The Chemistry of Abortion

By Christine Gorman

Amy, 36, a happily married mother of a four-year-old boy, was stunned last year to learn she was again pregnant. She and her husband--who had relied on the rhythm method and condoms for birth control--had been renovating their home outside Seattle, using a number of caustic chemicals. "I thought about the chemicals I had been exposed to and I thought about our very busy lives," Amy says. "I know what I can handle, and our lives were not settled enough or prepared enough for another child." She decided, with her husband's support, to have an abortion.

Under normal circumstances, Amy would have had to undergo a surgical abortion. But she found a clinic that offered the abortion pill mifepristone on an experimental basis. She thought taking the drug would give her a sense of control. And the regimen seemed simple: first an ultrasound test to make sure she was still in the early weeks of pregnancy, then a dose of mifepristone, which arrests the pregnancy, followed by another drug two days later to expel the mass of embryonic tissue. She was surprised at the pain, however. "It was more than a period," she recalls. "I had very sharp, stabbing pains." But if ever she had to do it again, she says, she would still choose the pills over surgery.

Last week's approval of mifepristone by the Food and Drug Administration means that millions more American women will have the same option. Not to be confused with the morning-after pill, which doctors believe prevents a fertilized egg from implanting in the uterine wall, mifepristone causes miscarriage by blocking the hormone progesterone, which is needed to maintain a pregnancy. Mifepristone is followed 48 hours later by a second drug, called misoprostol, which forces the uterus to contract; the fetus is expelled several hours later. When taken within 49 days of the last period, the two-drug combination is 95% effective.

One big advantage of the two-drug combo is that it can terminate an unwanted pregnancy earlier than most surgical procedures. And because surgery is not required, the risk of infection is lower. Yet there are drawbacks. Some women suffer excessive bleeding, nausea or diarrhea. Nor is it recommended for women with bleeding disorders or who smoke more than 10 cigarettes a day. Indeed, for many, surgery is less complicated--and quicker than the three-office-visit protocol required for the new pills.

Are those three visits medically justified? The first visit certainly is, since it's vital to ensure that a woman is within the 49-day limit and is not suffering from a tubal pregnancy--things that can be determined with the help of ultrasound. And a final visit to the doctor is needed for a second ultrasound to determine if the abortion is complete or if a surgical procedure is needed after all. New studies indicate, however, that there is no need to take the second drug at the doctor's office. As long as a woman has access to medical facilities in the unusual event of life-threatening bleeding, she can safely take the second drug at home.

The FDA's rules are actually less restrictive than many of those found in Europe. In Britain the pills are available only in licensed abortion facilities--usually clinics and National Health Service hospitals--and must be taken on the premises. Similar regulations exist in France, which requires four visits over a period of three weeks to a licensed hospital or clinic. Dr. Elizabeth Aubeny, one of the first physicians to test mifepristone, at the Broussais Hospital in Paris, contends there should be more flexibility in allowing women to take misoprostol at home, if they choose. Still, she admits, "there are a lot of women who prefer to stay in the hospital for three hours. They are afraid to be alone, afraid of the bleeding. For many it's psychological; they feel more reassured in a hospital than they do at home." Women who opt for the abortion pill must make up their minds very quickly. Since conception occurs about 14 days after a menstrual cycle begins, they actually have 35 days from the time they miss their period to suspect they are pregnant, decide to abort and set up the appointments. (Home-pregnancy tests will help.) But once they do, many women find the process oddly comforting. Although they expel the fetus, all they see is a bloody mass that's unrecognizable. The nausea passes soon after the expulsion is over, and they can go on with their lives.

--Reported by Helen Gibson/London, Tala Skari/Paris and Dick Thompson/Washington

With reporting by Helen Gibson/London, Tala Skari/Paris and Dick Thompson/Washington