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How to Talk with Clients About the Abortion Pill RU-486

April 2001
By: Lynn Bisbee and Paula Grimsley
The phone rings at your center. The volunteer who answered the phone isn't on very long and hangs up with a sigh. She tells you, "That client wanted the abortion pill. I told her we don't provide that, but I didn't know what else to say! How can we reach these women?"

Following the recent FDA approval of the French abortion pill RU-486 (or mifepristone marketed under the name Mifeprex), pregnancy centers all over the nation have been receiving phone calls requesting information about the drug. Many in pregnancy center ministry are somewhat apprehensive about clients' calls for this drug and feel unprepared to respond to these requests. There is also concern about whether or not this drug will reduce the number of clients who will seek services at pregnancy centers.

Clients want essentially the same care whether they are asking about mifepristone, surgical abortions, parenting, or adoption. They want accurate information, and they want to be treated with genuine concern and dignity. While the amount of information shared with a client over the phone usually will be less than in the center, we need to be well prepared for answering clients' questions about mifepristone.

HISTORY
Mifepristone was initially approved for use in France in 1988 and has been used in other European countries for years. In 1992 President George Bush had the drug placed on the FDA's list of drugs banned for importation for personal use. President Bill Clinton reversed that ruling in 1993, precipitating clinical trials of mifepristone in the U.S. in 1994. In 1996 the FDA gave preliminary approval for the use of mifepristone, but said that manufacturing and labeling issues needed to be addressed prior to final approval.

In June, 2000, the FDA published a statement that it would approve the drug with certain restrictions. Final approval was given in November of 2000 with fewer restrictions than those proposed in June. These restrictions currently include: (1) the prescribing physician must have a referring relationship with a trained abortionist for occasions when mifepristone fails to result in abortion, and (2) physicians must sign an agreement to follow the approved regimen and have patients sign a statement that they will make the three necessary office visits.

Planned Parenthood reports that within a year approximately one hundred eighty of their centers will be offering mifepristone.

ACTION AND SIDE EFFECTS
Proper client care requires that pregnancy centers provide accurate information about abortion. Information shared about abortion procedures must be fully up-to-date and medically verifiable.

Always state that the center neither prescribes nor makes referrals for abortions. At the same time, be sure to let the client know that the center can offer her a pregnancy test and more information about mifepristone and other pregnancy options. Suggest that a peer counselor can talk with her personally if she will make an appointment or come to the center as a walk-in.

Mifepristone is given in early pregnancy (within 49 days of a woman's last menstrual period) to induce abortion. On the first clinic visit, the woman receives an ultrasound to determine the size of the embryo. The woman is given mifepristone, which stops the production of progesterone, a hormone necessary for a pregnancy to continue. Two days later, on the second visit, the woman receives misoprostol, a prostaglandin medication that causes uterine cramping and expulsion of the embryo. The complete abortion may occur with just the first medication; however, most women are given the second drug. Three office visits are normally required. At the third visit (usually in ten to fifteen days) termination of the pregnancy will be confirmed by ultrasound.

Inform your client that mifepristone does not work in about five of every 100 cases. Some women who fail to abort may need a second dose of the misoprostol, and some are given a first-trimester surgical abortion.

The cost of this procedure varies but is usually similar to or slightly higher than a first-trimester surgical abortion.

The more common side effects include bleeding, clotting, cramps, nausea, diarrhea, and vomiting. In rare cases the bleeding can be so heavy that a blood transfusion is needed. Other potential side effects include infections and psychological trauma.

Little is known about the effect of mifepristone on a developing embryo. However, in several cases where women continued their pregnancies, the most common abnormalities reported were bone and limb deformities.

LISTEN TO YOUR CLIENTS
Every dialogue is an opportunity for reconciliation. God has orchestrated this conversation (II Corinthians 5:18). A woman who calls or visits your center inquiring about mifepristone needs to speak to someone who cares and will listen to her concerns. There may be people in her life who are pressuring her to abort. She is fragile and needs your love, interest, and help. Do not be afraid of her questions. Welcome her inquiries and invite her to make an appointment at the center.

PRAY FOR YOUR CLIENTS
Prayer is essential for your center and the clients. All involved with your ministry need to pray that abortion-vulnerable women will seek the center's services and that the center will be a safe place for them to come and have their concerns addressed. Peer counselors need intercession to be prepared to work with these clients and to have wisdom, compassion, and courage. Pray also that the clients will have their hearts softened by God's truth and grace and that they will choose life.

Remember, our job is not to make the decision for the client. We are to trust the Lord and to give the client such excellent information and support that she is empowered to make the right decision. Do not be afraid. "The battle is not yours, but God's" (II Chronicles 20:15).

Care Net has developed resources to help you serve the woman contemplating a medical abortion. One is a Medical Abortion Fact Sheet, and others include Suggestions for Dialog -- RU-486 and Suggestions for Dialog -- Methotrexate. Contact Care Net at (703) 478-5661 if you are interested in these resources.

Lynn Bisbee is the vice president of center services for Care Net. Prior to coming to Care Net, she served for six years as director of a pregnancy center in Cambridge, Massachusetts.

Paula Grimsley is the associate director of center programs for Care Net. She previously served as the executive director of the Alpha Center for Women in Ft. Collins, Colorado.

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