Now that abortion rights in many states are firmly in danger thanks to the Supreme Court's overturning of Roe v. Wade, equitable access to fair and safe reproductive healthcare is of utmost importance around the country. Should you find yourself with an unwanted pregnancy, you might be wondering what your options are, especially if you're a resident of one of the 15 states that now have bans or severe restrictions on abortions.
Thankfully, you have options, especially since abortion pills are protected in all states due to the Constitution's Supremacy Clause, which means you can access abortion medication no matter where you live. That said, you might not know the nitty-gritty of how these medications work to safely terminate a pregnancy. Fear not — we're breaking it all down for you with the help of a reproductive health expert.
What is Plan C?
Put quite simply, when it comes to preventing pregnancy, "plan A" refers to your standard contraceptive options (condoms, hormonal birth control, etc.). "Plan B" refers to the emergency contraceptive medication by the same name, which works within a limited timeframe after unprotected sex if your birth control method fails or isn't used. And "plan C" refers to an abortion medication (aka medical abortion or abortion pills).
Unlike Plan B, Plan C is merely a colloquial term for abortion pills, and it's a safe, effective, FDA-approved way to end a pregnancy through the 10-week mark. It's common for Plan C to refer to two different medications — mifepristone and misoprostol — which are used in tandem to terminate an early pregnancy.
Per the Mayo Clinic, patients can start the medication abortion process in their provider's office or at home, and it doesn't usually require any surgery or anesthesia. The main benefit of a medical abortion is being able to remain comfortable at home, as opposed to a surgical abortion, which might require mild sedation, local numbing, or general anesthesia when you're fully asleep during the procedure.
A person might choose surgical abortion for a few reasons: If someone is too far along in their pregnancy for medication abortion, if medical abortion fails, or if they prefer a fully in-office procedure. That said, medication abortion before the nine-week mark is 99.6% effective, with a 0.4% risk of major complications and an associated mortality rate of less than 0.001 percent (0.00064%), making it incredibly safe and effective for the vast majority of early pregnancies.
How does medication abortion work?
Mifepristone and misoprostol work very differently from each other, so it's important to understand the difference, as Lynae Brayboy, MD, FACOG, a reproductive specialist and Clue's chief medical officer, tells Scary Mommy. "Mifepristone, an oral medication, works by blocking a hormone called progesterone," says Brayboy. "Progesterone is necessary for the development of a pregnancy. Then, typically 24 to 48 hours later, you would take a different pill called misoprostol, but this time instead of swallowing it, you would put the small pills between your gums and your cheeks so they could dissolve there. Depending on where you live, misoprostol may also be put in the vagina or under the tongue. Misoprostol works to end a pregnancy because it is something called a synthetic prostaglandin, a chemical that the body makes naturally when you have period cramps. Misoprostol causes the cervix to become softer and the uterus to contract and then push pregnancy tissue out."
This two-part process might also be used for those experiencing early pregnancy loss/miscarriage, but have not passed the pregnancy naturally, adds Brayboy, noting that sometimes misoprostol is also used to help initiate labor in birthing people. Mifepristone can be taken on its own to induce abortion, but it's markedly more effective when used in tandem with misoprostol.
Though it's confusing, emergency contraceptive drugs like Plan B and Ella work completely differently and cannot be substituted as a medication abortion, says Brayboy. Thankfully, medication abortion does not seem to have the same weight limits that Plan B does, making it a solid option for patients in larger bodies, too.
What can you expect during a medical abortion?
The medication abortion process happens over the span of two or three days, and you should expect some side effects, including pain, cramping, and bleeding, says Brayboy. "Your healthcare provider may tell you to expect nausea, vomiting, cramping, pain, and heavier bleeding, but you should always refer to the patient instructions and/or guidance given to you by your healthcare provider. Often, healthcare providers will give their clients and patients other medications to help with pain and nausea." You might also receive a course of antibiotics to prevent infection.
If at any point you are concerned about your level of pain or blood loss (or any other concerns, really), you'll want to check in with your doctor, who can rule out anything serious. Even if it all goes smoothly, "It is important for anyone having a medication abortion to follow up with the healthcare provider who prescribed it to them," says Brayboy. "Often, your healthcare provider may do an ultrasound to make sure the pregnancy is not there, along with a pregnancy test to ensure the pregnancy hormone is negative. But it is always best to check with your healthcare provider about this because some clinics will simply ask a series of questions to determine if the medication abortion was successful. Follow your healthcare provider's instructions about when to call regarding medical attention."
You should also not take abortion pills if you have an intrauterine device (IUD) in place, as you will need to have it removed prior to starting the medication. If you're having symptoms of an ectopic pregnancy or have other blood-related conditions, such as anemia, your doctor will guide you toward the best abortion option for you.
Generally speaking, though, you'll want to call a doctor ASAP for heavy bleeding and/or large blood clots (soaking through two pads an hour for two hours or more), fever, vomiting and/or diarrhea, or severe, sharp pains in your stomach and/or back. Abortion-related complications are rare, affecting about 2% of patients in total, but it's worth knowing the signs in case you feel something's not right.
What about after it's over?
Brayboy emphasizes that after the medication abortion process is over, "ovarian function typically returns very quickly, even before your period returns, so it is important to think about what you would like to use for contraception and what works best for you and your lifestyle." You might notice period-like bleeding for up to four weeks afterward, but you can generally go back to your normal activities (including sex) as soon as you feel ready.
"Many people with periods are often scared into the incorrect thinking that abortion can prevent them from having a pregnancy in the future," she adds. "Medical abortion is very safe and does not impact your future ability to have children when you want them."
If you'd like to find out how to access Plan C, you can visit plancpills.org or plannedparenthooddirect.org, both of which will provide information about how you can talk to a provider virtually or in person, depending on the state you reside in. No matter what, you're not alone in the process — shame-free resources and support are available to you, and you have every right to access them whenever you need them.