If Plan B is Out, Plan C Is In

• Within the last week, the breadth of a woman’s reproductive rights has narrowed. The overturning of Roe v Wade has now placed the decision for abortion rights to be left up to individual states. 
• Less access to abortion services across the US, means that healthcare providers alike need to be aware there will be an increase in self-managed abortions.  
• Plan B pill, also known as the “morning-after pill” is an emergency contraception pill that will stop a pregnancy that has seeded. With reproductive rights being left up to the states, access to Plan B may be also in danger. 

Within the last week, the breadth of a woman’s reproductive rights has narrowed. At the least, millions of women will have limited or no access to safe and legal abortions. As a country, our attitudes toward abortion have innumerable, near unresolvable complexities, leaving the outcome of overturning Roe v. Wade volatile.  

Beyond the forthcoming condemnation by every medical society in America, healthcare professionals need a contingency plan (Plan C) for a handful of expected outcomes. 

And though large numbers of Americans have absolutist views on abortion, as a nurse, I believe foremost in an individual’s health autonomy and second in the underlying circumstance.

Beyond choice, is the health of the mother endangered? Does the fetus have severe congenital abnormalities with poor life expectancy? Was the pregnancy a result of rape or incest? 

Consequences

One potential outcome from the U.S. Supreme Court decision is an increase in self-managed abortions. Self-managed abortions are not a recent occurrence, but to manage, patients need access to the current information and proper medical care.  

A self-managed abortion occurs within a self-assessment of an individual’s personal circumstance. In privacy, away from an invasive public, or abusive partner, or abortion clinics that may be under attack.

Self-managed abortions negate barriers to access, including travel, access, and affordability. With more than two dozen states limiting in-clinic options, nurses and healthcare professionals may need to re-familiarize themselves with current oral options.  

Plan B Pill

Plan B is NOT an abortion pill. Nor is it effective when pregnancy implants. In short, Plan B will not stop a pregnancy that has seeded. Instead, Plan B works by preventing a woman’s body from releasing an egg.

There can be mild side effects, including nausea and changes to your next period. Plan B, when taken per direction, is 87% effective at preventing pregnancy.  

It is possible that with the U.S. Supreme Court ruling, access to a handful of contraceptives methods become restricted. This encompasses states with trigger laws designed to limit abortion from conception, not pregnancy. Methods with the potential for limited access may include Plan B, emergency contraception, and IUDs. 

Abortion Pill

The term “abortion pill” is the lay term for two medications used in combination to end a pregnancy: mifepristone and misoprostol (notice Plan B is not apart of that combination). Health care professionals can refer to medication abortion to as a medical abortion.

The drug regime, FDA-approved with allowance to administer up to 70 days after the patient’s last menstrual period. Mifepristone works by blocking progesterone, a required hormone for pregnancy progression; and misoprostol, administered 24-48 hours later, induces the onset of contractions, ending the pregnancy. Individuals can take the medications in the privacy of their own home. The drug combination is effective in 92-95% of women. A misoprostol only treatment regime is acceptable if mifepristone is unavailable. 

The FDA requires the designated medical personal provide the required information for access to Mifepristone. Misoprostol, not requiring FDA oversight, needs only on-site or off-site prescription. 

When the recommended dose of medication does not end pregnancy, surgical intervention may be an additional level of care. Side effects are comparable to a miscarriage: bleeding, cramping, discomfort, nausea, vomiting and chills. The complication rate secondary to medical abortions is low.

Data reports that post medication abortion transfusions rates are less than 1% with 2-10% of patients needing an intervention to control bleeding. With any intervention, providers need to be cognizant of the potential for ectopic pregnancy. 

Worst-Case Scenario

The consequences of the court ruling have yet to unfold, but nurses and healthcare professionals fear returning to a darker era littered with unsafe medical abortion practices. The legality of abortion will be determined by the state.

Abortion clinics in states neighboring those with trigger laws and bans will see an influx of patients from states that limit access to abortion. It may force pregnant women to travel significant distances to find medical care.  

Though a more contemporary discussion has developed since the “back-alley” or “coat-hanger” abortion, practitioners need to stay vigilant for perforated uteruses, hemorrhage, and severe infections.

In 2019, the CDC recorded 629,898 abortions, more than half accounted for by women in their twenties. The CDC reports the national case-fatality rate for legal induced abortion for 2013–2018 was 0.41 deaths per 100,000 abortions. 

The Bottom Line

Beyond the medical and social implications, the U.S. Supreme Court ruling has set an extremely dangerous medical precedent that requires forward vigilance by nurses and healthcare providers. 

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