Case Scenario

M.A. is a 24-year-old patient who presents to my office two weeks after using abortion pills that she ordered online because abortion is now illegal in this state. M.A. reports that she took 200 mg of mifepristone orally 10 weeks after her last menstrual period. Twenty-four hours later, she took four misoprostol (Cytotec) pills buccally. When nothing happened, she stated that she took another misoprostol dose, after which she experienced heavy bleeding and cramping. Ten days later, she is still bleeding irregularly. She is wondering whether this is normal or whether she is still pregnant. How should I answer her questions? What are my legal risks in this situation?

Commentary

The American politicolegal landscape surrounding abortion and routine pregnancy care has been changing rapidly since the 2022 Supreme Court of the United States issued its decision on Dobbs v. Jackson Women's Health Organization.¹

Patients and physicians face uncertainty about how abortion and miscarriage care may be accessed and what legal liability they may face. One grassroots response has included a dramatic increase in accessing medication abortion pills outside established health care systems, such as online pharmacies, telehealth visits with physicians from other countries, or even informal networks.^2,3 Patients commonly access resources such as Plan C, Mayday Health, and the Miscarriage + Abortion Hotline (833-246-2632). The hotline is staffed by more than 60 volunteer clinicians—mostly family physicians—and offers medical information via phone and text.²