What To Expect

The Abortion Pill

1st STEP OF MEDICAL ABORTION
“The Abortion Pill”
(for women 8 weeks or less in the pregnancy)

When you arrive at Hope Clinic:

There may be protesters at any abortion clinic. At Hope Clinic, they may not come onto our parking lot and a security guard is present. Legally, they can shout anything they can think of - true or not - to stop you from walking into the clinic.

You will be at the clinic for 3 to 4 hours.

You'll be greeted at the front desk and asked to fill out your paperwork and have your ultrasound.

You'll receive a Patient Information Notebook that will explain the pros and cons of medical and surgical abortion and how they are done.

A counselor will meet with you, discuss your decision, answer any questions and go over the procedure that best suits your needs. Birth control options will be offered as well.

You will a listen to a tape that reviews the informed consent forms. Please sign the forms after listening to the tape.

You'll go to the lab for a finger prick test for the Rh factor and anemia. We’ll take you blood pressure and pulse. If you are extremely anemic (hematocrit below 30%), you will not be able to have a medical abortion.

Rh - If you have Rh negative type blood, you must consent to a shot of Rhogam, which will help protect future pregnancies. There is an additional cost for Rhogam.

Next, you will pay your fee.

You’ll go to an exam room to receive a simple pelvic exam, and take the mifepristone pill (mif a priss tone) (which detaches the pregnancy from the wall of the uterus.) This begins the abortion process. Some women experience light bleeding the first day or two.

You will also receive pills, misoprostol (“my zo pross tul”) to take home with you. You will be instructed to wait several days before you use them. Once the pill has had enough time to work, the misoprostol causes uterine contractions and usually produces a miscarriage. This is the start of the abortion, and once started, you must complete the process.

1st day	3rd day	8th - 10th day
Mifepristone pills: This is the start of the abortion process.	If pills: insert misoprostol pills. The abortion (miscarriage) usually begins in 1–4 hours). Most women pass the pregnancy within 8 hours but it can take up to 12 hours or more.	Return to Hope Clinic. If a miscarriage has NOT occurred, you may need a surgical abortion to complete the process.

You will receive your 2nd appointment date and time, and you’ll be ready to go home. When you return to Hope Clinic, an ultrasound will be done to determine whether the abortion was successful, or if you are still pregnant. There is no charge for a vacuum aspiration procedure in the event of a failed medical abortion.

All our patients who choose a medical abortion are instructed to read about the surgical abortion, so they are fully informed about the procedure, aftercare, and possible complications ahead of time.

For Your Support Person Who Comes With You

For all patients’ safety and privacy…

If at any time you want to talk to a counselor about your questions or concerns, please let the receptionist know. It is important that each woman who takes the abortion pill have someone with her during the miscarriage at home.

2nd STEP OF THE PILL ABORTION PROCESS

Using Misoprostol Pills

	You must be at home or in the home of someone who knows what is happening.
		Two days later you need to insert the misoprostol pills between your gum and cheek; 2 on each side of your mouth. Let them melt for 30 minutes, then swallow what hasn't melted. They don't have much of a taste.
	There must be a phone where you are staying.
		We strongly advise that a support person be with you or at least be close by “on call” with a car on the day or evening you insert the misoprostol pills. It is possible to bleed too much or hemorrhage,” and you may need someone to take you to a hospital or Hope Clinic right away. It is therefore recommended that you be within 1 hour’s drive from either Hope Clinic or a hospital.
	If you have children, someone must be able to watch your children for you.
	You must be within 1 hour drive of Hope Clinic or a hospital.

When Will the Miscarriage Happen?
Most women begin having strong cramps and bleeding within 1 to 6 hours after they have inserted the misoprostol pills. The majority of women will have miscarried in 8 hours, but it may take, up to 12 hours or longer.

Managing the Possible Side Effects of Misoprostol
Misoprostol may cause nausea, vomiting, and diarrhea, and a rise in temperature, so drink plenty of fluids and eat lightly the day before and the day you insert the misoprostol pills. However, many of our patients have said they either did not experience these side effects, or the side effects were mild.
	Avoiding spicy or fried foods helps.

	If the vomiting and diarrhea is severe, or you have had a temperature of over 100.4 degrees F for over 6 hours, call Hope Clinic’s 24-hour number.

Cramping
	The cramps may be quite strong; however, some women say they are mild.

	If the vomiting and diarrhea is severe, or you have had a temperature of over 100.4 degrees F for over 6 hours, call Hope Clinic’s 24-hour number.

	Start taking the pain pills we gave you (or prescribed) an hour before you insert the misoprostol. Take as directed for pain relief.

	You may use a heating pad.

	You may also take 600 – 800 mg. of Ibuprofen every 4 hours in addition to the pain pills if you need added pain relief.

Bleeding
	Usually you can expect the bleeding to start after the cramping has begun. The bleeding may be very heavy, but many patients say the bleeding wasn’t as heavy as expected. You may pass small or large blood clots (the size of a quarter is very common, but passing a clot 2 inches round is nothing to be alarmed about). Bleeding, cramping, and passing clots are a normal part of the abortion process.

	Wear “heavy protection” maxi pads, and buy a large package.

	There is a less than 1% chance of bleeding too much, or “hemorrhage.”
	“Too much bleeding” is soaking through 2 pads in 2 hours.

	If your bleeding becomes this heavy, during or after the miscarriage process, we need to hear from you so we can advise what you need to do. CALL HOPE CLINIC at (800) 844-3130 or our 24-hour answering service!

	After the abortion has occurred, lighter bleeding often continues off and on for about 9 to 14 days, but could continue lightly through 4 weeks.
		Return to Hope Clinic on the day of your 2nd appointment even if you are still bleeding.

Your Second Appointment
	8-10 days from the 1st clinic visit, please return to HopeClinic for a 2nd appointment for an ultrasound.
		Remember, the abortion is not complete until the ultrasound on your final visit. Even if you bled heavily, cramped, and passed clots, you can still be pregnant! There is no extra charge for this ultrasound or for a surgical procedure in the event of a failed abortion.

	You may come alone on the 2nd visit, but if you need a surgical abortion, you will need a driver.
If the ultrasound on the 2nd visit shows you are still pregnant, Hope Clinic’s physician will perform a surgical abortion, and there is no additional charge.

If the Medical Abortion Fails
Remember, the medical abortion has a small failure rate, and the drugs can cause serious birth defects if this pregnancy is carried to term. It is absolutely necessary that you agree to have a surgical abortion if the medical abortion fails.
There is no extra charge for the ultrasound or surgical abortion at Hope Clinic should the Pill fail.

These drugs have not been found to cause fetal deformities in any FUTURE pregnancies.

If You Need a Surgical Abortion
1st Trimester Vacuum Procedure
	With surgical abortion there are NO sharp instruments, and the procedure itself generally takes 4-6 minutes. Before the abortion begins, you are offered pain medication given through a vein in your arm that relaxes you and helps with any strong cramping you may feel. You may not drive yourself home if you receive this medication.

	The physician numbs your cervix (mouth of the uterus) with a local anesthetic, opens or “dilates” the cervix, and removes the pregnancy with a plastic tube (no bigger than the width of your little finger) and a gentle suction from a vacuum aspirator.

	You will stay in the recovery room for at least 30 minutes after the procedure. When you leave, you may have a little bleeding that can last 2-3 weeks, and you may or may not have any cramping. All our patients who choose a medical abortion are instructed to read about the surgical abortion, so they are fully informed about the procedure, aftercare, and possible complications ahead of time.

Vacuum Aspiration
You will be cared for by physicians who have been experts in the field of abortion for over 15 years. Plus, Hope’s caregivers, nurses, counselors, and medical secretaries are hired for their friendliness and warmth as well as their competence. There may be protesters at any abortion clinic. At Hope Clinic, they may not come onto our parking lot and a security guard is present.. Legally, they can shout anything they can think of – true or not – to stop you from walking into the clinic.
A first trimester abortion procedure takes only about 5 to 7 minutes. Most women are at the clinic 3 to 4 hours, which includes an ultrasound, counseling, lab work, the procedure, and recovery time..
	You will have an ultrasound to confirm your pregnancy and determine length of pregnancy. You will talk to a counselor who will not try to talk you into our out of anything. We just want to be certain you are sure of your decision and all your questions are answered. You will also listen to a tape that goes over each item on the informed consent.

	Birth control options will be offered; you may be given a free pack of birth control pills and learn how to use them or hear about other methods of contraception. The birth control shot is available at an additional cost.

	The lab technician will check your blood pressure and pulse and prick your finger to do a blood test for the Rh factor and anemia. All patients with Rh-negative blood must receive a shot of Rhogam to protect future pregnancies. There is an additional charge for the Rhogam shot.

	After your fee is collected, you will go to the dressing room to change. You will be draped with a sheet from the waist down but wearing your own top. Your nurse will be by your side.

	The doctor does a pelvic exam to determine the size and position of your uterus. (For those of you who have never had a pelvic exam, the doctor puts on a latex glove, inserts two fingers gently into the vagina, and presses firmly on your abdomen with his other hand. This takes a few seconds.) You will be offered extra medication. If you choose it, it will relax you immediately.

	The cervix is numbed with a local anesthetic, then the doctor dilates, or opens, the cervix to about the width of your little finger. You may feel uncomfortable cramping, so do slow deep breathing at this time.

	The doctor completes the abortion by slipping a small plastic tube, a vacurette, into the cervix and connecting it to a small machine, called a vacuum aspirator, that creates a gentle suction. At the very end, the doctor inserts a sterile tampon, and the procedure is over.

	Your nurse will walk you to the recovery room where you’ll have a seat in a comfortable recliner for 30 minutes to an hour.