Nurses Explain What to Know About Medication Abortion Post-Roe

Roe v. Wade has been overturned, and abortions are now illegal in about half of the states in the U.S. However, people may have access to nonsurgical abortions in anti-abortion states.

A self-managed abortion terminates a pregnancy through a combination of medications. Abortion pills are safe, effective, and approved by the Food and Drug Administration (FDA).

We heard from two nurses who specialize in sexual and reproductive health who want people to know their options for self-managed abortions. Find out what people should know about accessing and taking abortion pills.

Medication abortions account for about half of abortions performed annually in the U.S. The process involves taking two drugs: Mifepristone (Mifeprex) and Misoprostol.

According to the FDA, medication abortions are safe and effective through 70 days (10 weeks) gestation. The FDA says a self-managed abortion should occur in this order:

Lauren Haines, MSN, APRN, FNP-BC, provides sexual health services for TBD Health and also works part time at an abortion clinic. She explains how medication abortions work:

“Mifeprex blocks progesterone and helps to prevent the pregnancy from continuing. Misoprostol helps to soften the cervix and causes cervical dilation and cramping to expel the fetus.”

Haines says the medications are safe and effective, but 2% of people remain pregnant after taking them. When this happens, she says medication abortions “are not recommended for individuals who have failed medication abortions in the past.”

People typically access medication abortions through a prescription from a healthcare provider at a clinic or via telemedicine. However, since the overturning of Roe, some states have imposed restrictions on accessing medication abortions.

For some people, the only option may be to get a prescription through telemedicine and have an abortion pill sent through a mail forwarding system. Services like Plan C are available to connect people with abortion pills by state.

Monica Skoko Rodriguez is a first-year doctor of nursing practice candidate in the executive leadership specialty at Duke University. They recently became the director of medical standards for Planned Parenthood Federation of America.

They share the importance of accessing self-managed abortions to maintain sexual health autonomy and reproductive freedom.

“Access to these pills allows people to access an abortion on their own terms,” Skoko Rodriguez says. “Trips to clinics, time off work, childcare, and other factors can create a difficult environment for accessing abortion care.”

Without access to safe abortion care, healthcare providers fear patients will die or suffer major health complications. People may experience complications related to illegal “back-alley” abortions, or patients may die because healthcare providers legally can’t terminate a pregnancy.

“Unfortunately, with Roe’s reversal, there is no longer any way to ensure that everyone has access to a safe abortion,” says Haines.

It’s natural for nurses to worry about patients whose options for safe abortions are limited. You can support your patients by getting educated and taking action as nurses.

Skoko Rodriguez says one way nurses can advocate for patients is by educating themselves and others about their options. This may involve encouraging providers to be comfortable prescribing medication abortions.

They say nurses can “learn the ways patients can access them independently and share these resources with patients. Nurses should also know how to counsel patients on what taking the abortion pills will be like for the patient.”

Self-managed abortions may be one of the most effective, affordable, and safe ways for someone to terminate a pregnancy. They’re approved by the FDA and have been widely used since 2000.

But in anti-abortion states, lawmakers are placing restrictions that make it difficult to get abortion pills.

According to Guttmacher Institute, 19 states require a person to be monitored by a provider during a medication abortion, which eliminates the option of self-managed care. In 29 states, medication abortions must be prescribed by a physician, removing privileges from advanced practice providers like midwives and nurse practitioners.

Skoko Rodriguez wants people to know they may be able to access abortion pills by mail by using mail forwarding services to a P.O. Box. However, she says different states have different penalties for people seeking abortion and people helping to provide abortions which span from fines to potential jail time.

“It is important that patients know they are not alone and there are networks of people working in every state to ensure everyone has access to care,” Skoko Rodriguez says.

As a nurse, you may encounter patient questions about self-managed abortions. Here are some talking points you may use to educate people seeking a medication abortion.

Skoko Rodriguez says a medication abortion is like a bad period. After taking the pills, patients should plan to experience bleeding and pain or cramping. Some people experience nausea or other side effects.

After a medication abortion, you can take acetaminophen or ibuprofen for pain. Patients will need to monitor themselves for heavy bleeding or severe pain.

Haines advises patients to seek emergency medical treatment if they’re:

Skoko Rodriguez says it’s important to practice self-care following a medication abortion by using comfort measures like over-the-counter pain relievers, heating pads, and comfort foods.

“It’s also important to remember to take any steps to take care of your mental health during this potentially stressful and emotional time,” they say. “It is good to identify someone you trust among your friends and family to support you however you may need.”