If you are on this page because you have taken mifepristone and are now second-guessing your decision, call the Abortion Pill Rescue network and they will connect you with a local doctor. The number is 1-877-558-0333.
Mifegymiso is a prescription drug used to terminate early pregnancies that was introduced in Canada early 2017. Medical abortion provides women with choice when it comes to the where and how they end their pregnancies—a prospect that thrills many midwives considering our passion and commitment to choice. Though medical abortion is not practically relevant to the midwifery scope as of now (considering we don’t usually meet our clients until the 10th-12th week of pregnancy), it is the hope of some that our scope expands to include medical abortion by adding Mifegymiso to our pharmacopeia.(1)Fitzpatrick M. Ontario midwives say there’s growing interest in letting them perform abortions. CBC News. 2017 If this development takes place, it is important for midwives to understand how the drug works, but also how the drug can possibly be reversed, which can be a topic of both contention and hope.
Mifegymiso is a two-step drug regimen that can be taken up to the 70th day of pregnancy. It involves taking 200 mg of mifepristone followed by 800μg of misoprostol 24-48 hours later. The mifepristone stops the effects of the pregnancy hormone progesterone, cutting off the embryo’s access to nutrition, and then misoprostol brings on uterine contractions to expel the starved embryo. Medical abortion can be considered less invasive and thus an option that abortion supporters can be excited about.
The fact that medical abortion is a two-step process provides hope because it may provide women a chance to reconsider their abortions.
Of course, as someone against abortion, another method of ending a human life is not very exciting, however, the fact that medical abortion is a two-step process provides hope because it may provide women a chance to reconsider their abortions. Since the introduction of Mifegymiso, many women start the abortion process, but some women have not gone on to complete it. Some have decided not to take the second drug, misoprostol, which in some cases was enough to stop the abortion.
Others have searched for a way to stop the effects of mifepristone and found Abortion Pill Rescue.(2)Abortion Pill Rescue This website provides a hotline number where volunteer nurses connect women who desire to stop their abortions to a network of physicians willing to prescribe progesterone to them.
Since mifepristone is a progesterone antagonist, high doses of progesterone can potentially reverse the drug’s effects. Progesterone has been used for decades in pregnancy to prevent miscarriage, so the concept of the abortion pill reversal process is really quite simple. Mifepristone is not known to cause birth defects,(3)Bernard N, Elefant E, Carlier P, Tebacher M, Barjhoux CE, Bos-Thompson MA, et al. Continuation of pregnancy after first-trimester exposure to mifepristone: an observational prospective study. BJOG. 2013. so provided that the second drug misoprostol is not taken and the progesterone is taken early enough to have an effect (within 72 hours of taking mifepristone), abortion pill reversal offers women a chance to change their minds and continue their pregnancies.
A study published by the doctor who started Abortion Pill Rescue, Dr. George Delgado, shows some promising results and a significant amount of successful reversal stories.(4)Delgado G, Condly SJ, Davenport M, Tinnakornsrisuphap T, Mack J, Khauv V, et al. A Case Series Detailing the Successful Reversal of the Effects of Mifepristone Using Progesterone. Issues in Law and Medicine. 2018. While this study and its participants all reside in the United States, the network now includes Canadian physicians and success stories of abortion reversals are beginning to arise in Canada.
Isn’t this a choice she should be informed about?
The potential to reverse a regretted abortion should be something to be appreciated by all abortion providers and supporters, especially midwives. Doesn’t this provide women with choice all the more? The decision to have an abortion is no doubt a difficult one that women carefully consider, however, sometimes in the face of immense stress, crisis, or in a time crunch, a decision can be made without a clear mind. For the woman deciding on abortion while in a “fight or flight” response, what happens when her mind clears after taking that first pill? If she suddenly sees her situation differently, if she suddenly is filled with regret? Isn’t this a choice she should be informed about? Deciding to take that first drug does not mean that the second drug must be taken. And if she knew that some women have taken progesterone and continued their pregnancies, what would she do? The anecdotal success stories that can be found throughout the Internet are nothing short of inspiring and heart-warming. Abortion pill reversal gives women the chance to reconsider.
Unfortunately, medical professionals do not universally accept the abortion pill reversal protocol. Delgado’s studies and his work are discredited as anecdotal, lacking proper randomization, or simply unethical.(5)Grossman D, White K. Abortion “Reversal” — Legislating without Evidence. New England Journal of Medicine. 2018. In some American States it has been legislated that abortion providers must inform women about the potential of reversal, and this legislation is disapproved of due to the lack of quality research for this medical procedure. If this is true, why are the same critics not supportive of furthering these studies, since Delgado’s small ones have shown some success?
It is challenging since there is only a small population that can even be studied, and with a matter such as trying to save a pregnancy, it would be unethical to use a randomized placebo-controlled trial when this method does seem to yield more success than doing nothing. What woman who is trying to undo the effects of the first stage of a medical abortion would want to be in a control group?
A woman’s ability to choose does not end the moment she takes the mifepristone.
Another criticism is that offering the abortion pill reversal protocol undermines a woman’s right to choose by implying she must not have thought it through. But a woman’s ability to choose does not end the moment she takes the mifepristone. For the women who have regrets or the women who were perhaps coerced into getting an abortion, this option gives them more choice, more autonomy, and is something they deserve to know.
The argument that women don’t need to know that sometimes abortions can be reversed because “of course they were of sound mind when they made their choice”, and “of course they don’t regret it”, and “once that mifepristone is swallowed, choice is over”, betrays the “pro-choice” façade of abortion supporters. While it’s obvious why someone against abortion would be thrilled at this procedure, it’s not clear why someone for choice wouldn’t at least be promoting further research and willing to inform women that something like this is out there and they don’t have to take the second pill.
Progesterone has been safely used during pregnancy for decades without undesired effects.(6)Dm H, Tj H, Ps R. Progestogen for preventing miscarriage in women with recurrent miscarriage of unclear etiology. Cochrane Database. 2018.(7)Carp HJA. Progestogens and pregnancy loss. Climacteric. 2018. For infants who survive the abortion pills first drug mifepristone, there is no evidence of birth defects associated with the medication.(8)Bernard N, Elefant E, Carlier P, Tebacher M, Barjhoux CE, Bos-Thompson MA, et al. Continuation of pregnancy after first-trimester exposure to mifepristone: an observational prospective study. BJOG. 2013. The efficacy of abortion pill reversal with the use of progesterone has been shown to be higher than doing nothing and waiting to see if a pregnancy continues.
There are some who want to take it back, who frantically Google-search their options, whose minds clear once the process has started and instantly regret. And for some of those women, the Abortion Pill Rescue network has given them a second chance, has given them their babies back, and has made a world of difference to them.
Maybe by-and-large once a woman decides to have a medical abortion, there is no looking back, no indecision, no need to reconsider. But the fact is that there are some who want to take it back, who frantically Google-search their options, whose minds clear once the process has started and instantly regret. And for some of those women, the Abortion Pill Rescue network has given them a second chance, has given them their babies back, and has made a world of difference to them. This population of women may be small, but I have never heard of midwives dismissing someone or not explaining their options because their pregnancy wishes were uncommon or they were the minority.
As midwifery in Canada develops a more direct relationship with medical abortion, our resolve to provide informed choice should implore us to consider the chance of abortion pill reversal.
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