Medical Abortion Process
Texas State law requires that you make an initial visit to the clinic for a sonogram with the physician. Twenty-four hours from that initial visit, you are eligible for the abortion. Listed below are the components of your multiple visits to the clinic.
Medical Records
Medical History – You will be asked to provide information about your medical history so that we may know of any previous or current illness and/or health problems that may affect your care.
Informed Consent – You will be asked to complete an informed consent. We must have your signature as consent in order to provide an abortion for you. It is your right to be informed of any and all possible risks and/or complications known to be associated with this procedure. You will be given the opportunity to discuss this consent prior to your abortion; please wait to sign this form until all of your questions have been addressed.
Medical Reports – All medical records are strictly confidential and will be released to No One without your written authorization
Determination of Pregnancy and Gestation
Pregnancy Test – When indicated, we will perform a pregnancy test. If your test is negative, we will inform you of these results and discuss with you the possibilities.
Sonography – It is necessary for us to perform a sonogram and pelvic exam prior to your abortion. These exams will determine the size of your pregnancy and provide us with information useful in performing your abortion safely. Patients do not normally view the sonogram. However, should you wish to view it, you may do so; please inform the nurse of this desire. Please note: we do not perform diagnostic sonograms. In order to be eligible for a medical abortion, your pregnancy must be 10 weeks or less the day of the abortion.
Counseling
You will be given the opportunity to talk with one of our counselors. She is available to answer any questions or concerns you have about the procedure and, if desired, help you explore your feelings. She will also want to help you with any concerns about birth control, pregnancy, and sexuality that you may have. You are in control of the counseling session. You are under no obligation to discuss anything you do not wish to. We are here to help in any way we can. Only you know what information, counseling, and help you want or need.
Laboratory Testing
We will test you for anemia and for the Rh factor of your blood. Also, your blood pressure, pulse and temperature will be taken. If indicated by the physician, a nurse may check the baseline level of the hCG (Human Chorionic Gonadotropin) hormone in your blood. If this is done, we will then compare this to a post-procedure level drawn at your follow up appointment. We will discuss any unusual results with you.
Medical Abortion
A medical abortion is one that is brought about by taking medications that cause the body to abort or expel the pregnancy rather than the traditional alternative of abortion done through uterine aspiration which ends the pregnancy by emptying the uterus with the use of special instruments. Two medications, mifepristone and misoprostol, will be given over the course of several days; together they will induce an abortion. Both mifepristone and misoprostol have been approved for use by the FDA in early abortion procedures. The protocol adopted by the Southwestern Women’s Surgery Center, LP for the combined use of 200 mg of Mifepristone and 800 mcg of misoprostol has been studied extensively and reported in medical literature. This differs from the FDA approved dose of 600 mg Mifepristone, but scientific evidence indicates that this alternative protocol is just as safe and effective. This regimen also causes less stomach upset and is more affordable for patients. In addition, the FDA recognizes that the off-label use of drugs by physicians is often appropriate and may represent the standard of practice. The overall success rate for this process is approximately 98%.
Mifepristone (Mifeprex, the early option pill, RU-486) is a medication that blocks the action of progesterone; a hormone needed to maintain pregnancy. It alters the endometrium causing an early pregnancy to detach from the uterine wall. It also helps to soften and dilate the cervix. This medication is taken orally in one 200-mg tablet. You will take this medication here in the office today. The most common side effects from the medication are bleeding, headaches and fatigue. Approximately 3% of women will have their abortion with the use of this one medication; most women will need to receive a second medication.
The second medication, misoprostol, is very effective at causing the uterus to contract (cramp), thus causing the pregnancy to be expelled. The side effects of this medication may include nausea, vomiting, diarrhea, dizziness, abdominal cramping, and bleeding. Most of the side effects will last only a few hours or days with the exception of light bleeding, which could last four to six weeks. Spotting may continue off and on until the start of the next menstrual period. You will be given a bottle containing 4 misoprostol tablets to take home and instructions on how to use the medication. The misoprostol tablets must be taken 24 to 48 hours after the Mifepristone. The medicines may not work as well if you take misoprostol sooner than 24 hours after Mifepristone or later than 48 hours after Mifepristone.
A medical abortion is a process that requires time. A minimum of two in-person visits at our clinic are required by Texas state law. Additional visits may be necessary if you require more time, medication, or a procedure to complete your abortion. About 93% of women will abort within 4 hours of taking misoprostol on day three and approximately 98% will have aborted by the two week follow up.
Follow up
Before leaving the office today, you will be given detailed written instructions regarding your treatment and after care. It is extremely important that you return to the clinic for a follow up exam as this is the only way to ensure that your abortion has been successful (the cessation of symptoms or a negative result on a pregnancy test does not always mean that the abortion has been complete).
A medical abortion will require a minimum of one follow up visit and possibly as many as three follow up visits. These visits will be provided at no additional cost. Your first follow up visit will be scheduled approximately two weeks following your initial office visit. This visit is to ensure that your abortion has been successful and that you have not experienced any complications that might require further treatment.
If you have successfully passed the pregnancy, then you will be released and will only need to contact us if you have further questions or concerns.
If you have not passed the pregnancy and it is still viable, you will need to have an abortion by uterine aspiration to terminate your pregnancy.
If your pregnancy is no longer viable, but you have not yet passed the pregnancy sac you have three options:
- Take an additional dose of misoprostol to empty the uterus
- Make an appointment to have an abortion by uterine aspiration to empty the uterus
- Continue to wait and see if a delayed abortion will occur
If your abortion was incomplete, additional follow up visits will be required.
UTERINE ASPIRATION ABORTION MAY BE NEEDED IF: The pregnancy is still continuing to grow at the 2 week follow up visit (1 –2%), there is excessive vaginal bleeding (1%), or non-viable pregnancy tissue remains after 5 weeks (1-2%). You may request a uterine aspiration abortion at any time during your treatment. If you choose to have a medical abortion, you must also be willing to have a uterine aspiration abortion if needed. The effects of the medications on a developing embryo make it extremely unadvisable to attempt to continue with a pregnancy once treatment has begun. Additionally, non-viable pregnancy tissue remaining in the uterus can cause complications that can lead to a reduction in fertility.
MEDICAL ABORTION IS NOT FOR EVERYONE: The medical abortion involves using medications that have side effects that can be uncomfortable. Uterine cramping can be painful and bleeding can be excessive. Witnessing the abortion may be emotionally difficult. Also, some women may not wish to involve other people in their abortion or have the inconvenience of multiple office visits. For some, an early uterine aspiration abortion may be preferable.
A uterine aspiration abortion involves dilating the cervix and removing the contents of the uterus with the use of a suction tube and a surgical instrument called a curette. In most cases, the procedure should take no more than five to eight minutes. This procedure is over 99% effective. Side effects such as bleeding and cramping are usually minimal. Complications such as infection or perforation are very rare.
Each woman will have her own preference for which method is used to terminate her pregnancy. If you have questions regarding either method, please ask. We are here to assist you in any way possible.
Waiting Time
Of necessity, we must work by appointment. This gives us an opportunity to allocate the time needed for each patient. Unfortunately, patients do not become ill on schedule, procedures do not always run on time, and emergencies do occur; hence, delays are inevitable. A sincere attempt is made to adhere to the schedule and we request your patience if, occasionally, you are forced to wait. When possible we will let you know if we are running unduly behind so that you can plan accordingly. As a new patient, do not be disturbed to see patients who have arrived after you being called before you. These are patients whom the nurse takes care of under the doctor’s supervision and do not affect your wait time.
Please Be Aware
The Southwestern Women’s Surgery Center provides both medical and uterine aspiration abortions because we believe abortion is an important health service for women. We respect women who make this decision and attempt to provide a caring and supportive atmosphere so that the process is as comfortable as possible. Therefore, if you have questions, ask them; if you have suggestions, please make them. We take your suggestions seriously and are constantly trying to improve our service and communications with our patients. Thank you for selecting us to help you with your medical care.
The Texas Department of Health licenses this facility. You may register compliments or complaints about our services with the Director, Health Facility Licensure and Certification division, Texas Department of Health, 1100 west 49th Street, Austin, Texas 78756. All correspondence must be in writing. You must give your name, although all contacts will remain confidential. You have the right to access information concerning this abortion facility. You may do so by calling 1-888-973-0022. This number is maintained by the Texas Department of Health. Your identity will remain anonymous.