Early Options: Challenges Specific to Medical Abortion Counseling

Early Options - A Provider's Guide to Medical Abortion

This page contains the following sections:

Why Women Choose Medical Abortion
Acknowledgement of the Procedure as an Abortion
Follow-up and Surgical Backup

After reading this page, you should be able to answer the following question:
What are the challenges specific to medical abortion counseling?

While there are many areas of overlap, counseling for medical abortion and for vacuum aspiration is not identical. Medical abortion allows for a much greater degree of patient autonomy. Many medical abortion patients will expel the pregnancy at home, so they have to know what to expect and what symptoms and side effects are considered normal. Providers can help the patient assess her feelings related to passing clots and pregnancy tissue. (This is discussed later in the module.) Patients also need to know what symptoms and side effects should prompt a call for advice and assistance.

Why Women Choose Medical Abortion
When asked why they chose medical abortion, many women cite their desire to avoid surgery. This noninvasive feature is often a major

After reading this section, you should be able to answer the following question:
What are common reasons women choose medical abortion?

factor in the decision-making process. Some women prefer medical abortion to vacuum aspiration because they perceive the method to be better, easier, or more natural ("like a miscarriage"), or because it may be available earlier in pregnancy.^9,10

Some women may also choose medical abortion because they feel it allows them more control. In the case presentation for this module, you will note that the patient describes medical abortion as "more natural" and "easier."

Although there are a number of reasons that a woman might choose medical abortion, our current understanding of women's actual preferences and rationales may be affected by the types of studies used to measure perceptions. For example, Wiebe⁵ presented women with a list of possible reasons for choosing medical abortion; the majority of women rated privacy as very important.

Creinin and Burke⁹ adopted a different survey approach. They posed open-ended questions about reasons for choosing medical abortion. In this case, only 1.4% alluded to "more privacy and control" as a rationale for selecting this method.

Click here to check your understanding.

Acknowledgement of the Procedure as an Abortion
Some women may not acknowledge the medical abortion process as an abortion. They may refer to the experience as a "miscarriage." For example, the woman presented in the case study towards the end of this module cites the similarity of medical abortion to a miscarriage as one of her reasons for wanting this procedure. When a patient's comments suggest that she may not view medical abortion as an abortion, the provider should explore issues such as (1) the quality of her coping and her acceptance of the decision to terminate the pregnancy, (2) the extent of her understanding of the process, and (3) her willingness to follow through with the protocol.

Follow-up and Surgical Backup
Follow-up is necessary after administration of the medications to ensure completion of the abortion. In addition, patients need to recognize that the choice of medical abortion does not absolutely rule out the possible need to undergo a vacuum aspiration. These two counseling issues are directly related.

Because the medications used in medical abortion are associated with a risk of birth defects, follow-up will determine whether or not the pregnancy is still growing and therefore whether vacuum aspiration is required.

Click here to check your understanding.

Proceed to The Decision-Making Process.

References for this module