National Women's Health Organization

Nationwide Toll-Free 800-532-5383

Wilmington DE | Raleigh NC | Columbus GA | Jackson MS

Early Medical Abortion with RU486 / Mifepristone

Introduction

  • National Women's Health Organization facilities are licensed medical centers which specialize in reproductive health care including surgical abortions and medical abortions with RU486 / Mifepristone. The Centers maintain a friendly atmosphere with patient care monitored at a high professional level. Our physicians performing abortions are Board Certified OB-GYNs with specialized expertise in reproductive medicine. They are assisted by licensed nurses, laboratory technicians, and trained counselors. The Centers comply with State regulations and local medical standards.

    Appointments

    Call us in advance to make an appointment. The toll-free 800 number is answered Mondays through Thursdays from 8:30 am until 8:00 pm EST, Fridays 8:30 am until 7:00 pm, and Saturdays 8:00 am to 2:00 pm EST. Please bring any special problems to the attention of the phone counselor. If you have medical insurance you would like to use, please have that information when you make your appoihtment. If the appointment has to be canceled for any reason, please let us know at least a day in advance.

    The Cost

    To ensure confidentiality we do not send bills. Fees are all-inclusive and include pre- and post-tubal counseling, laboratory studies, general (asleep) anesthesia, physician's fee, and a post-op exam. Full payment must be made on the day of the tubal in the form of money orders, cashier's check, ATM Card, American Express, Mastercard, VISA, Discover, or cash. The credit card owner must be present to sign the sales receipt if a credit card is used. For collection reasons, we do not accept personal checks. We accept direct payment from many insurance companies. All other iinsurance must be verified in advance before you come for your appointment. Otherwise, full payment is due the day of your appointment. The fees below are all subject to change.

    Low-cost medical abortions with RU486 / Mifepristone (Mifeprex) are performed at these NWHO centers:

  • Columbus GA - $500
  • Raleigh NC - $500.
  • Wilmington DE - $500
  • Jackson MS - $510
    •


    About Medical Abortion with RU486 / Mifepristone

    • Protocols

    ELIGIBLE PATIENTS:

    1) Must be in overall good health, and will be advised not to proceed with Mifeprex if:
    It has been more than 49 days since her last period began.
    The patient has current severe anemia Hemoglobin < 10 (hematocrit less than 30);
    The patient currently has an intrauterine device (IUD) in place;
    The patient has a pregnancy outside of the uterus;
    The patient has contraindications to a surgical abortion;
    The patient has problems with her adrenal glands (chronic adrenal failure);
    The patient has a bleeding problem;
    The patient takes any medication to thin her blood;
    The patient takes any steroid medicines;
    The patient cannot return for the mandatory follow up visit;
    The patient cannot easily get emergency help in 2 weeks after taking Mifeprex;
    The patient is allergic to mifepristone, misoprostol

    2) must have gestation no more than 49 days from the first day of the last menstrual period (LMP) confirmed with ultrasound;
    3) must be able to give informed consent and comply with treatment requirements;
    4) must have ready access to a telephone, emergency medical care, and transportation;
    5) must have no other medical contraindications or known intolerance to either mifepristone or misoprostol.

    PRECAUTIONS:

    1) Although there are no data available on the effects of mifepristone and misoprostol while breastfeeding, it is prudent to advise patients to discontinue breastfeeding for 72 hours after the misoprostol is taken.

    COUNSELING, EDUCATION, AND INFORMED CONSENT include:

    1. Discussion of the decision to have an abortion and assurance that the decision is patient?s own;
    2. Discussion of non-surgical and surgical alternatives and the risks and benefits of each, as well as consent for surgery if and when it is recommended by the doctor;
    3. Discussion of the known side effects and possible complications of mifepristone and misoprostol; explanation that both mifepristone and misoprostol can cause serious fetal anomalies, so that once Mifeprex has been administered, the abortion must be completed either medically or surgically.
    4. Discussion of the amount of time involved, the requirement of three visits, and the failure rate of Mifeprex-induced abortions resulting in the need for surgical abortion; patients should also be advised that if the pregnancy is not fully expelled from the uterus it could cause infection or other complications.
    5. Discussion of the patient?s choice of alternative treatment of Mifprex, how the alternative treatment differs from the FDA approved regimen, and her option to choose the FDA approved regimen if she desires and meets the criteria.
    6. Discussion of the amount of pain experienced by previous patients and the use of pain medications.
    7. Thorough explanation of when the misoprostol will be inserted.
    8. Discussion of the amount of bleeding associated with the abortion process and, in particular, the size of the clots and embryo and the possibility of observing the embryo at home; also a discussion of what post medication symptoms are normal and the parameters for calling the clinic.
    9. Availability of contraception and contraceptive counseling;
    10. A review of the consent form;

    MEDICAL HISTORY AND PHYSICAL EXAMINATION
    includes a thorough medical and obstetrical history, including history of allergies and all current patient medications; pelvic examination, and pertinent physical examination base-line blood pressure.

    ULTRASOUND
    1. Trans-vaginal ultrasound and/or abdominal ultrasound should be used to confirm gestational age. Document ultrasound examination (gestational sac, embroyonic pole, presence of cardiac activity, or yolk sac) for the medical records before administering Mifeprex.
    2. As soon as the embroyonic pole is visible, use this measurement instead of gestational sac measurement.
    3. If an intrauterine sac is not present, this could indicate early intrauterine pregnancy or ectopic pregnancy (or miscarriage if patient has bleeding). If the patient is at a high risk for ectopic pregnancy, give her precautions for ectopic pregnancy signs and re-evaluate in one week. If the patient is not at a high risk for ectopic pregnancy, simply schedule the patient for a re-evaluation in one week.

    LAB WORK
    Hematocrit/Hemoglobin;
    RH factor;
    Wampole slide pregnancy test and/or early detection pregnancy test.
    Other test as medically indicated and ordered by the M.D.

    MEDICATION AND FOLLOW UP

    DAY 1:
    Mifepristone 200 mg orally (three 200-mg tablet)
    RH Immune globulin for RH negative patients.
    Provide patient with adequate analgesic information and prescription as directed by M.D.

    DAY 2:
    Patient will return to clinic 48 or 72 hours after the first visit for Misoprostol 800 mcg to be inserted vaginally by the physician.

    DAY 14:
    Obtain patient history and perform trans-vaginal ultrasound or abdominal ultrasound.
    If gestational sac is absent, treatment is completed.
    If gestational sac is still present, perform surgical aspiration.
    If gestational sac is still present without cardiac activity, follow up in approximately 3 weeks or re-administer Misoprostol.

    CONCLUSION OF TREATMENT:

    When an ultrasound confirms expulsion of the gestational sac, the abortion has been completed. The patient should receive follow up instructions to include information about expected length of bleeding, increased heavy bleeding (which may indicate an incomplete abortion), birth control counseling and prescription if desired by patient, and other pertinent medical information.

    Alternative Treatment Information

    Before reviewing this document, please read the Mifeprex Medication Guide (in the lavender booklet which will be given you) carefully. This document you are reading now describes the alternative Mifeprex medical abortion procedure we use at this facility. The alternative procedure differs from the one you read about in the Mifeprex Medication Guide. Because clinics have performed medical abortion research through clinical trials preformed across the country, scientific evidence allows the provider to alter the medication dose

    Read this information carefully before taking the Mifeprex and misoprostol. It will help you understand how the treatment works. If you wish, you may choose to follow the FDA advised regimen. Please be aware that this protocol requires an increased fee.

    ALTERNATIVE TREATMENT PLANS FOR MIFEPREX (MIFEPRISTONE)

    In research studies, other ways of using mifepristone and misoprostol for medical abortion have been shown to be equally safe and effective as the regimen advised by the Food and Drug Administration (FDA) We offer the following alternative for using Mifeprex:

    Medication Dosing Changes:
    A lower dose of 200mg of Mifeprex (one pill) will be used instead of the 600mg (three pills) dose recommended on the package. The lower dose has been shown to be equally effective and less expensive.
    The dose of misoprostol will be 800 mcg (four pills) and they are inserted high into the vagina with a finger instead of taken orally. The combination of 200 mcg of Mifeprex (mifepristone) by mouth and 800 mcg of misoprostol vaginally has been shown to:
    Cause less nausea and vomiting
    Be equally effective when used on Day 3
    Be acceptable to women
    Be equally effective at ending early pregnancy.

    I, ________________________________________ have been given information about different methods of using Mifeprex and misoprostol to end my pregnancy. I have read and understand the treatment plan described in the Medication Guide and Patient Agreement that are provided in the Mifeprex labeling approved by the FDA (Food and Drug Administration). I understand that I am required to sign the FDA approved Patient Agreement if I want Mifeprex.

    I understand the alternative option for taking Mifeprex (Mifepristone) using the described treatment plan. This alternative method has been studied extensively and found to be as safe and effective as the method approved by the FDA. My provider has answered all my questions about the different methods of taking Mifeprex and misoprostol.

    ________ My medication will be 200 mg of Mifeprex by mouth and 800 mcg of misoprostol vaginally. I will return for my second visit in 24, 48 or 72 hours as directed by the physician on my Day 1 visit. I will return for a follow up visit in two weeks after using Mifeprex.

    Based on this information, I have chosen the method that is best for me. I have indicated that choice by my initials above. I understand that my choice is a change from the method approved by the FDA as stated in the Patient Agreement required by the FDA. I hereby release __________Women?s Health Organization from any and all damages that arise as a result of the alternative treatment chosen by me today. By signing below, I consent to the treatment plan I have initialed above.

    Post Op Information


    This information is to advise you of what to expect and do after a medical abortion and also what to do should the unexpected occur. As it is true with any medical procedure however, unexpected and unavoidable complication can occur.

    You have received mifepristone, the first of two medications necessary to complete a medical abortion.

    You have been given a copy of the consent form, which describes in detail what is expected of you and what you should and should not do. We have summarized the important Do's and Don'ts on this form.

    You have chosen the alternative plan, therefore you are to return to the WHO clinic as instructed 24, 48, or 72 hours after your visit. At that time Misoprostol will be inserted vaginally by the physician. You will also be scheduled for your final follow-up visit at this time.

    EXPECTATIONS:

    Expect cramping and bleeding for the next 1 to 10 hours after insertion of misoprostol.
    Drink plenty of fluids (avoid alcohol), and eat lightly.
    Monitor your bleeding. Un-dissolved tablets can come out after you begin to bleed, however in most cases enough of the tablets have been absorbed in order for them to still be effective.

    EMERGENCY:

    It is rare to have an emergency, but important to be prepared. You should have an emergency plan including how to call us, who might drive you, and directions to our facility. CONTACT US AT the clinic Emergency number given.


    WHEN TO CALL FOR HELP:
    If you think you need emergency care because of:
    · Excessive bleeding (soaking 4 pads over 2 hours)
    · Excessive cramping or pain (not relieved by prescribed pain medication)
    · Fever of 100.4 or higher
    · Severe vomiting or diarrhea

    Call the emergency numbers before taking yourself to another physician's office or emergency room. When you call be prepared with the following information:
    Telephone number of a convenient, open pharmacy
    Your temperature within the last hour
    The number of pads you have used within the last hour.

    AFTERCARE:

    Breast Tenderness
    Any pregnancy-related breast tenderness should disappear within a few days. If you are producing a milky discharge from your breast, use an absorbent material inside a snug fitting bra. The discharge should stop in a day or two.

    Nausea
    Nausea should stop within 24-48 hours

    Fatigue
    Because of the sudden change in body hormones following an abortion, you may experience a feeling of fatigue and/or mild depression for a few days.

    Activity
    You can resume normal activity-school, work, driving, as directed. Avoid strenuous activity, such as heavy exercise, swimming, lifting, horseback riding etc. for at least two weeks.

    Sexual Intercourse
    Because of the risk of post-abortion infection, and because you may become pregnant within a few days after the abortion, you should not have intercourse until after you've had your post abortion check up.

    Contraception
    You may be able to get pregnant very soon after your abortion. We advise you not to have intercourse until after your check up.

    Diet
    You may eat whatever you like. If you have been experiencing nausea, however, you may feel better if you eat cautiously.

    Tampons or pads?
    Also because of the possibility of infection, you should use sanitary napkins rather than tampons after your abortion. Douching is not permitted until after your 14 day check up.

    YOUR CHECK-UP
    Your check-up should be scheduled 14 days from your initial visit. You will be given an exam, pregnancy test, and ultrasound to determine whether the abortion is complete. Do not hesitate to contact us and return to the clinic at any time during your care.
    Most women (90%) have completed the abortion by the date of their check-up.
    If your pregnancy has continued (about 1%), a suction abortion will be scheduled as soon as possible.
    If your pregnancy has not continued, but has not passed from your uterus (about 5%), you may either:
    a. Use a second dose of misoprostol and return for a check up in one week, or
    b. Elect to have a surgical abortion.

    A suction abortion will be scheduled if you have not passed your pregnancy within 5 weeks of your initial visit or if the doctor advises a suction abortion be performed.

    SUCTION ABORTION POSSIBILITY
    Medical abortion is over 95% effective. Some women will need a suction procedure to complete the process if the medications are not fully effective or in the event of excessive bleeding. Both mifepristone and misoprostol are likely to increase the risk of birth defects. Continuing pregnancy is NOT recommended once you have taken one or both of these medications.

    Call us immediately at the clinic if you are experiencing any problems or have any questions.

    Appointments

    Call us in advance at our national toll free number 1-800-532-5383
    or at our local clinic number to make an appointment.
    The 1-800 number is answered Monday through Friday from 8:00 am until 8:00 pm EDT
    and Saturday from 9:00 am until 1:00 pm EDT.

    Clinic Locations for RU486



    Raleigh Women's Health Organization, Inc.
    3613 Haworth Drive, Raleigh, North Carolina 27609
    919-783-0444

    Delaware Women's Health Organization
    312 Mitch Road, Wilmington, Delaware 19804
    302-992-7996

    Columbus Women's Health Organization
    3850 Rosemont Drive, Columbus GA 31904
    703-323-8363

    Jackson Women's Health Organization, Inc.
    2903 North State Street, Jackson, Mississippi 39216
    601-366-2261

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