By: Ryan Mills – nationalreview.com –
Dr. Christina Francis was working in the labor and delivery unit of a Fort Wayne, Ind., hospital a couple of years ago when a sick young woman arrived in the emergency room.
The woman, in her 20s, had heavy vaginal bleeding, said Francis, an obstetrician-gynecologist. Her labs were abnormal, she showed signs of having an infection in her uterus, and she appeared to be in the early stages of acute kidney injury.
The woman, who arrived in the ER with a child, explained the situation to Francis: pregnant and desperate, she’d gone online and ordered a regimen of abortion pills. The website she ordered the pills from told her they would arrive in three to four weeks from India. She had not been given a thorough evaluation. She hadn’t been counseled about the risks involved with the pills. She didn’t even know the name of the drug she’d taken, Francis told NATIONAL REVIEW.
The woman needed a D&C, dilation and curettage surgery to empty her uterus. Francis had to call in a backup physician to handle another emergency back in the labor and delivery unit.
The woman survived, but Francis said her case highlights many of the problems with the increasing use of abortion pills: They’re often dispensed, in many cases online, without proper evaluations or counseling. The women who take the pills, often shocked by the bleeding and pain they experience, head to local emergency rooms for treatment. In some cases, they experience serious, and sometimes life-threatening, complications. And they often don’t receive proper follow-up care, and in the case of many online pill providers, any follow-up care at all.
“When I was in my medical training, I feel like we had it drilled into our heads that when you treat a patient, when you give a patient a drug, when you do surgery on a patient, when they’re your patient they’re your responsibility,” Francis said. “And we just don’t see that sense of responsibility from most providers of abortion, and certainly from a website that gives them no continuing care and no support from the medical system whatsoever.”
Francis is the CEO of the American Association of Pro-Life Obstetricians and Gynecologists, one of the plaintiffs in an ongoing federal lawsuit challenging the U.S. Food and Drug Administration’s approval of the two-drug abortion-pill regimen in 2000.
Last month, a federal judge in Texas overturned the FDA’s approval of mifepristone. Days later, a Fifth Circuit appeals court panel voted to temporarily restore access to the drug, but also to put a hold on more recent changes the FDA has made to make the drug easier to obtain, including limiting necessary doctor visits and allowing the pills to be
dispensed through the mail. The Biden administration immediately appealed, and in late April, the Supreme Court issued a stay in the case, keeping the pills on the market for now, and also allowing them to continue to be delivered through the mail.
A hearing on the merits before the full Fifth Circuit Court of Appeals is slated for mid May.
Francis is one of two doctors involved in the lawsuit who spoke with NATIONAL REVIEW about their experiences treating women who had complications after taking abortion-pill drugs — mifepristone, a progesterone blocker that kills the unborn child by depriving it of nutrients, and misoprostol, which causes uterine contractions to empty the uterus. Most abortions in the U.S. are now done with pills, though the pills don’t always work.
Francis and Dr. Ingrid Skop, a Texas-based obstetrician-gynecologist, said there is a lot of confusion around what the pills do and the potential complications. They said that women who have complications after taking the pills, or who are just surprised at the unexpected bleeding and pain they experience, often head into local emergency rooms for care, siphoning away critical medical resources. And pro-life doctors are sometimes put in the position of having to perform procedures that violate their consciences.
Francis said at least one of her pro-life colleagues had to end an unborn baby’s life to save the life of the mother after the pills the woman took didn’t complete the abortion. Francis said she hasn’t had to do that, but she said that having to perform procedures, including having to remove dead tissue from the uterus, can make her feel complicit.
“You know it was started as an elective abortion with the intent of ending that baby’s life,” she said, adding that it’s different feeling than helping a woman who had a spontaneous miscarriage. “It does feel like you are somehow participating in that procedure, even though you know you don’t have a choice because this patient that’s in front of you, you have to do what you need to do to take excellent care of her.”
Skop, vice president of the pro-life Charlotte Lozier Institute, agreed that it is “absolutely the case that those of us who don’t do abortions are cleaning up after these complications.”
Abortion-pill providers often tell women that after taking abortion pills they can expect to experience vaginal bleeding, similar to a heavy period. “No, you’ll bleed like a miscarriage,” Skop said, “because essentially that is what we’re doing.”
Pill providers, and even the FDA, insist that the pills are safe, like taking Tylenol or ibuprofen. The Fifth Circuit panel disagreed, noting that the FDA’s 2000 approval imposed a “black box” warning on mifepristone that it “may lead to death or serious injury.” The “FDA’s own documents show that mifepristone bears no resemblance to ibuprofen,” the judges wrote.
“Ibuprofen doesn’t have a black-box warning. Tylenol doesn’t have a black-box warning,” said Francis, decrying the lifting of safeguards the FDA originally established to protect women. “It really is a travesty to our patients, because they’re being sold lies about these drugs.”
Skop agreed that women aren’t getting the whole story from abortion-pill providers. “I think the misleading thing about the Tylenol, ibuprofen thing is, they think, well it’s a pill that made my [headache] go away, the [abortion] pill is going to make my pregnancy go away,” she said. “And they don’t recognize that it actually, the misoprostol puts them into labor.”
Potential complications from abortion pills include hemorrhaging, anemia, and uterine infections. In between 2 and 7 percent of cases, the abortion pills don’t complete the abortion, requiring surgery to finish the procedure and to remove dead tissue. If that tissue remains in a woman’s uterus for weeks or months, it can lead to Asherman’s syndrome, the buildup of uterine scar tissue, which can lead to future pregnancy complications or infertility.
Women who take the pills after eight weeks or so of pregnancy — the FDA has approved the pills for use through ten weeks of gestational age — can also be “totally unprepared for seeing their baby in the toilet,” Skop said.
“The lower gestational ages, I would say kind of looks like the tip of your pinky, kind of pinkish tissue,” she said. “But eight to ten weeks, they can see a baby.”
In some cases, particularly when abortion pills are ordered online, the source of the pills is unclear and it is not clear exactly what is in them. “We know that some of these companies that are dispending them are having them shipped from pharmacies overseas where there’s no quality control or anything like that,” Francis said.
Francis said the woman she encountered with the kidney infection questioned if her complications could have been due to tainted pills from India. “And I don’t know,” Francis said. “She’s certainly the only one I’ve seen with a kidney injury like that after these drugs.”
Even some abortion-pill supporters have acknowledged that pill providers often are not up-front about the pain and bleeding that women typically experience after taking the pills.
Last year, the feminist website The 19th talked to women who took abortion pills but who were “not prepared for how much pain” they would be in. One woman in California told the outlet that she was “nauseous nonstop,” spent days in bed with cramps, and took nearly two weeks to recover. Another woman, from Texas, said that “medication abortion was the most painful experience I’ve ever had in my life. I literally said to my boyfriend . . . ‘I just want to die.’”
“A lot of the content we see online tends to be about, like, ‘self-managed abortion, it’s so easy and with medication abortion, this is definitely a thing you can do,’” she told the outlet. “It is a thing you can do, but it’s also going to be a painful thing you can do.”
Because abortion-pill providers “sugarcoat it so much” and don’t always counsel women about just how much bleeding and pain they’ll experience, the women will in some cases come into the emergency room for treatment, Skop said. If that happens late at night, it can require calling in off-duty surgery teams. If it happens during the day, it can cause backups and lead to scheduled surgeries getting bumped, she said.
“There’s a ripple effect downstream to other doctors and to other patients when these emergencies come in that should be cared for by the abortion providers,” Skop said.
Earlier this year, Skop said, she treated a woman in her 20s who came into her San Antonio emergency room in the middle of the night after taking abortion pills months earlier that she’d received in California. “She had been bleeding every day for two months,” Skop said.
The woman had been in the ER a few days earlier, but they didn’t do an ultrasound. They instead gave the woman a pregnancy test, which came back negative, Skop said.
“The reason it was negative, the pregnancy tissue is dead. It’s been dead for two months. It’s no longer making hormones,” she said. “A lot of emergency-room doctors don’t understand this scenario. They knew she’d had an abortion. It should have been on their radar screen, it could be dead tissue.”
Skop said she performed a surgery to evacuate the tissue. She then called the pill provider in California to let them know about the complication. She said she questioned why they didn’t perform a surgical abortion, which is less likely to result in complications.
“And he goes, ‘We don’t offer them if we know they’re going to travel the next day. We don’t give them a surgical abortion because they might bleed on the plane.’ I’m thinking to myself, ‘Do you know what a chemical abortion does?’” Skop said, adding that the California abortionist proceeded to yell at her about the need to change Texas’s anti-
More than 5 million women have taken abortion drugs in the U.S. since the FDA approved them in 2000, and tens of thousands of them — likely hundreds of thousands — have experienced complications, according to court documents, though the FDA has gutted the requirement that prescribers report nonfatal adverse events.
Skop said one reason there aren’t a lot of public stories about abortion-pill complications is that many women are ashamed of having abortions. She said many choose not to report their complications because they believe “this is what I deserve for making this decision.” She said too many women are “suffering in silence.”
Providing women with abortion pills without proper counseling and without providing appropriate follow-up care if they have complications is “very poor care for women,” Skop said.
“I’ve seen women who go back to the abortion provider only to be given more and more doses of misoprostol. In many cases, they know it’s not worked, but they’re still kicking the can down the road,” she said. “I’ve had women come, and they’ve said, ‘I went back twice, and they gave me misoprostol twice,’ when clearly what they needed was a surgery.”
“If we profess to say we care for [women],” she said, “we need to care for them better than this.
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