Abortion by pills

Bleeding, oozing, draining—spending four hours in the bathroom gives a woman plenty of time to think. There are abdominal cramps. Intestinal cramps. And uterine cramps that do the actual work of emptying a womb.

“It’s painful,” says Anne, who opted for a nonsurgical chemical abortion to end a pregnancy that threatened her life. “It’s long. It makes you feel vulnerable. You feel like your entire insides are coming out. It’s one of the most unpleasant things to ever happen to me.

“It was such a difficult decision. I thought maybe it would be easier if I could do it at home with friends around me.”

After the ordeal, she says, she needed to talk to a therapist to deal with the traumatic experience. Though she still supports chemical abortion as an option for women seeking to end a pregnancy, she says that if she could go back she would opt for a surgical abortion. She says the word “vulnerable” doesn’t begin to describe the helplessness she felt.

“You’re more than completely open,” she says. “The drugs force your body to open and stay open while they force everything out. It’s humiliating. I wailed. I cried in pain.”

But worse than Anne’s physical distress, she says, was her emotional and psychological anguish.

Before being diagnosed with breast cancer, she had tried long and hard to get pregnant. By age 39, she’d about given up hope of ever having a child of her own. Then, just before having a lumpectomy—the removal of a cancerous lump from her breast—she missed her period. At first, she chalked this up to increased stress. She took a pregnancy test just to be sure. When the test was positive, she was distraught.

A lumpectomy needs to be followed by radiation to make sure the cancer’s completely gone. Radiation causes birth defects. Her doctor ordered five years of follow-up with the drug tamoxifen, an estrogen-blocking drug. Tamoxifen causes birth defects. Finally, estrogen levels tend to skyrocket during pregnancy, increasing odds that breast cancer will recur.

Even so, the decision to end her pregnancy was the hardest she’d ever made.

“For years, I wanted to have a child,” she says. “And then I got cancer, and it took that choice away from me.”

Anne’s nonsurgical abortion took place before she moved to the Truckee Meadows. For women in Reno, choosing a chemical abortion means making a trip to northern California. The only Reno doctor who regularly performs abortions, Damon Stutes, won’t prescribe the drugs used for medical abortion (mifepristone—marketed as Mifeprex and made by Danco—and methotrexate), though they were approved by the U.S. Food and Drug Administration three years ago.

The drugs, which induce a miscarriage, are a step backward for women, Stutes says. And his office doesn’t get many calls requesting drugs for nonsurgical abortion.

Anne’s unpleasant experience puts her in the minority of women who wouldn’t use the drug again, according to Planned Parenthood Mar Monte in Reno. The group cites a study that showed that 97 percent of women would recommend nonsurgical abortion to a friend, and 91 percent of women would chose the mifepristone regimen if they were having another abortion.

“Women who’ve used this option say it’s more natural, less invasive and more private,” says Pat Elzy, director of public affairs for Planned Parenthood. “They have more personal control. There’s no risk to the cervix or the uterus.”

More than 1 million women have chosen chemical abortion, she says. Only about 3 or 4 percent experience an incomplete abortion.

Elzy notes that some people are confused about the difference between nonsurgical abortion and emergency contraception, aka the “morning-after” pills marketed as Plan B and Preven. Emergency contraception—basically a hefty dose of hormones that can prevent pregnancy—can be prescribed and obtained in Reno and need to be taken within about 120 hours of unprotected intercourse. They will not induce an abortion, Planned Parenthood contends. The pills cost about $20 to $25. Elzy thinks that women should keep emergency contraception in their medicine cabinets at home.

Non-surgical abortion drugs require stricter supervision from a physician. These drugs are used to cause the miscarriage of a pregnancy within nine weeks of the first day of a woman’s last menstrual cycle. The cost of the regimen—about $350 to $575 for office visits, tests, exams and follow-up—is nearly the same as for a first-trimester dilation and curettage abortion (about $500).

“It’s not a cheap alternative,” Elzy says. “It’s an option for early pregnancy termination.”

Which do women say is more painful?

“You can’t compare one pain to any other pain,” Elzy says.

A nonsurgical abortion requires at least two visits to a clinic. Anne went on a Friday to have an ultrasound and receive her first dose—usually 600 to 800 milligrams—of mifepristone. She was instructed not to eat or drink much. Anne asked two of her closest women friends to spend the weekend with her.

“You have to have someone,” she says. “It’s a serious procedure.”

Mifepristone blocks the hormones necessary to maintain a pregnancy. The lining of Anne’s uterus softened and broke up as it would during a menstrual period.

At 8:30 a.m. Saturday, she took the misoprostol that causes contractions to expel the fetus.

Within two hours, she was experiencing the worst cramps she’d ever had. She spent about four hours in her bathroom, expelling the contents of bowels, bladder and uterus. By 1 p.m., the pain and bleeding had begun to subside. After the weekend, she returned to the clinic for another ultrasound—to make sure the abortion was complete.

Anne had had a miscarriage before, she says. This was not the same. If she could go back in time, she’d opt for a quicker, less painful surgical abortion.

"[Chemical abortion] is a significantly more intense experience than it would be for someone who has a surgical abortion,” she says. “You have all those hours to reflect while you’re in pain. You have moral ambivalence. There are a lot of conflicted opinions that anyone is going to have, any conscious, caring person.”

What some opponents of chemical abortion perhaps don’t think about, Anne says, is that her own unpleasant experience is argument enough for the drug.

“No one is going to abuse this drug,” she says. “I know there are people out there who think it’ll be used as a form of birth control. If anyone did use it as birth control, then they need to have their head examined because there’s something seriously wrong with them.”

While Anne’s chemical abortion was physically and emotionally painful, that of California teen Holly Patterson less than two months ago was fatal.

The 18-year-old from Livermore began a nonsurgical abortion regimen on Sept. 10 when she took mifepristone at a Planned Parenthood clinic in San Francisco. It was a Thursday. On Saturday, she reportedly took the misprostol tablets given to her by the clinic. This practice of sending the drugs home with the patient—also described in Anne’s case—is outside the regimen approved by the Food and Drug Administration, which requires that the second drug be taken under the supervision of a physician.

By Sunday, Holly’s cramping and bleeding were so severe her boyfriend took her to an emergency room, where she received pain killers and was sent home. Holly spent the next two days in such pain that she couldn’t walk, according to reports. Six days after her chemical abortion ordeal began, her boyfriend took her back to the emergency room, where Holly died that Wednesday afternoon.

Some reports quote Holly’s father saying a doctor indicated septic shock as the cause of death. This could happen if the fetus hadn’t been completely aborted—which leads to a systemic infection.

Serious infections occur in up to 4.7 percent of first-trimester surgical abortions, according to the FDA. They can occur in up to 6.1 percent of medical abortions. Though the FDA concluded the drugs are “safe and effective,” the agency notes that “safe does not mean risk-free.”

In a petition submitted in mid-October to the FDA requesting that the drug be taken off the market, the Christian Doctors Association describe what it calls insufficient testing and improper marketing of the drug.

The group also notes that hospital emergency rooms aren’t trained to deal with emergencies such as Holly’s. The drug combination could disguise such tell-tale symptoms of an infection as a high fever. That could be why emergency room doctors sent Holly home that Sunday, even though her body was in the beginning stages of an ultimately fatal infection.

In January, a bill was introduced in the U.S. House of Representa-tives, the RU-486 Patient Health and Safety Protection Act (HR486), that seeks to stiffen restrictions on physicians who could prescribe the medical-abortion drugs. The bill has been in the Subcommittee on Health since February.

With any medical procedure, complications can arise, says Elzy in Reno. In the case of the California teen, it’s her understanding that the autopsy is still incomplete.

“Planned Parenthood reaches out to her family at this time," she says. "But mifepristone has a long track record of safety and effectiveness."