• Discuss pregnancy options and ensure that the decision to have an abortion is informed, voluntary and uncoerced.

• Compare the advantages and disadvantages of medication versus aspiration abortion. Explain the differences, timing of the visits, known side effects of the medications, and what to expect during the process and at home.

• Ask what the patient already knows about medication abortion.

• Ask about any previous abortion experience(s) and fears or anxieties.

• Discuss time off from other responsibilities (work, childcare, etc.)

• Have patient identify a time and place to insert the misoprostol.

• Explain the basic clinical procedures.

• Discuss the potential teratogenicity of misoprostol and emphasize that once the drugs have been administered, the abortion should be completed either medically or surgically.

• Clarify the time commitment and the two office visits.

• Discuss issues of confidentiality and social and physical support; help patient evaluate her safety following the abortion decision.

• Discuss the amount of pain and bleeding associated with the abortion process, including possible heavy bleeding with clots and passage of products of conception.

• Instruct the patient on the use of all medications including self-insertion of vaginal misoprostol and use of pain medication.

• Advise the patient regarding substances to avoid (e.g. aspirin and alcohol.)

• Discuss sexual abstinence until abortion is confirmed.

• Be very sensitive to patients who learn they are not eligible for a medication abortion.

• Offer contraceptive counseling.

• Review aftercare instructions, including emergency contact information and what symptoms warrant a call to the on-call provider.

Compiled and adapted from:
Breitbart, V. Counseling for Medication Abortion. American Journal of Obstetrics and Gynecology August 2000; 183 (2), S26-33
Counseling Guide for Clinicians Offering Medication Abortion: Planned Parenthood of New York City, Inc., 1996.