‘I’m an Abortion Doula; Here’s How To Prepare for a Remote Abortion With a Pill’

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It's not an understatement to say abortion access in the U.S. is being systematically undermined. There are currently twenty-three states with legislation that could restrict the legal status of abortion. Six states in the U.S. have only one abortion clinic, and 38 percent of childbearing age women don't have a clinic in their county. The ability to safely end a pregnancy is part of the spectrum of reproductive health; however, red tape and restrictive legislation sabotage the process.

What's more? There's a bit of confusion around the kinds of abortions available. People might assume that all abortions happen inside of a clinic, but medication abortion has been a safe and affordable way to end pregnancy since 2000. Medication abortions are conducted by administering two pills: mifepristone and misoprostol. According to 2020 data from the Guttmacher Institute, over half of the abortions performed in the United States are medication abortions.

Mifepristone stops progesterone production, which halts the development of your pregnancy, and misoprostol induces cramps and bleeding similar to that of a miscarriage, according to Planned Parenthood.  The procedure is 94-98 percent effective for people who are eight weeks pregnant or less. Effectiveness is around 87 percent for people 10 to 11 weeks pregnant, but an extra dose increases the efficacy to 98 percent. After 11 weeks, you should talk to a provider about an in-clinic abortion, according to Planned Parenthood.

Taking the medication is relatively straightforward; however, they are not available over-the-counter. To acquire the medication, you'll likely see a provider. However, in 2020, the US Food and Drug Administration (FDA) relinquished the in-person appointment requirements.  This made it possible for telehealth services to offer medication abortion more broadly.

No matter how you access your pills, your prescribing provider should be able to walk you through how to care for yourself throughout the process. For instance, it's normal to see more blood than a regular period and experience more intense cramping, says Kim Landon, MD, staff obstetrician and gynecologist at Medzino.  However, beyond the more obvious side effects, you might prepare and care for yourself in other ways. And doulas—trained non-medical professionals who provide support during pregnancy, fertility journeys, adoptions, breastfeeding, miscarriage, and abortions—have unique insights into what you might need when experiencing a medication abortion.

Below, we asked Dr. Landon and Jessica Jolie Badonsky, FNP-BC, a registered family nurse and doula from New York, to break down how you might prepare.

Plan where and how you’ll take the medication

Some states don’t offer abortion via telemedicine, and finding a care provider can be challenging. You can use Planned Parenthood’s database to find a provider, and concierge abortion medicine start-ups like Hey Jane can help you get the pill either via mail or a pharmacy. Even so, you might still need to think through travel or boarding depending on how you receive your pills and where you live. An abortion doula is a great resource to support you in evaluating your options, legal barriers, and avenues towards getting treatment.

Do your best to prioritize rest, if you can

Even in a safe, comfortable environment, Dr. Landon stresses that terminating your pregnancy can be physically and emotionally draining. Planned Parenthood reports that you might experience heavy bleeding and cramping for around 24 hrs, but the whole experience can last between one to three days, depending on when you take each pill. Blocking out time to rest can help you manage physical discomfort and make navigating the experience a little easier.

Have pain management tools at the ready

Dr. Landon says that the abortion pill combination often comes with cramping and considerable pain. She recommends that you take nonsteroidal anti-inflammatory drugs, like ibuprofen or Tylenol, and keep a heating pad at the ready. Additionally, making sure you’re hydrating and eating enough should be part of your overall pain management strategy.

While some discomfort is normal (Dr. Landon says it feels like something between an intense period and a miscarriage), you should seek medical treatment if you experience pain that cannot be managed or have excessive bleeding. Heavy bleeding and blood clots are normal, but passing like large clots and soaking more than one pad in an hour are reasons to chat with a provider.

Figure out how you’d like people to support you

Family history, culture, and society can also weigh heavy on a person, says Badonsky. Having a support system that can follow your lead and listen without interjecting themselves in this process can be helpful.

It's understandable to want privacy for a personal choice like terminating a pregnancy. However, communicating with someone you trust can help you process unexpected thoughts and feelings, Badonsky says. She adds that having support, either from a loved one or an abortion doula, can also help you stay calm or strategize if something feels wrong.

If you are looking for a doula who supports people during abortions, you can look at databases or call support lines that can connect you with resources.

Unfortunately, the stigma surrounding abortion impacts people’s comfort level with disclosing their choice. Recent research from the UK showed that around 33 percent of women would feel comfortable disclosing their choice to have an abortion to friends, and 62 percent shared that they would tell their sexual partner. Whether or not the experience is challenging, how you support yourself and who you tell is entirely up to you.

Remember that any emotions you have are valid

Even if it is the right choice for you and you don’t have any regrets, it's normal to have challenging and even conflicting emotions. "It can come as a surprise that the experience is intense and difficult, at times," says Badonsky. On top of this, she adds that pregnancy and the end of pregnancy cause hormone changes, so try not to judge yourself for your emotions.

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