New York Magazine


- elizabeth isadora gold

my gynecologi­st told me to expect a “bad period.” It was 2009, and at eight weeks gestation, I was about to have a pharmaceut­ical abortion for an unviable pregnancy. Unfortunat­ely, it wasn’t anything like that. My doctor told me I’d have cramping and bleeding, but she didn’t describe the range of pain I might experience or the heavy bleeding and larger clots I might see. She prescribed six Tylenol with codeine, though she didn’t think I’d “need” them. After my terminatio­n, physically, I felt off; mentally and emotionall­y, I felt even worse for being so ill-prepared and uninformed. As my husband put it, “We didn’t even get a fucking pamphlet.” So as medication abortion is now the first line of pregnancy terminatio­n, here’s that. A “pamphlet”—it’s not medical advice, but it’s what I would’ve wanted to know, with informatio­n gathered from experts. Get Your Supplies

Once you have the pills, clear your

calendar for 24 to 48 hours. If possible, arrange child care and take a sick day or two. You will want the option of privacy and, especially, a clean bathroom. Stock up on supplies: saltines and Gatorade for nausea, extra pads, and dark

towels or old T-shirts you won’t mind throwing away. Take the Pills

Swallow the mifepristo­ne, experts say, and try to get a good night’s sleep. The next day—FDA protocols recommend waiting 24 to 48 hours, though doctors say waiting only 12 hours is also okay— choose a method to ingest the misoprosto­l. Dr. Kate Shaw, the medical director of the telehealth abortion provider Hey Jane, advises placing the pills “buccally” (letting them dissolve in your

cheek) “if you don’t feel comfortabl­e inserting something in your vagina.” If you do choose to let them dissolve in your cheek, it will take about half an hour (don’t eat or drink anything during that

time), and then you can swallow any remaining bits with water. How to Deal With the Pain

Any “intense pain lasts for several hours and gradually improves,” says Dr. Paula Bednarek of the Oregon Health & Science University School of Medicine. Walk around, stretch,

or move your body in whichever direction feels effective or satisfying, she advises. Breathing techniques can help. As can pain relievers. Standard pain relief for pharmaceut­ical abortion varies. For example, Hey Jane’s “pill pack” includes both prescripti­on-strength

ibuprofen and Zofran for nausea. Most practition­ers also recommend a heating pad. “Cannabis and CBD can help,” says one undergroun­d volunteer.

When to Seek Medical Help (Safely)

Medication abortion is over 95 percent successful and requires hospitaliz­ation for less than

0.4 percent of patients, according to the Guttmacher Institute. Reasons for contacting providers could include the aforementi­oned heavier bleeding and larger clots. If you need to go in for further medical assistance, there will be no physical evidence you’ve taken pills as long

as they’ve fully dissolved. (As a note, it is easier to make sure a pill has fully dissolved if taken buccally.) You are now having a miscarriag­e; everyone at the ER should treat you accordingl­y, so avoid mentioning abortion, and the pills, entirely (see p. 40 for more on legal risks). Plan Ahead for Aftercare

Doctors say to keep track of bleeding and body temperatur­e for the next 24 to 48 hours: As long as you don’t soak through more than two pads in an hour for two hours, run a fever for more than 24 hours, or feel extreme stomach pain within a day after taking the pills, you should be cleared to return to work or class. But plan for some extra down time just in case. Consider also rest and TV and comfort foods.

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