What Happens When an Abortion Doesn't Fully Work

Last year, I had an abortion. My reasons for doing so are deeply personal, painful and nobody’s business but mine. Once I'd decided to terminate the pregnancy, a woman from British Pregnancy Advisory Service (BPAS) asked me over the phone if I wanted a medical abortion – which was still possible at my stage of pregnancy (nine weeks) – or a surgical one. I had no idea.

“What’s the difference?” I asked.

“Well, one you take a pill and the other is more invasive."

I didn’t have much time to go into greater detail – and to be honest didn’t want to – so went for the medical abortion, assuming it would be simpler.

The nurse at the preliminary appointment explained that early medical abortions (EMAs) are most effective if you take the two sets of pills 24-48 hours apart. I took the first pill (mifepristone) on that day, and came back two days later to complete the procedure, which involved inserting the second set of pills (misoprostol) into my vagina. It felt like an act of self-violence. I remember walking back out into the waiting room and folding into my mum’s arms – crying with a ferocity I hadn’t experienced since childhood.

“I know,” she said softly as she stroked my hair.

The clinic had told me that the miscarriage could begin any time from the moment I’d taken the medication to up to two weeks later. It would be much like a heavy period, and should be over within a day, but that I could have some mild cramping for up to a week. I could take paracetamol and ibuprofen if it hurt.

Around four hours later once we’d returned to the flat, I felt an unfamiliar pain stir deep inside me, somewhere in between my lower spine and belly button. Within an hour, I had gone into full labour – I’ll spare you a long description, but: contractions, vomiting, bleeding, crying, shitting. It went on for hours. My mum was incredible; I was traumatised. Somehow it made us closer.

Around 12 hours later, the contractions became less frequent, which I assumed was a sign that the worst was over. A week later, though, after an unsuccessful return to work, the contractions persisted, and I went to the GP for some stronger meds. It was then that he took my blood pressure – which he said was “dangerously low” – and sent me straight to A&E.

After four hours of crying in agony, lying on the floor of the waiting room in the Pregnancy Unit among expectant mothers, a scan revealed what I was afraid of: that the abortion had not been successful and was classified as “incomplete”, a word I vaguely remembered hearing in my first consultation. In terms of understanding the complications that can happen, it is important to make the distinction between “unsuccessful” EMAs and “incomplete” ones. An “unsuccessful EMA” is when the patient takes all the pills and the abortion process fails to initiate for whatever reason. An “incomplete EMA” is when the process initiates but the body fails to expel the leftover waste “product”.

Surgery was scheduled for three days later to remove the “remaining products”, and I was signed off work for another week. The whole ordeal left me physically and emotionally wrung out.

As with any other issue surrounding women’s health, abortion – what it involves, how it feels, how you know if it’s worked, how different people experience it – is a topic of which our society is woefully ignorant. Instead of using our energy to spread valuable knowledge and experiences that could allow women to make more informed choices about their bodies, we often end up locked in never-ending debates on Twitter about morality. This distracts from the truth of the matter, which is that – like it or not – women are having abortions, regardless of whether they are legally, morally or medically supported. Ensuring that women have access to fair, honest and detailed information about the various procedures involved can therefore only be described as a matter of public health.

“As we know, abortion is incredibly common,” Dr Yvonne Neubauer, Associate Clinical Director for Marie Stopes UK, an abortion NGO, tells me. “We know that one in four women will terminate a pregnancy in their lifetime, and that medical abortion is by far the most common method, with 9 out of 10 abortions in 2018 being carried out before 13 weeks, when they are most effective.'' Of these, Dr Neubauer tells me, 70 percent were medically induced, of which 95 percent were “successful in causing the complete passage of the retained product,” making my experience of an incomplete procedure quite – but not extremely – rare.

When Diana*, an accountant, was 19 and in her first year of uni, she had an EMA. “At the time, I didn’t know anyone who’d had an abortion, let alone an unsuccessful one,” she says. The procedure went as planned, and Diana was sent home, looking forward to putting the experience behind her. A few weeks later, though, when on a family holiday, the bleeding hadn’t abated. “It was just awful. I’d have a shower and look down and the floor would be red. I’d bleed through pads at an astonishing rate and couldn’t go swimming.”

Diana realised something was very wrong when, on the plane home, the bleeding became more intense. “The blood felt like it was gushing out of me and it soaked through my dress and onto the plane seats. It was humiliating and terrifying.” On landing, Diana and her family went straight to casualty. She was told that the abortion had not been successful and that she’d need to have surgery.

“I was traumatised for a long time and I ended up dropping out of uni,” she says. On top of the trauma, she felt increased guilt and shame because of the complications. “I felt like I was being punished for my decision to end the pregnancy.”

The trouble is that as with anything regarding reproductive health, one woman’s experience can vary greatly from the next and – based on what Dr Neubauer has seen – even the same person can respond differently to the same procedure on two separate occasions. “We give advice based on the median experience,” she tells me.

We’ve all heard of the woman who sneezes out her firstborn after two hours of mild contractions, and equally, we’ve also heard of the woman who had an emergency C-section after 72 hours of agony. Ditto the friend who says they don’t get period pains and the one laid up for four days a month unable to work. “Women’s bodies are complex and extremely variable, and no experience of abortion is the same,” says Dr Neubauer. “This is why we prioritise support before, during and after the process, and provide access to a range of resources, including a 24-hour support line.

But what about the extremely rare (less than 1 percent) of cases, when an EMA just doesn’t work at all?

After undergoing an EMA at 9 weeks, Zoë Beaty, a freelance journalist, headed home, where she waited for her miscarriage to start. She waited and waited. Hours turned into days, and nothing happened. Unable to go to work for fear of miscarrying there and told by the clinic she couldn’t come back until the two-week post-treatment period had elapsed, she was marooned at home.

“It was just so frustrating,” she tells me. “I knew I was still pregnant, I could feel it inside me, but no one would take me seriously until the clinic confirmed it via a scan two weeks later.” This inevitably took an emotional toll. “It just felt like things were getting out of control. I’d never heard of abortions not working, and every time I googled it, all I found was some pseudo-religious bullshit telling me it was a ‘sign’ that it failed, which was obviously completely unhelpful.” Zoë was eventually booked in for surgery at 11 weeks, and the pregnancy was terminated.

Failed abortions can be hard to process psychologically. In some cases, bleeding commences after taking the medication, but the pregnancy itself continues. If you live in England, this can be remedied by a surgical procedure once the ongoing pregnancy is confirmed. But that is not always the case abroad.

Mara Clarke, founder of the Abortion Support Network, a charity that supports women forced to travel for safe, legal abortion, says this is especially crushing if the two-week window plus appointment waiting time pushes the patient over the limit to access legal abortion. This could happen in a country like the Republic of Ireland, for instance, where abortion is only accessible up to 12 weeks of pregnancy. “It’s heartbreaking,” she says, “and incredibly complex to process emotionally for those involved.” Thankfully, recent votes towards equal access in Northern Ireland and the Republic of Ireland, plus plans to allow women in England to take abortion pills at home, are great markers of progress.

I don’t regret for a second my decision to terminate the pregnancy, which was the right thing for both me and the potential child. Abortion is a safe medical procedure and many women have had abortions will few to no complications at all. Still, this is the article I wanted to read both before the procedure and afterwards, so that I could have been fully informed and prepared for what could happen to my body, rather than finding out during the process. I don't want anyone to be as in the dark as I was. As Dr Neubauer says, “The only way we can help each other is to be honest and open… and to talk about it.”

@RoseStokes