That company, and others serving patients at 11 or 12 weeks’ gestation, can legally use medical discretion to do so because studies suggest that abortion pills are safe and effective at that stage. The World Health Organization supports medication abortion through 12 weeks’ gestation.
Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, said that late in the first trimester, medication abortion is safe and effective, but that there’s “a somewhat higher risk of some complications, including heavy bleeding,” and an additional dose of misoprostol is often needed to fully expel the tissue.
Some services, including Abortion Telemedicine, automatically send a second round of the four misoprostol tablets for patients undergoing late first-trimester abortions.
Reproductive health experts said patients should be advised that, while earlier in pregnancy, expelled tissue resembles a heavy period, after 10 weeks, it can appear more fetus-like. Dr. Abigail R.A. Aiken, an associate professor at the University of Texas, Austin, who leads a medication-abortion research group, said preparing patients for what the tissue might look like could also help them guard against legal risk in states banning abortion — for example, in a situation where a patient is surprised by what they see and “then is disclosing that to someone who’s like ‘Well, I’m going to report you.’”
Joann, 23, a single mother, was already 10 weeks pregnant when she decided to abort, so she contacted Abortion Telemedicine. She said she initially planned to carry her pregnancy to term, but then her 3-year-old son was diagnosed with autism and her employer, the U.S. military, decided to transfer her to another state. Joann, who asked to be identified only by her first name to protect her privacy, was in Colorado at the time, where abortion is legal, but her community was conservative.
The service’s nurse practitioner told her that since she’d be taking the pills after 10 weeks’ gestation, she should expect more pain and bleeding, and counseled that the expelled tissue might resemble a fetus “so that I would be prepared for it,” Joann said.