Medication abortion

I decided to have a medication induced abortion rather than a surgical abortion.  A choice between a medication abortion and a surgical abortion is typically given if the pregnancy is no longer than 9 gestational weeks along.  While trying to find information about what a typical medication abortion would be like and the specific drugs given, I discovered that the information about it is limited and difficult to find.  I will explain everything in as much detail as I can muster so that other people may access this information a little easier.

Price:

The price at Planned Parenthood was a nonrefundable fee of $105.00 for the ultrasound to confirm gestational age, and $410.00 for the abortion.  The price of the abortion will be higher if the woman is Rh negative, or if the gestational age is more than 11.6 weeks.  It is possible to receive private funding to help reduce the cost of the abortion only, not the ultrasound, if you qualify.  There are only two private organizations in the north Texas area that can help with funding.  The first one is only contacted by a staff member at Planned Parenthood, called The Justice Fund.  The second one is called the Texas Equal Access Fund, and you can find their information here.  I reported my monthly household income as $1700.00 before taxes, and I did not qualify.  I am not sure about their limit for income.

Medications:

I will refer to each drug with a label of L1, L2, L3, L4, or L5.  What I am referencing is the safety of these drugs while breastfeeding.  Here are definitions of the classes of drugs in terms of safety while breastfeeding:

“L1 safest:

Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant.

L2 safer:

Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant; And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.

L3 moderately safe:

There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.

L4 possibly hazardous:

There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

L5 contraindicated:

Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.”

[1]

Now, onto the medications I took to complete the medication abortion.

Mifepristone or RU486:

This medication is a progesterone blocker and sends the message to the brain and body that the pregnancy has ended.  This medication is taken at the clinic.  I found research that concluded “The levels of mifepristone in milk are low (1.5% maximum), especially when using the 200 miligram dose.  Breastfeeding can be safely continued in an uninterrupted manner during medical abortion of this kind.”[2].  The doctor I spoke to at the clinic advised pumping and dumping for 24 hours.  I could not confirm what category this medication is placed in on the L scale.

Misoprostol or Cytotec:

This medication begins the process of expelling the uterine contents by causing contractions.  Common side effects include headache, nausea, diarrhea, fever and chills, bleeding, and cramps.  I experienced nausea, bleeding and cramps, but did not have diarrhea, fever, or headache.  This medication is taken 24-48 hours after ingestion of the mifepristone or RU486.  When looking for information about the safety of taking this medication while breastfeeding, I discovered that “Misoprostol is rapidly metabolized in the mother to misoprostol acid which is biologically active and is excreted in breast milk.  There are no published reports of adverse effects of misoprostol in breastfeeding infants of mothers taking misoprostol.  Caution should be exercised when misoprostol is administered to a nursing mother.”[3].  The last sentence refers to the possibility of diarrhea in the breastfeeding infant.  Given this information, I believe the drug would be classed as an L3 drug, but I was not able to confirm that conclusion.  The doctor, again, advised pumping and dumping for 24 hours.

Doxycycline:

A 7 day course of doxycycline is usually prescribed.  Because I was breastfeeding, they prescribed me a different antibiotic.  Although, upon further examination, doxycycline is classed as an L3 drug for breastfeeding if used short term (less than three weeks).  There have been no adverse effects to a child reported.

Azithromycin:

I was prescribed this antibiotic, an L2, upon informing the doctor I was still breastfeeding a child.  It was in a powder form, and I was instructed to mix it with two ounces of water and drink it.  This was probably the most horrid thing I have ever tasted.  It tasted like cherry flavored cough syrup and had an after taste of the most intense bitterness I have ever experienced.  Think 1000 times worse than a dark Guinness beer.  I was instructed to ingest this antibiotic the same day as the misoprostol.

Zofran:

This is an anti-nausea medication.  I did not take it and was not prescribed it since I was told it is not compatible with breastfeeding.  Upon further investigation, I did not find a straight answer about whether or not it is okay to take while breastfeeding.  I saw comments not from credible sources saying Zofran is an L2 drug, and only found negative statements otherwise.  I still don’t know the true answer.

Ibuprofen:

This medication (as most people know) is a pain reliever and anti-inflammatory.  I was prescribed 6 doses of 800 milligram pills of ibuprofen.  I took one dose one half hour before I took the misoprostol.  Ibuprofen is classed as an L1 drug.

Norco or hydrocodone/APAP:

This is a pain reliever.  I did not take it, nor was I prescribed it when I told the doctor I was still breastfeeding.  This medication is classed as an L3 drug.

The experience:

I think medication abortion is exaggerated about online.  Many people report an extreme amount of pain.  It is no cake-walk, but it is certainly nothing like childbirth or as bad as breaking a bone.  And this is coming from someone who is quite the wuss when it comes to pain.

I experienced no side effects from the mifepristone.  The next day, I took the ibuprofen and azithromycin 30 minutes before I took the misoprostol.  Other than the bad taste of the azithromycin, there is nothing to report about the mifepristone, ibuprofen or azithromycin.

I was instructed to take the misoprostol by placing the four small pills between my gum and cheek, and swallowing what was left after 30 minutes.  After 5 minutes, the pills turned into gritty pill goo in my mouth.  To avoid vomiting, I swallowed them after only 5 minutes.

30 minutes after the initial placement of the pills, I noticed the first twinges of pain and nausea.  After another 30-45 minutes, the cramping was very heavy and the nausea was intense.  The nausea was intense enough that I carried a bucket with me for the next three hours, but I never did vomit.  When the cramping became heavy, I started bleeding.  The rate of flow of the bleeding was a constant drip or a very small stream, and lasted about 6.5 hours total.

1.5 hours after initial placement of the pills, clots starting coming.  Golf ball sized clots appeared at an approximate rate of 1 every 3-5 minutes for the next 6 hours.  It did hurt pretty bad and felt very strange every time I passed a clot.  The cramping was intense enough that I either only wanted to lie down or sit on the toilet.  I switched from lying down to sitting on the toilet every 15 minutes or so for the first 6 hours.  I felt compelled to sit on the toilet while passing clots because any other position was uncomfortable while doing so.  I had a cold while having the abortion, and every time I coughed, it helped pass the latest clot, which relieved pressure.

Also, I breastfed Monkey Man once during the first three hours.  Doing so magnified the intensity of the cramps to the intensity of childbirth cramps.  In other words, about a 7 or 8 on a 1-10 pain scale.  Monkey Man did not experience any side effects from any of the medication.

After 3 hours, the intensity of the nausea and cramping waned considerably, though it did still hurt to pass clots.  I breastfed Monkey Man again about 5 hours after initial placement of the misoprostol, and it still made the cramping much worse, but not as bad as the first – a 5 or 6 on a 1-10 pain scale.

7.5 hours after the initial placement of the misoprostol, I stopped passing clots, the rate of bleeding declined, the intensity of the cramps decreased to that of normal menstrual like cramps, and the nausea was entirely gone.  I am sure there would have been much less pain and nausea during this experience if I had taken Zofran and hydrocodone, as most others would.

The next morning, I would liken the cramps and bleeding to that of a medium to heavy intensity menstrual cycle.  The morning after that, the cramps and bleeding were medium to low intensity.

All said and done, the first three hours were pretty intense, but definitely handle-able.  After that wasn’t easy, but wasn’t hard to handle either.  A medicated abortion is not like the nightmare some people describe.  However, I definitely think the experience of childbirth helped me put the pain in perspective.

Having already gone through childbirth did limit my ability to distance myself from the concept of aborting, though.  It was a much more emotional experience than my two previous abortions that happened before my son was born.  I do not regret my decision, but I am sad about it.  Making the decision to have an abortion should not be taken lightly.  That said, I am glad it is an option for those who need it.

If there are any questions about medication abortion that I have not addressed here, please feel free to ask me either in the comments or by email. You can find my email address on the “About” page.

I don’t care to properly cite today, but the information is there, nonetheless.

[1]

Medications and Mothers’ Milk (2004) by Thomas W. Hale, PhD

[2]
Acta Obstet Gynecol Scand. 2010 May;89(5):618-22. doi: 10.3109/00016341003721037.

Medical abortion in lactating women–low levels of mifepristone in breast milk.

Source

Department of Woman and Child Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.

http://www.ncbi.nlm.nih.gov/pubmed/20367522

[3]

MISOPROSTOL tablet
[H.J. Harkins Company, Inc.]

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2 thoughts on “Medication abortion

  1. Thank you for sharing your experience. Did you have someone else to care for your child while you experienced the abortion or were you able to care for him yourself?

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