Emergency Contraception - Plan B (The Morning-After Pill)

EC is also known as the morning-after pill. It’s a large dose of the common birth control pill and contains synthetic progestogen. EC is designed to be taken as a single dose within 72 hours after “unprotected sex.”

EC works in three ways: 1. It attempts to stop ovulation. Depending on where a woman is in her cycle, ovulation may or may not have already occurred before EC was taken. 2. It attempts to stop fertilization by impeding the transportation of the sperm to the egg. 3. It tries to stop implantation by altering (thinning) the endometrium (lining of the uterus) so the embryo cannot implant and receive nourishment from the mother.

Contrary to popular arguments, increased access to EC does not decrease the rate of pregnancies and surgical abortions.[1] In England, sexually transmitted infection rates have increased significantly since EC became widely available.[2]

The first two methods are contraceptive, but if they fail, the third method can cause an abortion because it occurs after fertilization.[3 ]

ella - Ulipristal Acetate (UPA)

Ella is a selective progesterone receptor modulator (SPRM). SPRMs block the action of the hormone progesterone, which is necessary for ovulation and implantation to occur. Progesterone also maintains the lining of the uterus and supports the embryo. Currently, the only other legal SPRM drug available in the United States is RU-486 (mifepristone). Although ella acts similarly to RU-486, it is being billed as an emergency contraceptive.[4] ella is designed to be taken as a single dose within 5 days of “unprotected sex.” It is thought to inhibit and delay ovulation, attempting to prevent fertilization. However, ovulation may or may not have already occurred before ella was taken. Ella also alters the lining of the uterus, which, if fertilization occurs, can prevent an embryo from implanting, causing an abortion.[5,6]

RU-486 - Mifeprex (The Abortion Pill)

Mifeprex blocks the action of the hormone progesterone which is needed to maintain the lining of the uterus and provides oxygen and nutrients for the baby. Without it, the baby dies. Mifeprex is used in conjunction with the drug Cytotec (misoprostol), which is taken two days after Mifeprex, causing uterine bleeding (sometimes profuse), strong contractions, and expulsion of the baby.

The pregnant woman first visits the abortionist to obtain the Mifeprex pills, returns two days later to receive misoprostol, and returns a third time to verify that the abortion is complete. The failure rate of this method is about 8% if the pills are taken within 7 weeks and up to 23% at 8–9 weeks. If the baby survives the abortion, there is a high risk that he or she will suffer mental and/or physical birth defects from the misoprostol.[7,8]


Vacuum Aspiration

In this first trimester procedure, the abortionist inserts a hollow plastic suction tube into the dilated cervix. The uterus is emptied by either a manual syringe or high-powered suction machine. The baby is torn into pieces as he or she is pulled through the hose.[1,2,3]


Dilation and Suction Curettage (D&C)

This is similar to the vacuum aspiration but is generally used after 14 weeks. After the baby is suctioned out of the uterus the abortionist inserts a curette, a loop-shaped steel knife, into the uterus. With this the abortionist cuts the placenta and umbilical cord into pieces and scrapes them out into a basin. The uterus is again suctioned out to ensure that no body parts have been left behind. Bleeding is usually profuse.[4]


Dilation and Evacuation (D&E)

Once the cervix is dilated considerably farther than in first trimester abortions, the abortionist inserts a narrow forceps that resembles a pliers. This instrument is needed because the baby’s bones are calcified, as is the skull. The abortionist inserts the instrument into the uterus, seizes a leg or other part of the body and, with a twisting motion, tears it from the baby’s body. The spine is snapped and the skull crushed. Body parts are then reassembled and counted to make certain that the entire baby has been removed and that no parts remain in the womb.[5,6,7,8]


Induction or Prostaglandin Abortion

Labor is induced using prostaglandin drugs, and the cervix is dilated. To ensure the baby will be dead upon delivery and to start uterine contractions, the abortionist may inject saline (salt water) or urea (a substance found naturally in urine and blood). To guarantee against a live birth and legal complications, doctors will inject the drug Digoxin or potassium chloride directly into the baby’s heart to kill the child before delivery. Other times the baby is delivered alive and left without medical intervention until he or she dies.[9] This method is used in the second or third trimester.[10]


Dilation and Extraction (D&X)

After the mother undergoes two days of dilation, the abortionist performs an ultrasound to locate the child’s legs and feet. The abortionist then uses a large forceps to grasp one of the baby’s legs. He pulls firmly, forcing the child into a feet-down position.

Using his hands instead of forceps, the abortionist delivers the baby’s body in a manner similar to a breech birth. The baby’s head remains inside the birth canal. The abortionist uses surgical scissors to pierce the child’s head at the base of the skull. The scissors are forced open to enlarge the skull opening. The abortionist then inserts a suction catheter into the brain and vacuums out the child’s brain tissue with a machine 29 times more powerful than a household vacuum.[11]


Medical Abortions
1 Polis, Chelsea B., Kate Schaffer, Kelly Blanchard, Anna Glasier, Cynthia C. Harper, and David A. Grimes. “Advance Provision of Emergency Contraception for Pregnancy Prevention.” Obstetrics & Gynecology 110.6 (2007): 1379-388. Print.
2 Paton, David. “Random Behaviour or Rational Choice? Family Planning, Teenage Pregnancy and STIs.” Proc. of Royal Economic Society Conference, Swansea. Apr. 2004. Web.
3 “Plan B One-Step® | How It Works.” Plan B One-Step® | How It Works. Web.
4 “ella (ulipristal Acetate) Tablet Initial U.S. Approval: 2010.” FDA, US Government, Aug. 2010. Web.
5 Ibid.
6 Ibid.
7 “RU486Facts.org - Medical Information about RU-486 (Mifepristone).” RU486Facts.org - Medical Information about RU-486 (Mifepristone). Web.
8 Ibid.
Surgical Abortions
1 Marshal, Sarah, MD, Rebecca H. Allen, MD, MPH, and Kirtly Jones, MD. “Manual and Vacuum Aspiration for Abortion.” Women’s Health. WebMD, 14 Nov. 2014. Web.
2 Ibid.
3 Ibid
4 “An Abortion Doctor Describes a D&E - ClinicQuotes.” ClinicQuotes. 31 Aug. 2012. Web.
5 Ibid.
6 Ibid.
7 Ibid.
8 Ibid.
9 United States. Cong. House. U.S. House Committee on the Judiciary Subcommittee on the Constitution and Civil Justice. Testimony of Jill L. Stanek , RN HR 1797, Pain - Capable Unborn Child Protection Act U.S. House Committee on the Judiciary Subcommittee on the Constitution and Civil Justice May 23, 2013. 113th Cong. H. Bill. Print.
10 “Abortion-Choices: Surgical Abortion.” WebMD. WebMD, 4 June 2014. Web.
11 “Abortion Procedures During First, Second and Third Trimester.” American Pregnancy Association. May 2015. Web.