How to have a safe at-home abortion: What to expect, aftercare, and effectiveness

• An at-home abortion involves taking two pills, mifepristone and misoprostol, to terminate a pregnancy.
• Take the first medication orally, and 24-48 hours later, dissolve the second pill in your mouth.

While many people think of abortions as procedures performed in a clinic, medical abortions, aka "at-home" abortions, are less invasive and completed in the comfort of your own home. All it takes is two medications, which are FDA approved for pregnancies up to 10 weeks along.

It's estimated that medical abortions are now more common than in-office procedures, accounting for 54% of abortions in the United States. Here's what you need to know about how at-home abortions work, steps for taking the medications, and aftercare.

What is an at-home abortion?

Having an abortion at home means using medication as a safe way to end an early pregnancy, says Dr. Kate White, OB-GYN and associate professor of OB-GYN at Boston University School of Medicine. The specific medications you use are mifepristone and misoprostol.

When you take these pills, the pregnancy sac detaches from the walls of the uterus. After this, bleeding and cramping causes any pregnancy tissue to empty out of the uterus, White says.

Mifepristone and misoprostol are very effective at ending pregnancies. However, your chances depend on how far along in the pregnancy you are.

• If you're eight weeks pregnant or less, a medical abortion is 94% to 98% effective
• If you're eight to nine weeks pregnant, a medical abortion is 94% to 96% effective
• If you're nine to 10 weeks pregnant, a medical abortion is 91% to 93% effective

White says if you are past nine weeks, you might need to take an extra dose of the second medication, misoprostol, to ensure that the process is successful. If you're nine to 10 weeks pregnant and take an additional dose, there's a 99% success rate.

While the FDA approved the medical abortion for up to 10 weeks of pregnancy, some people may have one slightly later. If you're 10 to 11 weeks pregnant, the success rate of an at-home abortion is 87%. However, if you take an extra dose, your chances rise to 98%.

If a second dose still doesn't completely end the pregnancy, an in-clinic abortion is necessary.

Note: Some fetuses have a protein called Rhesus (Rh) in their blood. If the fetus does have this protein and the mother does not, it could cause complications in a future pregnancy. For this reason, doctors recommend that you get tested for this if you are more than 8 weeks pregnant and considering an at-home abortion. You can get a shot that will minimize the risk to future pregnancies.

How to get abortion medication

Depending on your individual circumstances, there are two ways to obtain mifepristone and misoprostol for an at-home abortion.

White says you can go through a doctor or clinic and receive the medications in-office, where you will likely swallow the first pill (mifepristone) and bring the second medication (misoprostol) home with you to complete the process.

Alternatively, in more difficult situations where you don't live by a clinic or it isn't legal in your state, White says you can order these medications online, and they'll ship to you. From there, you follow the same instructions that you would if you were to go through the medical system.

A step-by-step guide to an at-home abortion

It's important to follow the correct steps in order to ensure your at-home abortion goes smoothly.

1. Take mifepristone

First, you take mifepristone, which is a progesterone antagonist, meaning it blocks the hormone progesterone, says Dr. Stacey Leigh Rubin, an OB-GYN who specializes in complex family planning and advocacy at the DuPont Clinic.

This helps start the abortion process since progesterone is necessary for a pregnancy to grow and thrive, Rubin says.

While this medication works, you aren't likely to feel any major changes in your body. "People often don't feel any effects of this first medication, though spotting or light bleeding may begin that day," White says.

2. Prepare to take misoprostol

Since misoprostol causes cramping and bleeding, you you want to make sure you have:

• A supply of sanitary napkins or reusable period pads on hand to manage the bleeding. "Tampons or menstrual cups are not recommended during this time, as the blood needs to flow freely from your body to prevent infection," White says.
• An over-the-counter pain reliever like ibuprofen or acetaminophen, which you can take prior to misoprostol to help with some of the pain that comes along with cramping.

3. Take misoprostol

Misoprostol is the second medication, which you typically take around 24 to 48 hours after ingesting mifepristone.

Rather than simply swallowing pills, misoprostol is best absorbed by letting the pills dissolve and pass through mucous membranes. You let the pills dissolve. Rubin says there are three ways to take it:

• Buccal: You place the pills between the cheeks and the gums
• Sublingual: You place the pills under the tongue
• Vaginally: You insert the pills into the vagina

Misoprostol causes uterine contractions and bleeding, allowing the pregnancy tissue to expel out of the uterus, and ultimately through the vagina, says Rubin.

4. Manage bleeding

As soon as one hour after taking misoprostol, you will experience intense cramping and heavy bleeding including clots, which signals the pregnanct tissue passing. In most cases, the pregnancy tissue will pass after four or five hours, and you can expect the worst of the cramping and bleeding to last a maximum of six hours, subsiding after the pregnancy has passed, Rubin says.

On top of cramping and bleeding, you may also experience symptoms, including:

• Diarrhea
• Dizziness
• Low-grade fever
• Nausea
• Vomiting
• Fatigue

During this process, there are a few things that can make you feel a bit more comfortable. White recommends:

• Staying nearby a bathroom for easy access
• Taking a hot shower or bath
• Using a heating pad or hot water bottle on your abdomen

When to seek immediate medical attention

Medication abortions at home are safe, but it's important to monitor yourself for any complications. Rubin says red flags to look out for are:

• Heavy bleeding, including clots for over six hours after taking the second medication (especially if clots are bigger than a golf ball).
• Soaking through an entire pad every half hour for more than two hours at any point after taking the second medication.
• A fever or GI issues over 24 hours after taking misoprostol, which could be a sign of infection.

In these cases, you should seek immediate medical attention.

Abortion aftercare instructions

During the first few days after the abortion, cramping will ease up and bleeding will slow down. White says it's normal to bleed over the next couple of weeks, with less and less bleeding as time goes on.

After two weeks have passed, you should take a pregnancy test to confrim that you are no longer pregnant.

Since everyone's body is different, there's a wide range of what's "normal" after an abortion. Rubin says this can range from very light spotting to more period-like bleeding throughout this time.

Avoid exerting yourself in the couple of days after your abortion, since this can cause more cramps and bleeding. You should abstain from strenuous exercise for a week.

Remember that it's completely normal to feel a wide range of emotions after an abortion. Confiding in a trusted loved one and seeking support during this time can be very comforting.

Additionally, you can ovulate within two weeks of an abortion, which means you can get pregnant again if you have unprotected sex. If you do not want to get pregnant again, Rubin recommends starting some form of birth control ASAP.

At-home abortion takeaway

An at-home or medical abortion involves taking two medications, mifepristone and misoprostol, to end a pregnancy and expel the contents of the uterus. This is a safe and effective option if you do not want to be pregnant and would prefer to avoid a surgical abortion.

Be sure to carefully follow instructions and monitor yourself during and after the abortion to ensure there are no complications. If at any point you notice red flags, do not hesitate to seek medical attention.