Medication Abortion Consent Form
What is medication abortion?
A medication abortion uses two medicines to end your pregnancy.
- Mifepristone is the first medicine – it starts the abortion process. Your pregnancy needs a hormone called progesterone to grow normally. Mifepristone blocks your body’s progesterone.
- The second medicine, misoprostol, opens the opening to your uterus (cervix) and makes your uterus contract in order to expel or push out the pregnancy.
What are the benefits of the medication abortion?
It is a safe and effective way to end a pregnancy. It can be done in the privacy of your home and does not require a pelvic exam.
How well does medication abortion work?
Medication abortion works over 95% of the time. Medication abortion is more effective after nine weeks when two doses of misoprostol are used. 5% of people who use medication abortion will need further treatment to end the pregnancy or manage complications or side effects.
Purpose: I understand that the purpose of abortion is to terminate a pregnancy.
Risks of Medication Abortion: Medication abortion is safe, but there are risks with any medical procedure. I understand these risks may include:
· Continuing pregnancy: In some cases, the pregnancy does not end after taking the medications. Because misoprostol can cause birth defects, if this happens you may need to take more medicine or have a procedure (called a “D&C” or “aspiration abortion”) to complete the abortion.
· Incomplete abortion: Some of the pregnancy tissue or the pregnancy may be left inside your uterus. This may lead to heavy bleeding, infection, or both. If this happens, you may need a procedure, other tests, or treatments.
· Hemorrhage: You may have too much bleeding or bleed for too long. If this happens, we may recommend medicine, a procedure, or, rarely, a blood transfusion or surgery to remove the uterus (hysterectomy).
· Infection: The infection rate from medication abortion is less than 1%. Antibiotics are used to treat the infection, and, rarely, a suction procedure.
· Allergic reaction: While rare, some people are allergic to the medicines used.
· Death: Death from medication abortion is very rare. The risk of death from childbirth is about ten times greater.
Side Effects of Medication Abortion: Side effects usually do not last long. They usually need little or no treatment. I understand the following:
· Cramping: This is normal and is supposed to happen. Cramping is usually worst when the pregnancy is passing. Milder cramps may last for a few days. If you are having pain in your belly that is unrelieved by pain medication more than 24 hours after taking misoprostol, please contact us 520-210-8300.
· Bleeding: This is also normal and is part of the abortion process. Bleeding is usually heaviest when the pregnancy is passing. You should call us if you are soaking 2 pads an hour for more than 2 hours in a row. You may bleed or spot for 4 to 6 weeks after the abortion.
· Fever/chills: The misoprostol can make you feel as if you have a fever. We recommend you do not take your temperature for the first 24 hours. Having a temperature of 99-100°F is okay. If you have a fever greater than 100.4°F more than 24 hours after taking the misoprostol, please call us 520-210-8300.
· Other side effects: It is common to have diarrhea, nausea, vomiting, headache, dizziness, back pain, and tiredness. These should go away 24 hours after taking misoprostol. If you are still having these symptoms more than 24 hours after taking misoprostol, please contact us 520-210-8300.
Options: I understand with pregnancy there are three options to think about - abortion, adoption, and parenting. I understand there are two ways to have an abortion, medication abortion, and an abortion procedure. I understand I can talk to the staff about all of these options to help make my decision.
What else do I need to know?
It is important to follow up after a medication abortion to ensure that the abortion is complete and that you are doing well. You may have a follow-up with a blood test or ultrasound in a week, or you may have a phone follow-up after the abortion. Do not take a home pregnancy test until at least four to six weeks after your medication abortion, as the hormones that can cause a “positive” result may remain in your body for a long time. If your provider recommends follow-up with a home pregnancy test, please follow their instructions. If after taking the medications you have no bleeding or cramping, or you are still experiencing pregnancy symptoms, please call us right away.
What if I have concerns or questions?
I have been given the contact information, and I agree to get in touch if I have any questions or concerns.
I have read and understand the information provided to me about medication abortion.
All information I have provided is true and correct and I acknowledge that the provider and their staff have relied on such information.
I give my consent voluntarily. No one is forcing me to make this decision. I am aware that I may have a copy of this information at my request.
All my questions have been answered to my satisfaction.