Pushing the envelope or pushing the coat hanger?

SPECIAL for ObGyn Physicians

May 7, 2020 | Eau Claire, Mich. | Donna J. Harrison M.D., Executive Director

Reprinted by permission of AAPLOG, American Association of Pro-life Obstetricians and Gynecologists


When we think of someone who sells drugs to a buyer, knowing that drug will result in an ER visit for nearly one out of 20 buyers and surgery for almost that many, we generally think of illegal drug dealers. Think again. The new drug dealers are pushing do-it-yourself abortion with Mifeprex and Misoprostol. Why?

The abortion industry has two significant problems:

  1. Most doctors don't want to do abortions. Roughly 3/4 of ob-gyns will not perform abortions. The doctors that do perform abortions are aging out of practice.
  2. Medical standard of care practice requirements like informed consent, at-minimum 24-hour waiting periods, hospital privileges, procedure rooms adequately sterilized and stocked with resuscitative equipment, trained anesthetists and other standards of medical care practice that the rest of us comprehend as essential to patient safety, the abortion industry disdains as "preventing access." The real complaint, however, is "cuts into our bottom line profit margin."

The COVID-19 epidemic has brought the primary, financial objective of the abortion industry into sharp focus: to abort as many women as possible in as little time as possible, with as little follow up as possible. Abortion clinics have flouted requirements to cancel elective surgeries, now claiming preposterously that instead of a "choice," elective abortion is essential medical care. Abortion clinics cancel pelvic exams, pap smears, other cancer screenings and STI screenings; they flout state laws by refusing to report pregnancies in cases of statutory rape, refusing to obtain state-mandated parental or legal guardian consent and ignoring COVID-19 abortion bans. But you can't have it both ways… essential medical care requires complying with medical standards of care, which the abortion industry refuses to do because money for abortion is their bottom line.

The fact is that COVID‐19 infection is not an indication for elective abortion. In fact, there is no medical indication for elective abortion, by definition. Dr. Christina Francis, Chair of AAPLOG Board of Directors, appeared on EWTN Pro-Life Weekly to discuss the fear and pressure women face when it comes to abortion during the COVID-19 pandemic and the dangers that chemical abortions pose.

The abortion industry never wastes a crisis to advance an agenda

In the spirit of Machiavelli, the abortion industry is seizing the COVID-19 crisis to reach for their ultimate goal: do-it-yourself abortion.

In protocol written well before the pandemic, the abortion industry has used the cover of "research" to initiate a de-facto DYI abortion access program nationwide, according to a recent webinar sponsored by the Society of Family Planning (SFP), which included Gynuity Health Projects and others. The Gynuity website states:

The COVID-19 epidemic has triggered an acute need to minimize the time that patients spend in medical facilities and to reduce physical contact between patients and providers. In response to this need, Gynuity recently led the collaborative development of a sample protocol for providing medication abortion without any routine facility-based tests either before or after treatment.

And the well coordinated legal arms of the abortion industry have walked in lock-step.

The irresponsibility and frank medical malpractice is breathtaking

1. Despite the obvious medical common sense and FDA label requirement to rule out ectopic pregnancy, there is no provision for ultrasound documentation of intrauterine pregnancy prior to taking Mifeprex, much less documentation of gestational age. Under this protocol, women with an ectopic pregnancy will take Mifeprex and be told that pain, bleeding and cramping are a "normal" part of the Mifeprex abortion process. Then these women will bleed to death from ruptured ectopic pregnancy as has already happened. In fact, none of the following contraindications are adequately addressed.

Who should not take Mifeprex?

Some women should not take Mifeprex. A woman should not take Mifeprex if it has been more than 70 days since the first day of her last menstrual period, or if she:

  • has an ectopic pregnancy (a pregnancy outside of the uterus)
  • has problems with the adrenal glands (the glands near the kidneys)
  • is currently being treated with long-term corticosteroid therapy (medications)
  • has had an allergic reaction to Mifepristone, Misoprostol or similar drugs
  • has bleeding problems or is taking anticoagulant (blood thinning) drug products
  • has inherited porphyria
  • has an intrauterine device (IUD) in place (it must be removed before taking Mifeprex)

This information applies equally to the approved generic version of Mifeprex.

2. There is no responsible medical person to administer Rhogam to Rh negative women, despite ACOG guidelines which clearly state that Rhogam should be administered to women with terminations. According to ACOG, one of the most common reasons for Rh isoimmunization is failure to administer Rhogam.

A recent retrospective study from New Zealand identified reasons for continued cases of sensitization, including omission of immune globulin after a recognized sensitizing event in 41% of cases and administration outside of recommended guidelines in 13% of cases.

Termination of pregnancy is a recognized sensitizing event (see Box 1 in the ACOG PB) and ACOG recommendations clearly state:

Rh D immune globulin should be given to Rh D-negative women who have pregnancy termination, either medical or surgical. (ref)

Yet, ACOG has been completely silent or supportive of the "self-managed" (do-it-yourself) abortion industry initiative. This is another glaring example of how ACOG ignores even its own recommendations and has abandoned advocacy for real women's health in its blind advocacy for the abortion industry.

3. There is no one to manage the common complications of hemorrhage, incomplete abortion and need for surgical completion. In one of the very few studies on adverse events after medical abortion that is not directly sponsored by the abortion industry, a recent study using the medical records of 42,000 women who underwent induced abortion in Finland reported the following complication rates:

RESULTS
The overall incidence of adverse events was fourfold higher in the medical compared with surgical abortion cohort (20.0% compared with 5.6%, P<.001). Hemorrhage (15.6% compared with 2.1%, P<.001) and incomplete abortion (6.7% compared with 1.6%, P<.001) were more common after medical abortion. The rate of surgical (re)evacuation was 5.9% after medical abortion and 1.8% after surgical abortion (P<.001). Although rare, injuries requiring operative treatment or operative complications occurred more often with surgical termination of pregnancy (0.6% compared with 0.03%, P<.001).

With the Gynuity do-it-yourself protocol, these one out of 20 women will just be dumped on the ER, as is already happening with online abortion drug availability and the women told to lie about the termination, as they are already being instructed to do for online self-managed abortion. Even the abortion industry recognizes that the ER plays a critical role in mopping up the complications. A recent Vice article argues that ER doctors need to be more knowledgeable about self-managed abortions. Pro-abortion ER Doctor Dara Kass admitted this abuse of the ER and also stated, “Recently published results of the Gynuity pilot project showed that eight percent of their patients who received abortion medication sought follow-up care at a local urgent care clinic or emergency department. Using the 339,640 (and growing) annual number we estimate that 27,000 women could report to an emergency department after a self-managed abortion every single year."

And things will be even worse because the Gynuity protocol recommends use up to 77 days (11 weeks). But there is no way to assure that a woman at a later gestational age will not use the drugs since no ultrasounds or tests are done. Note that after 10 weeks of pregnancy, the Finnish database publication reported that one out of every three women require surgical completion. The abstract also states:

RESULTS
When compared with first trimester medical TOP, second trimester medical TOP increased the risk of surgical evacuation [Adj. odds ratio (OR) 7.8; 95% confidence interval (CI) 6.8-8.9], especially immediately after fetal expulsion (Adj. OR 15.2; 95% CI 12.8-18.0). The risk of infection was also elevated (Adj. OR 2.1; 95% CI 1.5-2.9).

Women will essentially have NO ONE to turn to for complications. Abusers and pimps will have no medical interference from pesky medical personnel who are required to report statutory rape in minors. Unfortunately, such enabling has become commonplace in the abortion industry. See also AAPLOG Joint Committee Opinion on Pornography, Sex Trafficking and Abortion.

But something important still stands in the way of complete unfettered access to abortion: The FDA REMS.

The abortion industry has also used the guise of the COVID epidemic to launch a full scale assault on the REMS. For example, the New York Attorney General lobbied the FDA to lift restrictions on Mifepristone.

AAPLOG joined other pro-life leaders in a letter to the U.S. Food and Drug Administration (FDA) Commissioner Dr. Stephen Hahn urging him to take action to stop the illegal internet sale of abortion-inducing drugs, manufactured overseas and shipped into the U.S.

The FDA has the responsibility to provide oversight and regulation of dangerous and irresponsible use of drugs. Let's keep FDA accountable to their fiduciary.

The AAPLOG invites Pro-life Doctors to Join AAPLOG and help pursue an unprecedented opportunity to speak the truth in the public square!