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Why Telemedical Abortion is Different than Ordinary Telemedicine and Poses Real Dangers to Women

by | Nov 4, 2021

By Randall K. O’Bannon, Ph.D. NRL Director of Education & Research

Never let it be said that pro-abortionists ever miss a chance to expand abortion, regardless of the danger is poses to women. A recent, and very unsettling example, is telemedicine.

Though it existed before COVID, telemedicine has become increasingly common with the pandemic. Doctors and patients have found that standard checkups and medical interviews, even some “sick visits,” could be conducted over Zoom or other video conferencing platforms, so that a person never had to leave the comfort and safety of their own home.

Abortion advocates, who were already trying to promote webcam abortions and sell abortion pills over the internet, leapt at the chance to exploit the COVID crisis. They promoted telemedical abortion as a way for women to “safely” obtain abortions without having to go to the clinic. That this is potentially very dangerous to women is flatly ignored.

Earlier this year, for example, these advocates were able to convince the Biden administration to suspend regulations, while the pandemic lasted, on the prescription and distribution of mifepristone. This includes, among other things, the requirement that women make an in-person clinic visit to receive the pills. They aim to make these changes permanent, on the grounds (they claim) that the telemedical abortions are just as safe as the others and that there is no essential difference between those abortions and ones performed with pills picked up from the clinic.

Those who say this are seriously mistaken. Either they really do not understanding the chemical abortion process or are not really being honest about its unique dangers.

Chemical abortions are different

At first glance, chemical abortions sound like something that might be ideal for telemedicine. After all, is a clinic visit really needed just so a doctor can hand out a couple of pills?

The problem is that the process is nowhere near that simple.

Though most focus on mifepristone, or RU-486, the abortion pill which beginsthe process, that process actually involves multiple pills, taken over a series of days, and typically takes a number of days to complete – when it works.

Women first take mifepristone, the first pill, to block the pregnancy hormone progesterone and essentially starving the unborn child. A second drug, a prostaglandin named misoprostol, taken a day or so later, initiates powerful uterine contractions to force the emaciated baby out.

It is nearly always difficult, painful and bloody, and it doesn’t always work.

Failure isn’t entirely random. Though a certain percentage (2-7%) appears to fail no matter what, the farther along a woman is, the more likely it is that the abortion will fail and that the woman will suffer significant complications like hemorrhage.

This is why it is essential that a woman come in and have a medical professional examine her and date her pregnancy. Trials of the drug in the 1990s showed efficacy dropping off after 7 gestational weeks (49 days after a woman’s last menstrual period, or LMP).

The U.S. Food & Drug Administration (FDA) allowed the extension of its use to ten weeks LMP in March of 2016, but it did so with the understanding that prescribers would be careful not to give the drug to women past the deadline.

Furthermore, mifepristone also does not work in the situation of ectopic pregnancy, when the unborn child implants outside of uterus, a circumstance that occurs in 1-2% of pregnancies. Undetected, untreated, the growth of the child may eventually cause the fallopian tube to rupture, threatening the mother’s life.

These features make chemical abortion a poor candidate for telemedicine.

What telemedicine can and can’t do.

It is amazing what can be done with telemedicine. Doctors can teleconference with patients who can share their symptoms and be treated for colds or flu. They can diagnose rashes, conjunctivitis (pink eye), or other infections and can call in prescriptions for home delivery. If patients have blood pressure cuffs, glucose testing strips, or even a basic thermometer, they can check in with a nurse or doctor to monitor health conditions over the phone or internet.

If they have had laboratory testing done, blood work, or hospital x-rays and scans, specialists can receive and read these results electronically to identify and treat problems. This is some of what telemedicine can do.

But note that for those conditions where more advanced testing or scans are needed, or where some sort of hands on treatment (or surgery) is needed, patients still need to meet with an actual medical professional. Heart attacks, strokes, hemorrhages, traumatic injuries, anaphylaxis (severe allergic reactions) are all more appropriately treated in the ER rather than with bandages or over the counter remedies from the medicine chest.

Abortion advocates try to make it sound as if telemedical abortions are simply a matter of someone taking a pill, one they could just as easily pick up in the mail as they could by dropping by the clinic. But years of experience have shown chemical abortions are morecomplicated than that.

If a woman with certain disqualifying conditions takes the pills, or takes the pills at the wrong time, she can be in for a particularly rough time. The pills don’t work for everybody, and particularly don’t work for women who are farther along than the recommended date or may have pregnancies the pills don’t treat.

And that can be not just inconvenient but dangerous.

An online interview won’t catch important danger signs.

Advocates of telemedical abortions claim that a woman can simply do a webcam interview with someone at the clinic or the online sales office and do all the necessary screening over the computer. If she answers a few questions satisfactorily and maybe agrees to watch an instructional video, someone will ship the pills overnight to her home.

But it is plain that telemedical abortion is not like other telemedicine.

Though (if everyone is forthcoming) a webcam interview could potentially uncover certain medical conditions, critical dating and location of the pregnancy may be most carefully and accurately determined by an in-person examination, preferably with the superior clarity and precision of ultrasonagraphic imaging.

This is not something that can be adequately done by a remote webcam interview. Women can help the abortionist make an estimate of gestation by giving the date of their last menstrual period (LMP), but the possibility of spotting or bleeding upon implantation can lead both woman and doctor relying on reported LMP to misestimate gestational age by several weeks. This can also be an issue if women misremember or deliberately mislead about their LMP in order to qualify for the drug.

Again, if the date is off, for whatever reason, the pills are less likely to work and the possibility of complications, some quite serious, is significantly higher.

Though there are signs of ectopic pregnancy, these may not be immediately apparent at the time of a positive pregnancy test. If a woman has taken the abortion pills, it may be easy to mistake the cramps, pain, and bleeding of a rupturing fallopian tube for the signs of an ordinary chemical abortion. But, again, mifepristone will not resolve that problem in such circumstances.

To rule out ectopic pregnancy, a woman needs to be professionally examined, to have blood tests, to have an ultrasound identifying where the child has implanted. This cannot be done in an online interview.

With 1-2% of pregnancies being ectopic, with failure rates of 2-7% and higher for women with later, more advanced gestations, chemical abortion is ill-suited for telemedical management.

Telemedical abortion will put more women at serious health risk.

Those who argue that an online interview is sufficient are simply willing to roll the dice and gamble with women’s lives. They know full well that a certain percentage of them will end up facing serious complications and a certain number will see their abortions fail.

Thousands of women who have taken these drugs have ended up in the hospital with hemorrhages, infections, ruptured ectopic pregnancies. At least two dozen have died. Advocates of telemedical abortions know this, but continue promoting their product anyway.

An in-person examination is no guarantee that there won’t be critical problems or failures, but it could help ensure that there are considerably fewer of them. A woman being examined by an actual medical professional, undergoing blood tests, having an ultrasound examination can have some assurance that she does not have an ectopic pregnancy, that she is not weeks past the deadline, that she does not have some physical condition which might make the drugs dangerous or ineffective for her.

Whether they fail or trigger some serious complications, in either case, telemedicine is not likely to be the answer. More pills shipped in the mail will result in more women needing to find the nearest emergency room to get a handle on the bleeding, or to treat an infection, or deal with a ruptured ectopic pregnancy.

If they are still determined to abort, they may have to find a clinic to perform a surgical procedure to complete the abortion. If they have changed their minds, they can seek out some pro-life doctor who could help them try and reverse their abortion.

For those women trying to save their lives, or hoping to preserve their fertility, additional online consultations will not suffice.

Telemedicine simply isn’t appropriate for chemical abortion. It only magnifies its deficiencies and increases the risk of failure and injury. And it won’t be the answer when things go wrong.

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