“The Abortion Pill” (mifepristone plus misoprostol) is the most common form of medical abortion. It was approved by the Food & Drug Administration (FDA) for use in women up to 10 weeks after last menstrual period (LMP).¹¹ It is even used beyond 10 weeks LMP, despite an increasing failure rate.^{12, 13, 14}  The medical abortion is done by taking a series of pills that disrupt the embryo’s attachment to the uterus, and cause uterine cramps which push the embryo out.¹⁵

Things to consider:¹⁶

• Bleeding can be heavy and lasts an average of 9-16 days.
• One woman in 100 need a surgical scraping to stop the bleeding.
• Pregnancies sometimes fail to abort. This risk increases as pregnancy advances.
• For pregnancies 8 weeks LMP and beyond, identifiable parts may be seen.¹⁷ 
• By 10 weeks LMP, the developing baby is over one inch in length with clearly recognizable arms, legs, hands, and feet.¹⁸

Methotrexate is FDA-approved for treating certain cancers and rheumatoid arthritis, but is used off-label to treat ectopic pregnancies and to induce abortion.^{19, 20} Given by mouth or injection, it works by stopping cell growth, resulting in the embryo’s death.

This procedure induces abortion by using drugs to cause labor and delivery of the fetus and placenta. Drugs may be injected into the fetus or the amniotic fluid to stop the baby’s heart before starting the procedure to avoid a live birth. There is a risk of heavy bleeding, and the placenta may need to be surgically removed.^{21, 22}

1. Thorp, J.M., Hartmann, K.E., Shadigian, E. (2003). Long-term physical and psychological health consequences of induced abortion: Review of the evidence. Obstet Gynecol Surv.58(1):67–79.

2. Cougle J., Reardon, D.C, & Coleman, P. K. (2003). Depression associated with abortion and childbirth: A long-term analysis of the NLSY cohort. Medical Science Monitor, 9 (4), CR105-112.

3. Fergusson, D. M., Horwood, J., Ridder, E. M. (2006). Abortion in young women and subsequent mental health. Journal of Child Psychology and Psychiatry, 47, 16-24.

4. Pedersen W. (2008). Abortion and depression: A population-based longitudinal study of young women. Scandinavian Journal of Public Health, 36 (4):424-8.

5. Rees, D. I. & Sabia, J. J. (2007) The relationship between abortion and depression: New evidence from the Fragile Families and Child Wellbeing Study. Medical Science Monitor, 13 (10), 430-436.

6. Cougle, J., Reardon, D.C., Coleman, P. K. (2005). Generalized anxiety associated with unintended pregnancy: A cohort study of the 1995 National Survey of Family Growth. Journal of Anxiety Disorders,19 (10), 137-142.

7. Coleman, P.K., Rue, V.M., Coyle, C.T. ( 2009). Induced abortion and intimate relationship quality in the Chicago Health and Social Life Survey. Public Health, 123(4):331–38.

8. Coyle, C. (2007). Men and abortion: A review of empirical reports. Internet J of Mental Health, 3(2).

9. Rue, V. (1996). His abortion experience: The effects of abortion on men. Ethics and Medics, 21(4), 3–4.

10. Coyle, C., Rue, V. (2014). A thematic analysis of men’s experience with a partner’s elective abortion. Counseling and Values, 60:138-150.

11. U.S. Food & Drug Administration. (2016, March 30). Mifeprex (mifepristone) Information. Retrieved April 8, 2016, from http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111323.htm

12. Raymond, E. G., Shannon, C., Weaver, M. A., & Winikoff, B. (2013). First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review.Contraception, 26-37. Retrieved from http://dx.doi.org/10.1016/j.contraception.2012.06.011.

13. Chen, Q. (2011). Mifepristone in combination with prostaglandins for termination of 10–16 weeks’ gestation: a systematic review. European Journal of Obstetrics & Gynecology and Reproductive Biology, 159, 247–254.85.

14. Chen, M. J., & Creinin, M. D. (2015). Mifepristone With Buccal Misoprostol for Medical Abortion. Obstetrics & Gynecology, 126(1), 12-21. doi:10.1097/aog.0000000000000897

15. U.S. Food & Drug Administration. (2016, March 30). Mifeprex (mifepristone) Information. Retrieved April 8, 2016, from http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111323.htm

16. U.S. Food & Drug Administration. (2016, March). Mifeprex label information. Retrieved from http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020687s020lbl.pdf

17. The Endowment for Human Development. (2006). The Rapidly Growing Brain. Retrieved from http://www.ehd.org/movies.php?mov_id=28

18. The Endowment for Human Development. (2006). Right- and Left-Handedness. Retrieved from http://www.ehd.org/movies.php?mov_id=44

19. Physician’s Desk Reference (2014). Drug Summary: Methotrexate. Retrieved October 28, 2015, from http://www.pdr.net/drug-summary/methotrexate-tablets?druglabelid=1797&id=2398.

20. Creinin, M. , Danielsson, KG.(2009). Medical Abortion in Early Pregnancy. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp.114, 120-29). Chichester, UK: Wiley-Blackwell.

21. Kapp, N., von Hertzen, H. (2009). Medical Methods to Induce Abortion in the Second Trimester. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 178-88). Chichester, UK: Wiley-Blackwell.

22. American College of Obstetricians and Gynecologists (2013). Practice Bulletin: Second-trimester abortion (135).

23. Paul, M., Lichtenberg, E. S., Borgatta, L., Grimes, D. A., Stubblefield, P. G., & Creinin, M. D. (2009). First Trimester Aspiration Abortion. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 135-156).

24. Chichester, UK: Wiley-Blackwell. Planned Parenthood Federation of America Inc. (2014). In-Clinic Abortion Procedures : Planned Parenthood. Retrieved July 19, 2014, from http://www.plannedparenthood.org/health-info/abortion/in-clinic-abortion-procedures.

25. Planned Parenthood Federation of America Inc. (2014). In-Clinic Abortion Procedures : Planned Parenthood. Retrieved October 28, 2015, from https://www.plannedparenthood.org/learn/abortion/in-clinic-abortion-procedures.

26. Paul, M., Lichtenberg, E. S., Borgatta, L., Grimes, D. A., Stubblefield, P. G., & Creinin, M. D. (2009). Dilation and Evacuation. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 157-74). Chichester, UK: Wiley-Blackwell.

27. Paul, M., Lichtenberg, E. S., Borgatta, L., Grimes, D. A., Stubblefield, P. G., & Creinin, M. D. (2009). Dilation and Evacuation. In Management of unintended and abnormal pregnancy: Comprehensive abortion care (pp. 157-74). Chichester, UK: Wiley-Blackwell.

28. American College of Obstetrics and Gynecology. (2013). Practice Bulletin: Second-Trimester Abortion (135).

29. Pasquini, L., et al. Intracardiac injection of potassium chloride as method for feticide: Experience from a single U.K. tertiary centre. Br J Obstet Gynaecol. 2008;115(4):528–31.

Most early surgical abortions are performed using this method. Local anesthesia is typically offered to reduce pain. The abortion involves opening the cervix, passing a tube inside the uterus, and attaching it to suction device which pulls the embryo out.^{23, 24}

Most second trimester abortions are performed using this method. Local anesthesia, oral, or intravenous pain medications and sedation are commonly used. Besides the need to open the cervix much wider, the main difference between this procedure and a first trimester abortion is the use of forceps to grasp fetal parts and remove the baby in pieces. D&E is associated with a much higher risk of complications compared to a first trimester surgical abortion.^{25, 26}

This procedure typically takes 2–3 days and is associated with increased risk to the life and health of the mother. General anesthesia is usually recommended, if available. Drugs may be injected into the fetus or the amniotic fluid to stop the baby’s heart before starting the procedure. The cervix is opened wide, the amniotic sac is broken, and forceps are used to dismember the fetus.

The “Intact D&E” pulls the fetus out legs first, then collapses the skull in order to remove the fetus in one piece.^27-29