Microsoft word - mife aftercare.doc

Whole Woman's Health of Austin
Transforming healthcare one woman at a time Take-Home Instructions for Mifepristone Abortion

Administering the Misoprostol Pills
A small percentage of women may pass the pregnancy after taking the Mifepristone pills, before they've taken the Misoprostol pills. If this occurs, you should still use the Misoprostol pills as instructed. You will receive the Misoprostol ("my so pros tul") pills today. In 6-48 hours from the time you take the Mifeprex in our office, you need to take the Misoprostol pills by putting them in your mouth, between your cheek and your gums. Plan to take the pills during normal business hours (8 am-5pm any day of the week) so we are immediately available if you have problems after using them. Once you have held the Misoprostol in your mouth for half an hour, you may swallow any undissolved pills with water. Misoprostol Day: _________________ Date: ___________________ Time: ___________ Because of the risk of hemorrhage, on the day that you take the Misoprostol pills, you must: • Be at home or in the home of someone who knows what is happening, • Have a phone, • Be within one hour of an emergency room, • Have no other obligations including small children to care for, • Have with you, or "on call," a support person who knows what is happening and who has a car.
You may have some bleeding or spotting - it may be somewhat heavy - after taking the Mifeprex only.
Do not be alarmed. IF you do experience bleeding, this is not necessarily an indication that the
pregnancy had ended. It is still VERY IMPORTANT that you take the Misoprostol tablets. Continue as
scheduled with the medication and follow-up appointments. This is not an emergency. You may call
the office during regular business hours to speak with a nurse if you need to.
Sixty-seven percent (67%) of women begin having cramps and bleeding within 1 to 4 hours after
they have taken the Misoprostol pills. Seventy-five percent (75%) of women will have miscarried
within 24 hours.
1st day
6-48 hours later
7th-10th day
Begin the antibiotics as directed. Please plan to take them during normal business hours so we are NOT occurred, you may need here in case you have problems. more Misoprostol pills and The miscarriage usually begins Whole Woman's Health of Austin
Transforming healthcare one woman at a time
Preventing Infection
During a medical abortion, your cervix is slightly dilated, so you need to be particularly careful not to
expose yourself to infection by introducing bacteria into the vagina. Do not put anything into your
vagina, have sexual intercourse, or sit in a bath until your final follow up at the clinic. Use maxi pads
instead of tampons.
The physician will prescribe some antibiotics for you to start taking preventatively once you take the
Mifeprex pill. We recommend taking antibiotics with something in your stomach to prevent nausea.
Take these antibiotics exactly as directed by the physician, and please call us if you experience any
signs of infection.
Take your temperature every day at home. It is normal to see a little rise in body temperature after
you take the medications, but a high temperature (over 100.4 degrees) is not normal. Call Whole
Woman's Health, as this could be a sign of infection or other serious problems that require treatment.

Managing the Possible Side Effects of Misoprostol
Drink plenty of fluids and eat lightly the day before and on the day you take the Misoprostol pills.
Misoprostol may cause nausea, vomiting, and diarrhea, and fever, so you need fluids. Spicy or fried
foods worsen the distress. If you are concerned about nausea, our physician can prescribe a
medication to help manage nausea. If the vomiting and diarrhea are severe, call Whole Woman's
Health.
Cramping
Very strong cramping is a normal part of the process. Start the pain pills we prescribed 30 minutes
before the Misoprostol insertion. Take up to 2 pills every 3 hours for pain relief. Heating pads are ok
and can help with cramping. You may also take Tylenol or 600-800mg ibuprofen every 4 hours in
addition to the pain pills. Taking ibuprofen without food can irritate your stomach.
Bleeding and Clots
The bleeding may be very heavy, and you will pass small or large clots (up to and including the size of
lemons) within the first four hours, which is OK. Also at 42 days, the embryo is so small (about the
size of a grain of rice), it may not be visible.
Wear "heavy protection" maxi pads, and buy a large package (Stayfree, Always, and Kotex "Super
Long" or "Overnight"). Call Whole Woman's Health if you soak through 2 pads per hour for 2 hours.
That's too much bleeding! After aborting the pregnancy, lighter bleeding usually occurs and lasts
about 9 to 14 days (on average) but may end sooner or continue off and on for 4 weeks.
DOs and DON'Ts
• Do NOT use tampons until after your final clinic appointment. Tampons will block the passage of the clots and tissue and worsen the cramping. They also may expose you to infection by introducing bacteria into the vagina while the cervix is dilated. • Do NOT have sexual intercourse or douche until after your final appointment to avoid infection and pregnancy. Do not put anything at all in your vagina-your fingers, sex toys, etc. • Do NOT drink alcohol or take aspirin or aspirin products: they thin the blood and cause too • Misoprostol can cause a rise in your temperature, call Whole Woman's Health if your temperature is over 100.4 degrees for more than 6 hours (there may be an infection). Whole Woman's Health of Austin
Transforming healthcare one woman at a time Follow-up with Ultrasound
It is important that you have a follow up exam 7 to 10 days after you have taken the Misoprostol and
had your bleeding. We will do an ultrasound to check that the abortion was successful and that there
isn't anything left behind in the uterus. Sometimes women need to take a second dose of Misoprostol,
other times a surgical procedure is necessary. The follow up is the time when we can check to make
sure that everything is back to normal, that you don't have any infections and that the abortion was
successful. This is also a good time to discuss contraception and your ongoing GYN care.
There is no fee for the post operative exam. However, there will be a fee of $30.00 if you do not get in
for your appointment within 30 days of the procedure. If you request or require any additional
services, such as lab testing, there may be additional charges. Some women experience a yellowish-
brownish discharge for several weeks after the procedure. If this discharge is accompanied by itching,
burning or bad odor it may be vaginitis which needs to be diagnosed and treated. This can be done at
your follow-up visit for $20.00.
Follow-up day: _____________________ Date: ___________________ Time: ________
Whether or not you had heavy bleeding, passed clots, and had strong cramps,
RETURN TO WHOLE WOMAN'S HEALTH ON THE DAY OF YOUR SECOND
APPOINMENT FOR YOUR ULTRASOUND. If you don't return, the pregnancy could
still be growing without your knowing it, or you could have a twin tubal pregnancy!
Even if you are still bleeding, keep your second appointment at Whole Woman's
Health.
Pregnancy and Contraception
There is no way to know when you will ovulate after your abortion, so it is possible to become
pregnant at any time. A reliable method of contraception is recommended when you resume
intercourse to prevent another unwanted pregnancy. Unwanted pregnancies occur for many reasons.
The most common are failure of contraceptive method, failure of a couple to use contraceptives, or an
unfortunate lack of knowledge about birth control. If sexual intercourse is practiced without the use of
contraception there is an 80% probability that pregnancy will occur within a year. We are happy to
help you with making a choice of method and giving you samples if possible.
Feelings
After an abortion some women feel elated and relieved while others feel sad. It is best not to ignore
your feelings, but to talk about them with someone you trust. If your feelings become overwhelming
for you, you may need professional help. We are happy to provide post abortion discussion and/or
referrals. Please call our office anytime. We also recommend the following books, which have proven
to help many women in your same situation. (Some of these books are for sale here - please ask a staff
person)
The Healing Choice, Your Guide to Emotional Recovery After an Abortion, by Candace De Puy and Dana Dovitch. Peace After Abortion, by Ava Torre-Bueno Unspeakable Losses, Understanding the Experience of Pregnancy Loss, Miscarriage and Abortion, by Kim Kluger-Bell. If you need to talk with someone after the abortion, there are several places we recommend: Backline, honest pregnancy options discussion and information: (888) 493-0092 Gianna Viola, LMSW-ACP: (512) 585-4518 Polly Brannen, LMSW-ACP: (512) 329-6699 Exhale, an after-abortion counseling talkline: (866) 439-4253 Whole Woman's Health of Austin
Transforming healthcare one woman at a time To Emergency Room Health Care Professionals: This woman is a patient at Whole Woman's Health of Austin. This patient is taking a combined regimen of Mifeprex (Mifepristone) and Cytotec (Misoprostol). These medications were given to induce a medical termination of pregnancy. At the time she was administered the Mifeprex, she was given a prescription for prophylactic antibiotics and instructed to start them immediately. She will be seen for follow up in approximately 7-10 days. Please call our office at (512) 250-1005 or (800) 282-1005 before initiating any treatment, unless the patient is medically unstable and is felt to require hospitalization. We are committed to handling complications free of charge in our office. There is a physician on call for Whole Woman's Health 24 hours a day, 7 days a week. Thank you for your assistance in this matter. Juliana Gonzales, Executive Director Robert Hanson, MD, FACOG Medical Director

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