In March of 2016, the Food and Drug Administration (FDA) approved medical abortions up to 70 days from the first day of the last menstrual period, using RU-486 (mifepristone) 200 mg orally, taken while in the clinic, under a “certified healthcare provider” followed in 24-48 hours by 800 mcg of misoprostol applied in the cheek. Providing medical abortions does not require a physician, only that the drugs are “dispensed in clinics, medical offices, and hospitals by or under the supervision of a certified healthcare provider.” There are about 30 categories of "health care providers" according to the FDA, including medical assistants.
Despite just being handed a few pills for the woman to take herself, the cost of a medical abortion as of 2009, the year of the most recent data, is $490 which is higher than the $470 fee charged for a surgical abortion. Spontaneous miscarriages at 70 days from the last menstrual period are associated commonly with heavy bleeding and incomplete passage of the placenta. If a woman experiences a complication from a medical abortion, the abortion clinic does not provide follow-up care or admission to the hospital. The patient is sent to the closest emergency room.
Because the woman can choose a medical abortion without involving anyone else and she can drive herself to the clinic and back home, we can project RU-486 abortions will make up a large percentage of the abortions done in the U.S. Medical abortions potentially will expand the number of abortions in the U.S. and the world. By 2011 they accounted for 36% of abortions before 9 weeks in the U.S. In European countries they make up two-thirds of the first trimester abortions. Medical abortions cause more bleeding than surgical abortions and the further along she is in pregnancy, the greater the bleeding and the more likely she will also need a D&C.
However, some women change their minds after taking the abortion pill. Through a website developed by Dr. George Delgado and supported by a group of RNs around the country, patients are finding they can stop their medical abortion on www.AbortionPillReversal.com. Dr. Delgado’s office puts them in touch with a physician in their area who can start them on high doses of progesterone to override the effects of the mifepristone. The protocols were developed based on case reports. Mifepristone does not cause fetal abnormalities, but if the second drug misoprostol has been taken, the pregnancy cannot usually be saved and misoprostol does cause fetal anomalies. So far, about 60% of the medical abortions have been reversed at the request of the mother. Even if the abortion cannot be stopped, these women encounter caring physicians who treat them with respect and concern for them and their unborn child. These physicians adhere to the Hippocratic Oath which is no longer taken upon graduation from medical school. Written in the 5th century B.C. by Hippocrates, a Greek physician and the father of Western medicine, the oath states “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion.” If only all physicians and those they supervise returned to the principles of the Hippocratic Oath.
Dr. Kathleen Raviele is a board-certified OB/GYN and is the volunteer Medical Director for the Pregnancy Aid Clinic. She is a past-President and current member of the Catholic Medical Association. She also represents the CMA as a member of the U.S. Conference of Catholic Bishops Pro-Life Committee.