifepristone as the drugs may interact. Finally, people who have an IUD, even if it has failed to prevent pregnancy, need to remove the device first because of the risk that the IUD may be partially removed from the medication. ۔

How do you know it works?

On the other hand, if you do not have any pain or bleeding, it may be a sign that the medicine is not working. Pregnancy symptoms such as nausea or tenderness in the breast should disappear within a week of taking the abortion medicine. It takes four to five weeks longer for hormone levels to return to normal and for home pregnancy tests to be negative. Be sure to test yourself one month after taking the medicine to make sure. When taken during the first 10 weeks of pregnancy, mifepristone and misoprostol are 97% effective, but if the pregnancy test is still positive, you should immediately contact the clinic or online provider from which you Has received pills.

What should I know about potential legal risks?

The safety and efficacy of Mifepristone and misoprostol are very straightforward when it comes to terminating pregnancy. What is less clear is their legal status.

Mifepristone was approved by the FDA in 2000 for use to terminate pregnancy up to 10 weeks. Misoprostol was originally developed in the 1980's to treat ulcers, but was soon discovered to cause pain. In countries where abortion was illegal, such as Brazil, it became a popular off-label abortion. Although Misoprostol is not technically authorized by the FDA for self-abortion, it was included in the 2000 approval of mifepristone. By itself, misoprostol is about 85% effective in terminating pregnancy. mifepristone alone is only 15% effective.

Due to political pressure, Mifepristone has been approved by the FDA as a risk assessment and mitigation strategy. As a result, by 2021, mifepristone could only be obtained in person from designated suppliers and not from pharmacies. (Misoprostol is available in pharmacies with a prescription.) A small silver lining of the Covid-19 epidemic is that the FDA has removed many of these restrictions, and mifepristone is now available by mail with telehealth appointments. ۔ Telemedicine abortion services such as Abortion on Demand, Just the Pill, and Hey Jane can now deliver both drugs to a woman's home using online pharmacies after an instant virtual appointment.

The catch is that many states are now restricting access to medicine for abortion. If mifepristone and misoprostol are banned in your state, there are still ways to get the medicine. Groups such as Aid Access, Women on the Web, and Plan C help send people out of the country with mifepristone and misoprostol. Local abortion funds can also connect you to clinics in nearby states that offer these services.

Another gray area is how far the medicine can be used until pregnancy. Mifepristone and misoprostol are only approved for termination of pregnancy up to 10 weeks, but they can be taken in the second trimester. In fact, Misoprostol is often used off-label in cases of stillbirth, albeit in large quantities. In these cases, the medicine is given in a hospital or in-patient facility as the pain and bleeding can be very severe.

With abortion restrictions in place, both Grossman and Horowitz say they are more concerned about the legal implications than the health consequences for women who manage their own abortions and need medical attention.

"My biggest concern is the legal risk and the criminal proceedings. I think it's more dangerous than any possible medical concern," says Horowth. "I would love for everyone to be honest with every caregiver they face. But I know there are people out there - doctors, nurses, emergency department workers, EMTs, the like. There are things - people report and will continue to do.

This was recently the case with Leslie Herrera, who was arrested following a report of an abortion by a Texas hospital.

How can I legally protect myself?

If you take mifepristone and misoprostol and you need medical help, you do not need to tell the doctor, nurse or anyone else that you have taken them.

"There is no way for a physician to tell if someone has taken the drug. Grossman says there is no commercially available blood test that can be done." It's the same regardless of whether the miscarriage was accidental or a self-inflicted abortion. "

If you live in a place where abortion is illegal, it is also important not to leave a digital sign of access to medicine for abortion. The Digital Defense Fund has a complete guide to avoiding online trackers and archived searches that may be used against you. Their suggestions include using DuckDuckGo instead of Google. Firefox Focus instead of Chrome or Safari; And if you need to talk about your abortion, use an encrypted messaging app like Signal.

This may sound dystopic, but this is the situation. Lettuce Fisher of Stark's Will, Mississippi found herself in 2017 after giving birth to a stillborn baby. Fisher was charged with second-degree murder after his phone revealed a "buy Misoprostol abortion pill online" searched on the Internet.

If you find yourself in legal trouble because of a systematic abortion, there are organizations such as the National Advocate for Pregnant Women and if / when / how legal aid for people convicted of abortion or miscarriage. Provide The groups defended Fisher and Herrera and successfully dropped their charges in both cases.

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