Counselling is important to help clients make informed decisions by understanding their options (abortion versus becoming a parent, and medication abortion versus procedural abortion). During the counselling, it is also important to understand clients’ preferences and circumstances to advise the best course of action.

Medication abortion is suitable for patients who^[6]:

• Prefer a non-invasive method.
• Prefer to have an abortion in the comfort of their home.
• Have the confidence of being able to manage the process and side effects at home.
• Are able to take 1 to 3 days off work or other responsibilities to undergo the abortion process.
• Lack means of transportation to travel to the clinic for a procedural abortion (but still have access to emergency services in event of complications).

Procedural abortion is suitable for patients who^[6]:

• Prefer to have in-person support and monitoring from healthcare professionals at a clinic or hospital.
• Want to have the abortion completed quickly to return to work or other responsibilities.
• Are comfortable with the use of medical instruments and internal exams.
• Are comfortable undergoing local or general anesthesia to manage pain.
• Do not want to disclose the pregnancy and the abortion to those patients live with (such as partners, roommates, co-workers), as it might be difficult to conceal heavy bleeding and strong cramps.

Prior to taking medication abortion, clients should know how to administer the medication, what the side effects are, how to identify the signs of complications, and when to seek emergency care^[2].

Do ensure that clients have the following before they take medication abortion:

• Sanitary pads and liners.
• Pain medication and / or anti-nauseants (over-the-counter or prescriptions).
• Access to emergency care.
• Support for childcare, transportation, and groceries.

Both MIFE and MISO are teratogenic and have been associated with fetal abnormalities. Once the MIFE / MISO treatment has been started, there is a risk of embryotoxicity if the pregnancy is not terminated^[10].

If MISO is forgotten and > 48 hours have passed since MIFE: take MISO right away and inform the prescriber at follow-up^[10].

Buccal administration of MISO^[10]

• If vomiting occurs < 1 hour after taking MIFE or during buccal absorption of MISO: contact a prescriber / pharmacist for assessment.
• If vomiting occurs > 30 minutes after swallowing MISO fragments: No action is required.

Vaginal insertion of MISO^[10]

• If tablets fall out before bleeding starts: Re-insert the tablet or contact a healthcare professional if unable to reinsert.
• If tablets come out while bleeding: No action is required; in most cases, a sufficient portion of the medication will have been absorbed.

In any case, if bleeding does not start within a few hours, contact a healthcare professional.

Clients who undergo medication abortion are required to have follow-up consultations with their prescribers to confirm the termination of the pregnancy, manage complications, receive counselling on contraception and get emotional support if needed. Clients may also require ultrasound or bloodwork to confirm the completion of the abortion and to rule out the possibility of ectopic pregnancy.

Mode of follow-up^[6]:

In most situations, follow-up consultations are given 7 to 14 days after taking misoprostol (the second medication) but sometimes follow-up can take place as early as 3 days after misoprostol. The consultation can be over the phone or in-person, depending on the circumstances.

Emotional support^[6]:

Emotional response after medication abortion often vary. Some people feel relieved and positive while some feel grief, sadness, or guilt, and have mixed feelings. These emotions are normal, and they may or may not be related to socioeconomic circumstances, the lack of social support, moral discomfort, and family conflict.

People undergoing medication abortion can be supported by understanding that mixed emotions are normal and by exploring coping strategies and assistance. Useful resources include:

• Exhale, a talk-line that provides emotional support, resources and information after abortion.
• All-Options, a talk-line to discuss past or current experience with abortion, adoption and parenting for people in Canada and the United States (1-888-493-0092).

Post-abortion Contraception:

People taking medication abortion can return to fertility rapidly and hence should consider taking contraceptives.