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Reproductive Health Access Project
 
 
Provider Packet
Abortion Pill / Medication Abortion
With Mifepristone and Misoprostol
Aspiration Abortion
(Suction or Vacuum Aspiration)
1. How far along in the pregnancy can I be?
Up to 9 weeks from the first day of your last period. Up to 12 weeks from the first day of your last period.
2. What will happen?
• The actual abortion takes place at home.
In the office, you swallow the abortion pill (mifepristone). Most women feel fine after taking mifepristone. Some women have nausea.
At home, 6-72 hours later, you insert the misoprostol pills.
• The abortion usually starts 1-4 hours after you take the misoprostol. You will probably have heavy bleeding and cramps for a couple of hours.
• You return to the office about 1 week later.

• The abortion takes place in the office.
• The actual abortion procedure takes 5 to 10 minutes.
• The doctor will put instruments in your vagina and uterus to remove the pregnancy.
• You return to your regular doctor or to the office where you had the abortion 1-2 weeks later.

3. How painful is it?
Women have mild to very strong cramps off and on during the abortion. Pain pills help. Women have mild to very strong cramps during the abortion. Pain pills help.
4. How much will I bleed?
Heavy bleeding with clots is common during the abortion. After that, lighter bleeding may continue off and on for 1-2 weeks or more. Most women have light bleeding for 1-7 days. Bleeding may continue off and on for a few weeks.
5. How much does it cost?
For both types of abortion, the exact cost depends on where you go.
6. Can the abortion fail?
The pills work 98-99% of the time. If the pills fail, you must have an aspiration abortion. It works 99% of the time. If it fails, you must have a repeat aspiration.
7. Can I still have children afterwards?
YES. Neither type of abortion lowers your chances of getting pregnant or staying pregnant in the future.
8. Is it safe?
Both pills have been used safely for over 10 years. Big problems are rare. Medication abortion is at least 10 times safer than continuing a pregnancy. Aspiration abortion has been done safely for over 25 years. Abortion in the first 12 weeks leads to very few problems. Abortion is at least 10 times safer than continuing a pregnancy.
9. What are the advantages?

• You won’t have shots, anesthesia, or instruments in your body
• It may feel more natural, like a miscarriage.
• It can be done earlier in the pregnancy than an aspiration abortion.
• Being at home instead of in an office may be more private.
• You can choose to have someone with you, or you can be alone

• It is over in a few minutes.
• It works 99% of the time.
• You see less bleeding than you would with a medication abortion.
• Medical staff members are with you during the abortion.
• A counselor may be there for support.
• It can be done later in the pregnancy than with a medication abortion.

10. What are the disadvantages?

• It takes 1-2 days to complete the abortion.
• It is not the same for all women.
• Bleeding can be very heavy and may last longer than with an aspiration abortion.
• Cramps can be severe and last longer than with an aspiration abortion.
• It cannot be done as late in pregnancy as an aspiration abortion.
• It cannot end a tubal pregnancy.

• A doctor must insert instruments inside the uterus.
• Anesthetics & pain medicines may cause side effects.
• You have less control over the abortion procedure and who is with you.
• The vacuum aspirator may seem noisy.
• It cannot be done as early in pregnancy as a medication abortion.
• It cannot end a tubal pregnancy.

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Updated Consent for an Early Medication Abortion

Write your initials before each statement to show that you understand and agree with it.

____ I know that my 3 choices for this pregnancy are parenthood, adoption and abortion.

____ “Medication abortion” means an abortion using drugs. An aspiration abortion uses instruments to empty the uterus or womb. I should not begin a medication abortion unless I am sure that I want to end my pregnancy. I am willing to have an aspiration abortion if the medication abortion fails.

____ I know that medication abortion must occur in the first 9 weeks of pregnancy.

____ I will take 2 medications. The first is mifepristone, which blocks a hormone needed to continue a pregnancy. I will take a 200 mg dose because research shows this dose works. The second drug is misoprostol. It causes the cramps which push out the pregnancy.

____ I will swallow the mifepristone tablet before I leave the health center. I know that this can cause nausea, diarrhea, and cramps.

____ I will take 4 misoprostol tablets home with me. I will take them as instructed.

____ One to six hours after I insert the misoprostol, I will have cramping and bleeding. The cramping can be very strong for a few hours, but usually not for more than 24 hours. The bleeding can be quite heavy with clots for a few hours. I may see some pregnancy tissue (usually white or gray in color). If the heavy bleeding lasts for more than 12 hours, or if I soak more than two maxi pads each hour for two hours in a row, I should call my provider. I should call if I do NOT bleed within 24 hours of inserting the misoprostol.

_____If I start to feel very ill, I will call the health center. Very rarely, women have had “toxic shock” type illness after a medication abortion.

____ I should return for my one-week check-up to make sure that the abortion is complete.

____ The abortion must be complete because misoprostol can cause serious birth defects. If the abortion is not complete, I may need a vacuum aspiration (a suction procedure to empty the uterus) to end the pregnancy.

____ I have read this form and have had time to think about it. I have had all of my questions answered.

____ If a complication occurs, I request and allow the provider to do whatever is necessary to protect my health and welfare.

____ I hereby consent that _____________________________ give me mifepristone and misoprostol for an early medication abortion.

Signature of patient: ___________________________

Date: _____________

Witness: ________________________

Date: _____________
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Medication Abortion After-Care Instructions (Buccal Miso)

Today, _________________, you took Mifepristone to end your pregnancy. You took 200 milligrams of Mifepristone at ____am/pm. You may have some vaginal bleeding after taking this pill.

Any time from 24 to 48 hours from now, _____am/pm, you must take another medicine, Misoprostol (also called Cytotec). Choose a time when you have had a good meal and plenty of rest. Swallow one Ibuprofen pill one hour before you take the Misoprostol – this will help decrease your cramps. You must take the Misoprostol even if you have started to bleed.

Each misoprostol pill is 200 micrograms. Place 2 misoprostol pills in each cheek. Leave them in your cheeks for 30 minutes. After 30 minutes, swallow the pills with water.
What to Expect:

Misoprostol causes cramping and bleeding, often with clots. The cramps and bleeding may be much more than you get with a period. The cramps usually start 2 to 4 hours after you insert the pills, and may last for 3 to 5 hours. This heavy bleeding means that the treatment is working. The bleeding often lasts 1 to 2 weeks, and it may stop and start a few times.

You may have a lot of pain or cramps – if so, take pain medicine. You can take ibuprofen (Motrin or Advil) up to 800 milligrams every 8 hours and/or hydrocodone up to 2 pills every 4-6 hours. You can also use a heating pad to relieve the pain. Some women get nausea, diarrhea or chills. This should get better in a few hours.

You should call me if:

  • Your bleeding soaks through more than 2 maxi pads per hour for 2 hours,
  • You do not bleed within 24 hours after taking the misoprostol, OR
  • You start to feel very ill after the heavy cramping and bleeding is over.
To reach me:
Call my 24-hour number: _________________________. If you have any questions or think something is going wrong, call this number and I will call you back. It may take me 10 to 15 minutes to return your call. No question is too small. Please feel free to call me.
Follow-up:
You have an appointment to come back to my office on __________at _________ am/pm. At this visit I will make sure that the abortion is complete.
Birth Control:
If you want to use birth control pills, patch, or ring, I have given you a prescription. You should start these on ___________, even if you are still bleeding.
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Medication Abortion After-Care Instructions (Vaginal Miso)

Today, _________________, you took Mifepristone to end your pregnancy. You took 200 milligrams of Mifepristone at ____am/pm. You may have some vaginal bleeding after taking this pill.

Any time from 6 to 72 hours from now, _____am/pm, you must take another medicine, Misoprostol (also called Cytotec). Choose a time when you have had a good meal and plenty of rest. Swallow one Ibuprofen pill one hour before you take the Misoprostol – this will help decrease your cramps. You must take the Misoprostol even if you have started to bleed.

Each misoprostol pill is 200 micrograms. Place 4 misoprostol pills in your vagina. Lie down for 30 minutes. It’s OK if the pills fall out after 30 minutes.
What to Expect:

Misoprostol causes cramping and bleeding, often with clots. The cramps and bleeding may be much more than you get with a period. The cramps usually start 2 to 4 hours after you insert the pills, and may last for 3 to 5 hours. This heavy bleeding means that the treatment is working. The bleeding often lasts 1 to 2 weeks, and it may stop and start a few times.

You may have a lot of pain or cramps – if so, take pain medicine. You can take ibuprofen (Motrin or Advil) up to 800 milligrams every 8 hours and/or hydrocodone up to 2 pills every 4-6 hours. You can also use a heating pad to relieve the pain. Some women get nausea, diarrhea or chills. This should get better in a few hours.

You should call me if:
  • Your bleeding soaks through more than 2 maxi pads per hour for 2 hours,
  • You do not bleed within 24 hours after inserting the misoprostol, OR
  • You start to feel very ill after the heavy cramping and bleeding is over.
To reach me:
Call my 24-hour number: _________________________. If you have any questions or think something is going wrong, call this number and I will call you back. It may take me 10 to 15 minutes to return your call. No question is too small. Please feel free to call me.
Follow-up:
You have an appointment to come back to my office on __________at _________ am/pm. At this visit I will make sure that the abortion is complete.
Birth Control:
If you want to use birth control pills, patch, or ring, I have given you a prescription. You should start these on ___________, even if you are still bleeding.
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Documentation of Ultrasound Form

Tape Sonogram Picture(s) here

INDICATIONS:

Prior to Medication abortion

hormonal contraception (Past 3m)
uncertain LMP
irregular cycles/cycle length>35d
cost/logistical issues
teaching
size-date discrepancy
IUD at follow up
   bleeding
   8 weeks or greater by LMP

Post Medication abortion
Pre Aspiration abortion
Post Aspiration abortion

Prenatal

hormonal contraception (Past 3m)
uncertain LMP
breastfeeding
irregular cycles/cycle length >35d
1st tri bleeding/threatened abortion
teaching
size-dates discrepancy

IUD localization
Other ___________________________

FINDINGS:

Gestational Sac ____________mm (MSD)
CRL___________mm
Yolk Sac
Fetal Heart
Other ___________________________

 

GS: ______ mm+30 = _____ Gestational age (days)

CRL: ______ mm+42 = _____ Gestational age (days)

Dating by Hadlock: __________________________
For Pregnancy dating:
1st Tri, use crl + 42 until crl = 25, after crl > 25 use hadlock

EDD __________________________

 

Scan

  ___________________________________
  Provider Signature

  ___________________________________
  Date

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These forms are not intended to provide legal, medical or other professional advice. They are not a substitute for consultation with a healthcare provider or for independent judgment by healthcare providers or other professionals regarding individual conditions and situations.