By Dr. Jonathan Scrafford, MD, Ob/Gyn Via Christi Health, Wichita
Abortion is often regretted by the parents who choose it as well as the physicians who perform it. While various ministries serve the needs of those affected by that regret long after an abortion, there has until recent years been little help available for women who experience regret soon after beginning a medical abortion process, but before it has completed.
This is an important population to minister to, as one of the most commonly used medical abortion protocols – which involves administration of mifepristone followed later by misoprostol – entails a 24-72 hour window during which a woman may regret the decision and desperately seek to save her baby.
Abortion Pill Reversal (APR) is a medical protocol increasingly available throughout the United States which offers hope to such women.
The hormone progesterone serves many important functions in reproductive health. During an early pregnancy, progesterone facilitates the healthy attachment to the uterus of the trophoblast, the tissue which nourishes an early pregnancy and later forms the placenta.
Mifepristone, the medication which starts a medical abortion in the FDA protocol, competes on a molecular level with progesterone to prevent progesterone from having those effects in the uterus: this diminishes oxygen and nutrient delivery to the early embryo. While mifepristone is therefore very effective in ending the life of an embryo, that process often takes a few days, and usually the uterus does not expel the pregnancy in the meantime. Therefore, the medical abortion protocol uses misoprostol, a medication typically taken 1-3 days after mifepristone: that medication leads to strong and irreversible uterine contractions to expel a pregnancy.
Typically, the amount of progesterone naturally produced during early pregnancy is insufficient to compete on a molecular level with mifepristone. However, if after taking mifepristone a woman were to take very high doses of progesterone, then in theory the progesterone could outnumber the mifepristone molecules so as to ensure the healthy development of the embryo.
If progesterone supplementation were continued until mifepristone had cleared from the body and the placenta had formed sufficiently to maintain high sustained progesterone levels, then pregnancy would be expected to develop normally. This type of progesterone supplementation is the cornerstone of the APR protocol.
Such a protocol is considered controversial in the field of women’s health. Until recently, there was minimal research on the safety of such a protocol: many physicians have expressed concerns over the long-term health of pregnancies affected by mifepristone in early pregnancy. Additionally, there has been even less research on whether the protocol would successfully reverse the abortion process for women willing to take such a risk.
Safe and Effective
Earlier this year, Dr. George Delgado and a team of researchers published the results of the largest clinical study yet on abortion pill reversal. Over 500 women completed the study by initiating the progesterone supplementation protocol within 72 hours of taking mifepristone (but before taking misoprostol) and following up long enough to record the pregnancy outcomes. Overall, 48% of the pregnancies were successfully saved; the protocol was even more effective (up to 77%) among women undergoing the protocol in the late first trimester.
Considering that a woman would have otherwise had virtually no hope of reversing the process otherwise, these are astonishingly high rates of success. The rate of birth defects was 2.7%, essentially the same as the 3% rate of birth defects in the general population, so the study suggested that the protocol did not increase the risk of harm to babies born after APR.
Similarly, the rate of preterm delivery was even lower than that in the general population (2.7% compared to 10%). In the largest trial on the topic to date, this data offers very reassuring insight into the safety and efficacy of the APR protocol.
How You Can Help
Medical abortion has come to be thought of as a single irreversible process, and it is true that some medical abortion protocols are beginning to eliminate the gap in time between giving mifepristone (which is reversible) and misoprostol (which appears to be irreversible). However, for the time being, most women who regret the decision to begin a medical abortion still have a narrow window of opportunity to reverse it: the APR protocol must be started within 72 hours of taking the mifepristone and is more effective the sooner it is started.
Pregnancy resource centers, pro-life advocacy groups, and friends and family of such women should be prepared to direct them to the Abortion Pill Reversal Network, which can be reached at: www.abortionpillreversal.com, which is the first result when “abortion pill reversal” is searched on a search engine. Support is available 24/7 on the website, and the network can connect a woman within minutes to a physician who can start her on progesterone within minutes or hours, depending on her location. 877-558-0333. This is a 24/7 hotline where the network can also immediately connect a woman with a provider to start the progesterone protocol.
If a pro-life advocate is aware of a woman contemplating an abortion, informing her of these resources ahead of time might aid her later on if she does decide to begin the medical abortion process but goes on to regret the decision. There are several physicians in Kansas affiliated with the Abortion Pill Reversal network, and because a provider’s prescriptive authority is backed by his or her state medical license, the protocol can be started virtually anywhere in the state as soon as the provider can call or electronically submit a prescription to a local pharmacy.
Conclusion Abortion Pill Reversal is a protocol which utilizes progesterone supplementation within 72 hours of administration of mifepristone, to reverse the abortion process. It is a safe and effective option which should be discussed with who are considering an abortion or who experience regret after initiating one.
Study citation: Delgado et al. “A case series detailing the successful reversal of the effects of mifepristone using progesterone.” Issues in Law & Medicine. Vol 33, No 1. 2018.
Editor’s note. This appears in the current newsletter of Kansans for Life and is reposted with permission.