No one's talking about the trauma of abortion by pill

Pills Credit Mike Rogal Shutterstock CNA Mike Rogal via Shutterstock.

While the number of abortions in the United States has declined, a recent report shows that women seeking abortions are increasingly preferring medical abortions, rather than surgical ones.

According to data from Planned Parenthood, in a report from Reuters, medical abortions – those by pill – made up 43 percent of all abortions in the U.S. in 2014, up from 35 percent in 2010.

In some places, the demand for the abortion pill tripled after March, when the FDA expanded the use of the abortion pill (mifepristone or RU486 used together with misoprostol) to include pregnancies up to 10 weeks. Previously, only women who were up to seven weeks pregnant were able to take the pill, due to concerns about side effects.

Some have hailed it as a victory – the popping of two pills seems more accessible and less invasive, expensive and time consuming than a surgical abortion, which requires anesthesia, multiple appointments and walking past picket lines.

But for those who have worked with post-abortive women, and for doctors who perform abortion pill reversals, the rise in medical abortions is nothing to be celebrated.

Vicki Thorn is the founder of Project Rachel and the National Office for Post Abortion Reconciliation and Healing, and has worked with post-abortive women for decades.

Thorn said while a medical abortion may seem like an easier method, in reality, it can actually be more traumatic for women and families, in large part because women who take these pills abort their babies in their own homes.

The trauma of aborting at home

Because of the recently expanded use, Thorn said, the fetuses that are aborted this way look more and more like recognizable babies than just clumps of cells.

"I've talked to these women – some of them get really panicked because they see the baby," she said, which typically doesn't happen during a surgical abortion.

Dr. John Bruchalski is an obstetrician-gynecologist with the Tepeyac Family Center in Fairfax, Virginia. A former abortion doctor, he is now part of a network of doctors that provide abortion pill reversals.

Dr. Bruchalski also said that seeing the baby, which is the size of a blueberry at seven weeks, and the size of a kumquat at ten weeks, is what makes medical abortions possibly more traumatic than surgical abortions for women.

"When you subject a woman who's pregnant to watch the process happen, it's a challenge, it can be brutal," he told CNA. "There's lots of contractions without anesthesia, lots of clots, that's not even the issues that come with seeing the tissue with the baby."

"Now these women are miscarrying at home? And you call that more empowering?" he added.

Clinics that prescribe abortion pills instruct women to flush their baby down the toilet. But many women panic once they see their baby and don't know what to do.

Thorn said some women she has worked with did not own the property they lived on, and so did not want to bury their baby at a place that wasn't their permanent residence. Some women were at such a loss that they kept their baby in the freezer.

This problem compounds when a teenage girl takes the abortion pill without the knowledge or permission of her parents, which is legal in many states. She may leave her baby in the bathroom at her high school or other public places, Thorn said.

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Some Catholic cemeteries offer special burial services for aborted or miscarried babies, but many women either don't know about them or are too ashamed to call and ask.

The place in the home where the baby was aborted – often the bathroom or a bedroom – also often becomes a place of trauma and recurring memories for these women, Thorn said.

"Women talk about how the place where they lost the baby becomes traumatic to them, so the bathroom at home where they lost the baby, they can't use that bathroom anymore, because it triggers the memory," she said.

Another "advantage" of the pill versus surgical abortions touted by abortion proponents is that a woman can take the second pill and medically abort at home with her partner. But men also experience trauma after seeing their aborted children, Thorn said.

"What happens to him? Because fathers involved in miscarriages grieve profoundly. And they see the baby," Thorn said.

"It's an incredibly complex thing, and there's no good answer."

Reversing the abortion pill

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A medical abortion consists of a woman taking two different medications within about 48 hours of each other – the first, mifepristone, blocks the progesterone that makes the womb an inhabitable place for a baby. The second, misoprostol, is taken 48 hours after the first pill, and makes the uterus contract and expel its contents – the baby.

But what happens if a woman takes the first pill and regrets her decision?

Several doctors throughout the country, including Dr. Bruchalski, do abortion pill reversals, though women are not likely to hear about them from Planned Parenthood or other clinics that prescribe abortion pills.

Typically, women are told that the abortion begins the hour they take the first pill (mifepristone), Dr. Bruchalski said, which is not true.

While the mifepristone blocks progesterone to make the womb uninhabitable, it does not directly affect the fetus or have any direct side effects to the fetus. A woman who takes mifepristone and decides not to take the second pill still has a 7-20 percent chance that her baby will survive.

If she receives abortion pill reversal treatment, which typically involves progesterone injections, her baby's chances of survival increase to 60 percent.

"So all is not always lost," said Dr. Bruchalski.

Dr. Edwin Anselmi in Centennial, Colorado also performs abortion pill reversals.

He told CNA that of the babies who survive the first abortion pill and the reversal procedure, the outlook is very good – he is not aware of birth defects in children who have survived the treatment.

Both Dr. Anselmi and Dr. Bruchalski are part of a network of doctors that provide abortion pill reversal throughout the country. If a woman looking to undo the procedure Googles "abortion pill reversal," the first result is, a website that is a project of Culture of Life Family Services in San Diego, California, which includes a hotline that connects women to doctors in their area who can perform abortion pill reversal procedures.

Since the launch of the abortion pill reversal hotline in 2012, more than 200 babies have been saved, and over 100 more are expected to be born in the coming months, a representative from the hotline told CNA.

Dr. Anselmi said he is willing to meet with these women at any time, because the sooner they start the reversal process, the better.

"(When) they know that they don't want to go through with (the abortion), I'll meet them at the office as soon as possible, in the evening or on the weekends, to get the process started," he said.

Dr. Bruchalski said that besides medical treatment, his clinic offers patients counseling to deal with any trauma that they may have experienced throughout the process.

"It's about meeting this woman in a place where you can give her positive affirmation and hope in the middle of a very difficult situation," he said.

"There's many different types of counseling, but you have to meet the woman where she is, and you can't push her, you can't rush her, she has to do it on her own, and you have to accompany her."

Follow-up for completed medical abortions can also be problematic, Dr. Bruchalski explained, because women often don't have a relationship with the clinic where they received the abortion pills, making them less likely to go back for regular follow-up appointments or if they experience complications.

"They're only going there for a service, they're not going there for their regular care, usually. It's like a vending machine. I want an abortion, I go here," he said.

It's even more difficult in third-world countries, where abortion pills are increasingly being used in order to expand women's access to abortion, but where women are less connected to a system of support – many of them don't have their own phones, or reliable access to transportation, Dr. Bruchalski said.

The after-effects of an at-home abortion

Thorn said that immediately following an abortion, it's normal for many women to feel relief. It's afterwards – in the following months and years – that trauma can hit, perhaps when a woman is trying to conceive again, or when she thinks about the person who may be missing from her family.

With medical abortions, the feelings of guilt can be even more intense than women who had surgical abortions, Thorn said.

"A surgical abortion in some respects is much easier on the woman," Thorn said. "She'll grieve eventually, but it happened somewhere else, it happened at that clinic, I don't have to go that clinic anymore, somebody else did it, I for the most part didn't see the baby."

"But the issue women have with medical abortion is: 'I did it'," she said. "There is no outside party that I can blame or hold accountable...and that bothers women."

Abortion pill rates are much higher in Europe than in the United States, although its proponents in the U.S. would like to see its use increase. Proponents of the pill argue that it's easier, more private, and normalizes the procedure of abortion, making it seem more like a normal medical procedure than an intrusive surgery.

But the rhetoric that treats abortion like a non-event is dismissive of the scores of women who experience serious trauma after the procedure, Dr. Bruchalski said.

"In the pejorative, abortion is talked about as no big deal, as this really common procedure. But the reality for me as a doctor? It's visceral, it goes through my hands and my heart. For these women, it's going to happen in the privacy of their own home – and it's not always 'that easy'."

Another reason women have a hard time forgetting abortions is because they carry cells from their children inside them for the rest of their lives, Thorn said – a phenomenon known as microchimerism. During an abortion, studies show that more cells from the baby transfer to the mother than during a full-term pregnancy.

"The fact of the matter is there's still footprints in her body from her baby," Thorn said. "I carry cells from that child, I can't forget it, and at some point, I have to resolve it."  

That women are not told the full truth about the trauma they may experience after taking an abortion pill is highly problematic, Thorn added.

"It's the continuing theme that, in the apparent guise of freedom for women, we get used and abused all the time on all kinds of health issues," she said.  

"The reality of this is that this is not a non-event, which is what people try to portray it as."

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