In the short term, RU-486 and Misoprostol cause severe cramping, contractions, and heavy bleeding, which force the dead baby out of the mother’s uterus. Contractions and bleeding to expel the baby can last from several hours to several days, and can be very intense and painful. Many women also experience nausea, vomiting, diarrhea, abdominal pain, and headache.1 Maternal deaths have occurred, most frequently due to infection and undiagnosed ectopic pregnancy.2
Even after the baby is expelled, the bleeding and spotting may continue for several weeks. Bleeding usually lasts 9 to 16 days. Eight percent of women (1 in 12) bleed more than 30 days, and 1 percent require hospitalization because of heavy bleeding.6
About 5-8 out of 100 women (5-8%) may need a surgical procedure to complete the abortion or to stop too much bleeding.7
There is insufficient reporting on the long-term effects of medical abortions. Approval for RU-486 in the United States only extends back to October, 2000, and long-term effects and risks must still be evaluated. This means women who undergo medical abortions could be prone to unknown risks.
There are studies that indicate the risk of depression, anxiety, and suicide is greater for a woman who aborts an unwanted pregnancy than it is for a woman who carries an unwanted pregnancy to term.9
Von Hertzen, H, et al. “Misoprostol Dose and Route after Mifepristone for Early Medical Abortion: A Randomised Controlled Noninferiority Trial.” British Journal of Obstetrics and Gynaecology, June 18, 2010. <onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02636.x/full>.
Ellertson,Charlotte, et al. “Can women use medical abortion without medical supervision?” Reproductive Health Matters, Vol. 5, No. 9, Abortion: Unfinished Business, May 1997, pp. 149-161. <http://www.rhm-elsevier.com/article/S0968-8080(97)90019-7/abstract>.
Von Hertzen, H, et al. <onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02636.x/full>.
Food and Drug Administration. “MIFEPREX (mifepristone) Tablets, 200 mg.” accessed 19 Jan. 2016. <http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020687s015lbl.pdf>.
Grimes, D.A. “Risks of mifepristone abortion in context.” Contraception, Vol. 71, 2005, p. 161. <https://www.arhp.org/uploadDocs/journaleditorialmar2005.pdf>.
Food and Drug Administration. “MIFEPREX (mifepristone) Tablets, 200 mg.”, <http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020687s015lbl.pdf>.
Food and Drug Administration. “MEDICATION GUIDE Mifeprex.” accessed 19 Jan. 2016 <http://www.fda.gov/downloads/Drugs/Drugsafety/ucm088643.pdf>.
Food and Drug Administration. “MIFEPREX (mifepristone) Tablets, 200 mg.”, <http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020687s015lbl.pdf>.
Fergusson, David M with Joseph M. Boden and L. John Harwood. “Does abortion reduce the mental health risks of unwanted or unintended pregnancy? A re-appraisal of the evidence.” Australian & New Zealand Journal of Psychiatry, Sept. 2013, Vol. 47, No. 9, pp. 819-827. <http://www.ncbi.nlm.nih.gov/pubmed/23553240>.
How is a D&E abortion performed?
To prepare for a D&E abortion, the abortionist uses laminaria, a form of sterilized seaweed, to open the woman’s cervix 24 to 48 hours before the procedure. The laminaria soaks up liquid from the woman’s body and expands, widening (i.e., dilating) the cervix.
When the woman returns to the abortion clinic, the abortionist may administer anesthesia and further open the cervix using metal dilators and a speculum. The abortionist inserts a large suction catheter into the uterus and turns it on, emptying the amniotic fluid.
After the amniotic fluid is removed, the abortionist uses a sopher clamp — a grasping instrument with rows of sharp “teeth” — to grasp and pull the baby’s arms and legs, tearing the limbs from the child’s body. The abortionist continues to grasp intestines, spine, heart, lungs, and any other limbs or body parts. The most difficult part of the procedure is usually finding, grasping and crushing the baby’s head. After removing pieces of the child’s skull, the abortionist uses a curette to scrape the uterus and remove the placenta and any remaining parts of the baby.
The abortionist then collects all of the baby’s parts and reassembles them to make sure there are two arms, two legs, and that all of the pieces have been removed.
What if a woman changes her mind after laminaria insertion?
If a woman has been dilated with laminaria, but not yet undergone the surgical abortion, she can still change her mind. Depending on how much her cervix has dilated, there is a potential risk of miscarriage as dilation continues because her body may begin contractions and labor. A woman who changes her mind should immediately contact a medical professional to ensure the laminaria is properly removed. [1] Kaufman, K. The Abortion Resource Handbook.” New York: Fireside, 1997, 32, 153.
What are the short-term and long-term risks and adverse effects of medical abortion?
For the woman, this procedure carries a significant immediate risk of major complications. Since the baby is removed in pieces, sharp pieces of broken fetal bones can puncture the woman’s uterus or cause a large tear (laceration). This perforation or laceration of the uterus or cervix, can also possibly damage the bowel, bladder, the rectum and other maternal organs.
In addition to perforation and damage to internal organs, a second trimester abortion has a greatly increased risk of excessive bleeding and hemorrhaging. This is because the placenta is tightly adherent to the lining of the womb at this stage in pregnancy, and removing it often requires considerable scraping. The risk of excessive bleeding as a result of the abortion increases as the baby develops. The woman may also experience extreme blood loss if her uterus or cervix is injured, if the uterus does not contract properly after the procedure, or if she has an incomplete abortion. She also runs a higher risk of cervical damage, uterine perforation and scarred tissue, which may result in future pregnancy complications, such as miscarriage and preterm birth.1 Uterine rupture can even lead to maternal death.
Long-term damage from second trimester abortion is more frequent than for abortions in the first trimester. Because the cervix has to be so widely dilated to extract the larger child, the risk of cervical damage is much greater, increasing the risk that a woman will be unable to carry a future pregnancy to term. The CDC also estimates that the risk of death increases by 38% for each additional week of gestation.2
There are studies that indicate the risk of depression, anxiety, and suicide is greater for a woman who aborts an unwanted pregnancy than it is for a woman who carries an unwanted pregnancy to term.
Lohr, Patricia A. “Surgical Abortion in Second Trimester”, Reproductive Health Matters, May 2008, 156. <www.ncbi.nlm.nih.gov/pubmed/18772096>.
Bartlett, Linda A., et al. “Risk Factors for Legal Induced Abortion–Related Mortality in the United States.” Obstetrics & Gynecology, Vol. 103, No. 4, April 2004, pp. 729-737. <http://www.ncbi.nlm.nih.gov/pubmed/15051566>.
Fergusson, David M with Joseph M. Boden and L. John Harwood. “Does abortion reduce the mental health risks of unwanted or unintended pregnancy? A re-appraisal of the evidence.” Australian & New Zealand Journal of Psychiatry, Sept. 2013, Vol. 47, No. 9, pp. 819-827. <http://www.ncbi.nlm.nih.gov/pubmed/23553240>.
Fox, Michelle C. and Jennifer L. Hayes. “Cervical Dilation in Second-Trimester Abortion.” Clinical Obstetrics and Gynecology. Vol. 52, Issue 2, June 2009, pp. 172-8 <http://journals.lww.com/clinicalobgyn/Abstract/2009/06000/Cervical_Dilation_in_Second_Trimester_Abortion.8.aspx>.
Cates, Willard Jr. and David A. Grimes. “Deaths from Second Trimester Abortion by Dilatation and Evacuation: Causes, Prevention, Facilities.” Obstetrics & Gynecology, Vol. 58, Issue 4, October, 1981. <http://www.ncbi.nlm.nih.gov/pubmed/7279335>.
Peterson, W.F., et al. “Second-Trimester Abortion by Dilatation and Evacuation: An Analysis of 11,747 Cases.” Volume 2, No. 2, Aug 1983. <https://venus.ipas.org/library/fulltext/PetersonOG1983.pdf>.
“Risk Factors for Legal Induced Abortion-Related Mortality in the United States.” American College of Obstetrics and Gynecology, Vol 103, No. 4, April 2004.
Are late-term abortions legal in the India?
In India, while the Medical Termination of Pregnancy (MTP) Act regulates when and under what conditions an abortion may be performed, different states and medical boards may vary in how these provisions are implemented. Although no Indian state has enacted a total prohibition on abortion, the law imposes gestational limits and requires specific medical approvals after a certain stage of pregnancy.
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The woman visits an abortion clinic or doctor’s office and ingests pills containing Mifepristone (also known as RU-486) at the clinic. This drug blocks the action of the hormone called “progesterone,” which is naturally produced by the mother’s body to enable the mother to sustain and nourish the pregnancy. When RU-486 blocks progesterone, the lining of the mother’s uterus breaks down, cutting off blood and nourishment to the baby, who then dies inside the mother’s womb. Twenty-four to forty-eight hours later, the woman ingests another drug called Misoprostol (also called Cytotec), administered orally or vaginally, which causes contractions and bleeding to expel the baby from the womb.
The Food and Drug Administration (FDA) specified exactly how the drug regimen was to be given.
There is usually limited medical supervision for the woman during a medical/chemical abortion. Prior to the abortion, she should receive an exam that includes an ultrasound in order to confirm the pregnancy and diagnose any complicating factors, such as a tubal or ectopic pregnancy.
After taking the first pills (Mifepristone/RU-486) in the clinic, she is sent home to complete the abortion. This means she must correctly follow the directions for taking the remaining set of drugs and is responsible for judging whether her body’s reaction to the abortion is normal or not (such as a dangerous loss of blood). With this type of abortion, it is likely that she may not have a doctor to provide immediate help should a potentially life-threatening complication occur, so it is very important that she report any concerns to her doctor and seek emergency help if necessary.
The woman will also be responsible for disposing of her child’s remains. While she could lose her baby anytime and anywhere during this process, the woman will often sit on a toilet as she prepares to expel the remains, which she will usually then flush— she may even see her dead baby within the pregnancy sac.
It is also important that the abortionist perform a follow-up exam and ultrasound to ensure that the abortion is complete.
If a mother changes her mind after taking RU-486, she might still be able to save her baby, especially if she has not yet ingested the second drug, Misoprostol. To increase her chances of saving the baby, progesterone must be administered as soon as possible to counteract the effects of RU-486. Helpful guidance, resources, and stories of successful abortion pill reversals are available at abortionpillreversal.com.
The failure rates for medical abortion increase as the pregnancy progresses.
According to the FDA’s assessment, using published and unpublished studies, the failure rate of RU-486 rises to over 7.3% when administered in the 10th week. This is more than three times higher than their assessed failure rate for RU-486 abortions in the 7th week.
Other studies have recorded even higher failure rates for medical abortion. The Von Hertzen study found failure rates of 5% at seven weeks and under, 8% at eight weeks, and 10% at nine weeks.
Von Hertzen, H, et al. “Misoprostol Dose and Route after Mifepristone for Early Medical Abortion: A Randomised Controlled Noninferiority Trial.” British Journal of Obstetrics and Gynaecology, June 18, 2010. <onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02636.x/full>.
Von Hertzen. <onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02636.x/full>.
During this stage of pregnancy, the preborn child is developing rapidly. At four to five weeks LMP — that is, four to five weeks since the first day of the mother’s last period, and just two to three weeks following fertilization (conception) — the baby’s organs start to develop, and the heart begins to beat. These developmental milestones often take place before the mother even knows she is pregnant.
At eight weeks LMP, the preborn baby’s hands and feet are developing, and the neural pathways in her brain start to form. The child is constantly moving in the womb, although the mother cannot feel it. Source: Baby Center.
By nine weeks LMP, the child can suck her thumb, open and close her jaw, stretch, and sigh. The baby’s teeth begin to form and the heart completes dividing into four chambers. Source: Baby Center.
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