Sam Wise

[Note: This is a repost from my Tumblr. The original post was published on May 3, 2022.]

This knowledge might save a life someday.

That might sound like an exaggeration, but like I mentioned in my last post, the Supreme Court’s pending decision to overturn Roe v. Wade opens the door to new state laws that will gut reproductive healthcare. Carrying dangerous pregnancies to term can be life-threatening. So can botched attempts to end the pregnancy yourself. If safe, legal abortion performed by medical professionals isn’t an option, we need to make at-home abortions safer.

Remember, in most cases the pregnant person has immunity from being prosecuted for ending their own pregnancy. While there have been notable exceptions (like Brittney Poolaw, an Oklahoma resident who was convicted of manslaughter after a miscarriage), usually anti-abortion laws target the person providing the abortion, not the person receiving it. This may change, so make sure to keep up with your own state’s laws regarding abortion. And I’m not a lawyer, so please do fact-check me.

This post includes instructions for performing an at-home, self-managed abortion. As of this post’s publication, this is something that is 100% legal. I am not encouraging you to break the law, but this is information that is important. We need to know this stuff.

Also remember that in Texas and in states that have modeled their anti-abortion policies on Texas’s, citizens can be sued for helping a pregnant person seek an abortion. (But again, the pregnant person has legal immunity.) If you live in one of these states, you should know that anyone who helps you with a self-managed abortion is vulnerable to being sued. Keep that in mind as you plan.

And obviously, if you are able to travel to another state where abortion is protected and get a clinical abortion there, I strongly encourage you to consider doing so. While the methods for self-managed abortion I’ll discuss here are very safe, it can be reassuring to know you’re in the hands of an experienced medical professional. Not everyone will be able to get an out-of-state abortion — they can be very expensive, and clinics may have long wait times. But if you have access to this option, it’s a good choice.

Now, let’s talk methods. I see people online talking about DIY abortions using fenugreek, Queen Anne’s Lace, and pennyroyal. While I can’t speak to the safety or effectiveness of any of these herbal options, I can say that there’s a safer, more effective method that’s still 100% legal in most of the US.

The easiest and safest way to have a self-managed abortion is with a medication abortion, aka “the abortion pills.” This is a very, very safe (like, statistically safer than Tylenol) and non-invasive method, and is widely prescribed by doctors to patients who want to terminate a pregnancy and is approved by the U.S. Food and Drug Administration (FDA). This method is used for more than half of abortions in the US. It is also 95-98% effective.

Medication abortion involves two pills. First, you take mifepristone, which blocks pregnancy hormones and stops the pregnancy. Then, 24 to 48 hours later, you take misoprostol, which causes the uterus to contract and the cervix to dilate — basically, it triggers labor. Typically, this causes a few hours of cramps and heavy bleeding, followed by a few days of lighter bleeding. It’s more or less a medically-induced miscarriage.

If you have access to an abortion clinic, you can get mifepristone and misoprostol there. Usually, you need a prescription for these. If you don’t live near a clinic, you may be able to get them from your doctor.

You can also get them through the mail from telehealth services, which the FDA has approved for all 50 states. This is much cheaper than a clinic visit, usually between $200 and $350 without insurance. (Unfortunately, this is banned in states like Texas. Some women in Texas get the medication sent to a friend in a state where it is legal, who then mails it to them, but there is some legal risk in this. Again, do your research.)

There are ways to get these medications without consulting a doctor, like Aid Access, a nonprofit harm reduction group that provides prescriptions from European doctors, then ships the pills from a pharmacy in India. This option is the cheapest I’ve found ($110), but it also takes the longest — up to four weeks for shipping. Thankfully though, you don’t have to be pregnant to order the pills from them. Aid Access provides the pills for medication abortions to people who may become pregnant and want to have them on hand just in case. They currently ship to all US states. (Including Texas. Don’t ask me how that works. I assume they’ve found a loophole that lets them get away with it.)

Here’s my advice to everyone, regardless of your gender, your anatomy, and the likelihood that you’ll be pregnant someday: stock up on these medications now, while it’s still legal to get them. Have some on hand, just in case you or someone you know needs them and can’t get them in the future.

Mifepristone and misoprostol have a guaranteed shelf-life of two years. They’ll still work after that, but they may not be as effective. Get some now, and keep it in a safe place at room temperatrue.

You should not use these medications if you have blood-clotting problems or if your pregnancy is ectopic, meaning it is growing outside the uterus.

So, once you have the medication, then what? Well, if your pregnancy is still in the first 13 weeks, you can have a safe self-managed abortion at home.

First, make sure you have an over-the-counter painkiller on hand. Ibuprofen is recommended. Acetaminophen and paracetamol do not work for pain caused by an abortion.

Second, take a couple of days off and prepare to take it easy during this process. Stock up on food, books, movies, and anything else that will help you in your recovery. Also stock up on maxi pads. Lots of maxi pads.

To start the process, take one 200mg pill of mifepristone with water.

After between 24 and 48 hours, place 4 misoprostol pills (200 mcg each) under your tongue and let them dissolve for 30 minutes. Do not speak or eat during these 30 minutes. After 30 minutes, wash down anything left in your mouth with some water. Go ahead and take 3 or 4 ibuprofen pills (200 mg each).

You shuld start feeling cramps within 3 hours after taking the misoprostol, and you should start to bleed within 24 hours. If you aren’t bleeding after 24 hours, take 4 more misoprostol.

Continue taking 3 or 4 ibuprofen pills every 6 hours for pain. If you need extra help with the pain, you can also take 2 Tylenol every 6 hours.

Cramping during this process may be much more painful than normal menstrual cramps, and your bleeding may be much heavier than a normal period. It’s normal to pass blood clots during the first few days. Other people have minimal cramping and light bleeding. You might even run a fever, feel nauseous, or vomit. Most people start to feel better after 24 hours.

If your pregnancy was 10 or more weeks along, you may pass something that may look like tissue. This is normal and means that things are going as planned. You can dispose of this in the toilet like you would large blood clots.

The symptoms should start to improve after a couple of days. If you feel sick, if the pain doesn’t improve after 3 days, or if you still have heavy bleeding after 2 weeks, get emergency medical care immediately. Remember, these side effects are very, very rare, but if they do happen you need to get to the ER. If you’re worried about legal prosecution for having an abortion, tell the doctors that you’re bleeding, but it doesn’t feel like a normal period. Tell them that the bleeding started suddenly and that you’re worried something is wrong.

A pregnancy test will still be positive for a couple of weeks after the pregnancy is terminated. If you still “feel pregnant” (breast tenderness, nausea, fatigue, etc.) after two weeks, see a doctor.

It’s also possible to perform abortions with just misoprostol, but this is only 85% effective. However, this method is sometimes more accessible because misoprostol is available over-the-counter in many countries, including Mexico. Medication abortion with only misoprostol is approved by the World Health Organization. You can find full instructions for this method at www.howtouseabortionpill.org.

Note that you should not use mifepristone and misoprostol if you have an IUD. Get the IUD removed first.

If you are breastfeeding, wait 4 hours after taking misoprostol before you breastfeed again.

It’s normal to feel emotional after an abortion, even if you don’t regret it. (Which, for the record, almost no one does.) You may even feel grief. This is normal, and aftercare is really important here. Be gentle with yourself.

Recommended Reading:

• https://www.howtouseabortionpill.org/, which has a great step-by-step how-to guide
• The Plan C Guide to Abortion Pills
• Brennan Center for Justice on criminalizing pregnancy outcomes
• Vox’s “The FDA made mail-order abortion pills legal. Access is still a nightmare.”
• Time’s “Hardly Any Women Regret Having an Abortion, a New Study Finds”