The first thing I knew when I found out that I had accidentally gotten pregnant was that I was going to have an abortion. The second thing I knew was that there was no way I could deal with having a traditional surgical abortion. I didn't and still don't believe that having an abortion is psychologically harmful; rather, I was already hanging by a thread (for unrelated reasons) at the time, which I knew meant that I absolutely had to get an abortion. I also knew that the vulnerability involved in lying on an operating table alone or sitting among strangers in the group recovery room afterwards would probably break me. I scrolled through the Planned Parenthood website, desperate for some kind of solution, when I read about another option: a medical abortion, aka "taking the abortion pill."
In a day, I had made an appointment, and a week later, I was at a clinic, being talked through the procedure. My experience with medical abortion happened a decade ago, when there were fewer blocks to reproductive freedom in the United States than there are now. According to reproductive health advocacy group the Guttmacher Institute, "from 2011 to 2014, 231 abortion restrictions were enacted, while 189 were enacted during the previous decade (2001-2010)." I realize that I was very lucky to be able to make an appointment without being forced to go through a waiting period to "think about" a choice that I had already made. Many women today don't have this option, which I think is profoundly unfortunate — especially because, though it is not right for everyone, medical abortion is an option that every woman dealing with an unplanned pregnancy should be allowed to consider.
If you're dealing with your own unplanned pregnancy and wondering about your options, or are simply curious about the so-called "abortion pill," read on for my experience.
1. I Had To Get A Vaginal Ultrasound
An abortion ends a pregnancy that has already begun, so you can only have a medical abortion if you are actually pregnant in the first place — something the clinic will confirm by giving you an ultrasound. My clinic gave me a vaginal ultrasound during my appointment, which was a total surprise to me at the time. I later found out that this happened because I was only a few weeks into my pregnancy, and that early on, the embryo can't be viewed through the kind of stomach-based sonogram we've all seen on TV shows.
2. I Paid A Bit Less Than I Would Have For A Surgical Abortion
Though the idea of being able to process my feelings at home, rather than in a medical center, was the biggest draw for me when deciding which option to go with, I was also drawn to the price. According to Planned Parenthood, medical abortions typically cost $800 or less, while a first-trimester abortion can cost up to $1500. My own medical abortion cost closer to $400, because I had recently lost my full-time job and was paying on a sliding scale.
Though deciding based on cost seemed like a reasonable idea at the time, I have to recommend that you don't choose based on price alone, if at all possible. Medical abortion is very physically different than a surgical abortion, and can be quite painful, and I hate to think of someone going through that pain just to save money.
3. I Was Only Able To Do It Because I Was Less Than 10 Weeks Pregnant
Though surgical abortions can be performed after several months of pregnancy (depending on your local laws), medical abortion is only administered to women who have been pregnant for nine weeks or less. This cutoff exists because treating a woman who is further along in her pregnancy with the medicines used in a medical abortion can increase the risk of complications. When performed on a woman who has been pregnant for nine weeks or less, the odds of complications arising from a medical abortion are less than one percent.
4. My "Abortion Pill" Was Actually Two Pills
When you show up to your appointment to have your medical abortion, your doctor will confirm that you're pregnant. After that, you'll be given two pills: mifepristone and misoprostol. You take mifepristone first, which blocks the production of the hormone progesterone, causing the lining of the uterus to slough off and the cervix to soften. Then you take misoprostol, which causes the uterine cramps which expel the embryo from your uterus.
I've read a lot of different things about the time frames in which the pills are given. Though mifespristone is always taken first, some people take the pills several days apart. I wasn't told to do this — I took mifespristone in my doctor's office in the morning, and was told to take the misoprostol at home a few hours later. I swallowed the mifespristone as you would any pill, but inserted the misoprostol vaginally.
5. The Actual Abortion Process Lasted For A Few Hours
During a surgical abortion, surgical tools are used to remove the embryo from the uterus in a matter of minutes. With a medical abortion, you trade efficiency for privacy. After I went home and took my second pill, I began cramping, and it lasted for a few hours, until I had completely passed the embryo. According to Planned Parenthood, the average medical abortion takes four or five hours from the time the misoprostol is used.
6. It Was Very Painful
This procedure was exactly what I needed at the time, so I don't really feel great saying anything negative about it. That said, I would be dishonest if I didn't say that I experienced some of the worst pain of my life during my medical abortion. All the pain came from the cramps; they have to push out all your uterine lining and the embryo, so they are very powerful. They felt like a worse version of the debilitating menstrual cramps I used to deal with in high school. I felt sweaty, a little woozy, and in agonizing pain.
My doctor had emphasized the importance of having someone in the house while I went through with it, and I'm glad that I listened to her. While my original urge had been to go through it alone so that I wouldn't have to talk to any of my friends about my abortion until I was ready, when the cramps actually kicked in, I was grateful to have someone in the house who could hold my hand and tell me that it was almost over. I found that getting to have the emotional support of my choice on hand, rather than going it alone in a medical exam room, was one of the major pluses of having a medical abortion.
7. I Bled A Lot
So what happens when you're going through a medical abortion? You cramp, and you bleed. You bleed a ton. It looked like I was having my entire week-long period in fast motion — after a few hours, as it seemed like my bleeding was hitting its peak, I gave up trying to change menstrual pads and just plunked myself down on the toilet. I also had some diarrhea, which I usually got during the first few days of my period each month.
It looks like a lot of blood, but you're not hemorrhaging — all that blood is just uterine lining which your body is now sloughing off, as you would during your period. And the bleeding doesn't actually hurt — for me, it just felt like a demonic version of very bad period cramps.
8. I Cramped A Lot
Did I mention the cramping? Because you don't just cramp; you cramp. My cramps began after I took the misoprostol. After some time, they developed into the most painful menstrual-type cramps I had ever experienced.
This doesn't mean that all medical abortions feel this way; people's bodies respond in different ways. I've heard that other women have felt fever, dizziness, and nausea. Planned Parenthood's website recommends taking some acetaminophen or ibuprofen (but never aspirin) to deal with the pain. I tried a heating pad and took some ibuprofen at first, but after a little while, I realized that was like throwing a golf umbrella at a tsunami, and that all I could do was breathe deeply and try to get through the cramping on my own.
9. I Felt Incredibly Relieved When I Expelled The Embryo
I had hoped that since I had caught my pregnancy after only a few weeks, perhaps I could take some kind of magic pill that would just sort of make my embryo evaporate. But unfortunately, there's no such thing. Medical abortions make the embryo detach, and it has to come out through your vagina. My doctor had warned me that I might see a sac when the abortion was successfully completed. For this reason, I opted not to look at the blood that was now coming out of me in clots.
But I felt when the sac passed through my vagina; it was like a bit of a "plop" sensation, and I immediately knew what happened. I felt incredibly relieved; it had worked, and it was almost over. After I realized that the embryo had fallen out of me, I flushed the toilet, which is what you're supposed to do. Since a medical abortion happens so early in your pregnancy, your embryo is a tiny blob, rather than a large thing that would need to be disposed of as hazardous waste.
10. I Felt Really Tired
By this time, it was the middle of the night. I had told my roommate to go to bed, because I didn't want to have her standing around while I bled on the toilet for an hour. However, my bleeding had tapered down significantly, and I felt pretty weak by the end of it, so I woke her up and made her hang around while I took a shower. I then put on a massive pad and immediately fell into deep, exhausted sleep. The entire thing had taken, from the first pill to the last moment, about 12 hours, with six hours of active cramping and bleeding.
11. I Bled For A While After
The next day, I didn't feel great, but I also didn't feel awful; I just felt profoundly spent. I took the day off from my temp job and watched TV in bed. The day after that, I felt fine, and was almost completely back to normal, but I was bleeding. I didn't bleed heavily, but I did spot consistently for four weeks after my abortion. By the end of that month, I was seriously ready to have one day when I didn't leave the house with a pantyliner on — but I still thought it was a better deal than having a child I wasn't prepared for. I started taking the birth control pill very soon after my abortion, so I didn't experience an irregular menstrual cycle.
The Bottom Line
If I found myself dealing with an unplanned pregnancy again, I don't know that I'd choose a medical abortion over a surgical abortion. I'm in a more stable place emotionally, and I think feeling a few moments of vulnerability in an exam room now might be a decent tradeoff for not being in cramped agony for five hours straight.
Deciding between the two options is mostly about personal preferences. Would you rather have a procedure that is finished quickly, or one that feels less like a medical procedure and more like a miscarriage? Do you feel like you would emotionally benefit from being able to be at home during it, or can you emotionally process the experience while in a traditional medical setting? Do you need a partner there to support you during your abortion? Will you feel stressed and anxious bleeding and going through a medical procedure without a doctor on hand?
Of course, I hope that this is an issue that I never have to deal with again. But if I do, I am thankful to have options.
Images: Rooks Nest Entertainment/ Sundial Pictures/ Votiv Films; Giphy (12)