There are two ways to have an abortion. One is called a ‘medical abortion’, the other is a ‘surgical abortion’. With a medical abortion you take drugs, with a surgical abortion you have an operation. In India, early stage pregnancies, upto eight weeks, are usually terminated through a medical abortion. A more advanced pregnancy may need a surgical abortion.
Medical abortion, sometimes referred to as abortion pill method, is a method of termination of pregnancy using two different medicines – Mifepristone and Misoprostol – used in combination for termination of first trimester pregnancy. Here are some things to keep in mind when you opt for an abortion
Think clearly and act in time
Medical abortion is perfectly safe especially when supervised by a qualified medical practitioner. But it is effective only up to a certain length of the pregnancy. Nine weeks is the upper limit for the use of medical abortion method, according to Directorate General of Health Services, India. So, reach out to a doctor well in time.
If the term of pregnancy has passed more than nine weeks ( and still below 20 weeks mark), then you can go in for a surgical abortion. Read more about it here.
Head to a doctor
The first thing to remember upon getting a positive pregnancy test is to consult a doctor. If the pregnancy is unwanted, the doctor will offer options for termination of pregnancy.
In India, medical abortion needs to be executed with the prescription of and in supervision of a doctor. According to the Medical Termination of Pregnancy Act (MTP), only registered doctors, with a clinic, can prescribe the pills, so that in case of emergencies, they can move the person to hospital. Though it is prohibited by the law, the pill is available over-the-counter at most pharmacies.
Here are a few other things that are essential to be clarified before going for a medical abortion with your health professional.
- Determining whether person is fit for medical abortion: The doctor will need to screen the person’s body weight, haemoglobin level, pre-existing health issues and 10-15 other parameters as per standard criteria before they can induce medical abortion. They need to ensure that the person’s body responds in a desirable way to medical abortion and that any pre-existing health issues or medication being taken for them will not interfere with smooth conduct of medical abortion.
- Sonography/Ultrasound: It ensures, among other things, that the developing pregnancy is not an ectopic pregnancy: An ectopic pregnancy is one that is developing in the fallopian tubes, ovary or some other reproductive organ instead of the uterus. In case medical abortion is carried out when there’s an ectopic pregnancy, the embryo can rupture the fallopian tubes (if pregnancy is developing here) and lead to an abdominal emergency. Even if person is not going for medical abortion, an undetected and untreated ectopic pregnancy can be dangerous and fatal for the pregnant person.
The abortion process
The termination of pregnancy is a two stage process and requires two pills that are taken within a gap of two days. The first pill makes sure the fertilised egg can’t settle in the womb, and the second type of pill pushes it out. After taking the second pill it takes about a while, several hours or days, for everything to leave the body.
The first pill Mifepristone blocks the pregnancy hormones. The second pill Misoprostol, that is taken after 48 hours starts starts the expulsion of the foetus or miscarriage. You can take the first pill at a clinic or at your doctor’s and the second set of pills you can safely take at home. Read more about it here.
You may experience some pain, such as bleeding, cramps, diarrhoea or sickness. This may feel like really bad period pains. If the bleeding and pain feel too severe, you should go to the nearest clinic or hospital.
Stay in touch with your doctor
Medical abortion is a process with gap day(s) between the intake of Mifepristone and Misoprostol. Each person’s body reacts differently to the process of medical abortion. A few things that need the doctor’s monitoring at this stage are:
- Excessive bleeding or pain: The doctor might help with a painkillers. In some cases, antibiotics might also be needed to prevent infections. Only a qualified and certified health professional can ascertain the symptoms and suggest recourse.
- Diet and rest: Diet rich in protein and iron may be recommended by doctor to person undergoing medical abortion. On first day of bleeding induced by medicines consumed for medical abortion, the doctor may also recommend resting.
- Loose motions in reaction to Misoprostol: This medicine is known to cause loose motions. If loose motions are not controlled in consultation with a doctor, medical abortion may fail or may be only partially successful. The doctor may assess and choose to administer Misoprostol vaginally, if needed.
Follow up to complete the process
This follow-up is conducted 10-12 days from administration of dose of Mifepristone, and is the last and equally important aspect of the process of medical abortion. Following are a few essentials at this stage:
- General check-up: At this stage, the doctor needs to ensure that there’s no fever or infection, or any complications that might have arisen due to medical abortion.
- Reproductive health: Through an ultrasound, your doctor will need to ensure that the termination of the pregnancy has been successful and that the person’s uterus is back to pre-pregnancy condition.
Anti D injection
If a person with Rh-negative blood has conceived pregnancy with person with Rh-positive blood, the pregnant person must be administered anti-D after medical abortion to prevent the offspring from a future pregnancy from being affected by Rhesus disease. Anti-D vaccine is administered even in case of pregnancy that’s been conceived by Rh-negative person with Rh-positive person is carried to term.
Medical abortion care advice for this article given by Dr Nimmi Rastogi and by Dr Nutan Yadav.
Persons in the picture are models. This article was first published on 27 July, 2020.