On a spring afternoon in 2013, Rebekah Buell swallowed the first of two doses of her medical abortion treatment at a Planned Parenthood center in North Highlands. The then-19-year-old Roseville woman said she returned to her car with the second dose in hand. The four white pills in a bag taunted her from the passenger seat.
“As soon as I got to my car I knew it wasn’t the right decision,” Buell said. “Everything just hit me. … I just felt like, ‘I can’t believe I just did that.’ ”
Since that day, Buell has become a champion of what’s known as “abortion reversal therapy,” an increasingly popular procedure promoted by anti-abortion advocates despite the warnings of many physicians about its effectiveness. The therapy purports to undo the effects of non-surgical abortions, also called medical abortions, in the crucial window after women take the first dose of the abortion regimen and before they swallow the second dose a few days later.
Several California clinics advertise the therapy, claiming to be able to undo the effects of the first dose containing mifepristone, which blocks progesterone production and causes the uterine lining to shed. The second set of pills contains misoprostol, which makes the uterus contract and initiates bleeding and cramping.
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More than 350 providers nationwide perform abortion reversal therapy, according to proponents of the treatment. One Sacramento clinic, Alternatives Pregnancy Center, began offering the service free of charge this spring.
Family physician Dr. George Delgado, medical director of the Culture of Life Family Health Care clinic in San Diego, said he developed the therapy in 2009 to give women more choices.
“Women who take mifepristone sometimes change their minds,” Delgado said. “If they change their minds, they have the right to a second chance at choice.”
Opponents argue the therapy is part of a larger effort to undermine women’s reproductive freedoms, especially as national policymakers threaten funding for abortion providers.
The only human study on the treatment, which isn’t approved by the Food and Drug Administration, is a Delgado-authored analysis of six patients, four of whom went on to deliver babies after receiving the therapy. The American Congress of Obstetricians and Gynecologists has cautioned against the procedure, arguing that progesterone, while generally well-tolerated, can cause significant cardiovascular, nervous system and endocrine reactions if used improperly.
The congress found that between 30 to 50 percent of women who take only the first pill go on to carry their babies to term.
Jessica Dieseldorff, a longtime nurse practitioner and training manager with Planned Parenthood Mar Monte, with locations in Central and Northern California, said there’s no proof that taking progesterone after the first abortion pill is any more effective at saving pregnancies than just taking the first pill and doing nothing.
“There’s just not enough information to know if it made a difference,” Dieseldorff said of the therapy. “There isn’t evidence showing it’s safe or effective. I wouldn’t consider it to be very ethical to be offering patients treatments that don’t have an evidence base.”
Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, said he doubts many women are seeking abortion reversal. In a 2015 study, he found that less than 0.004 percent of women taking mifepristone in the U.S. later chose to continue the pregnancy.
“It’s very, very rare that women are in this situation where they need the therapy,” Grossman said. “If Delgado and other colleagues want to study this in a rigorous way, it could be useful, and then we would know if it’s better to actually treat with the progesterone or just do watchful waiting.”
Several states, including Arkansas and South Dakota, require physicians to tell abortion-seeking patients that reversal is an option. California Assembly member Marie Waldron, R-Escondido, proposed similar legislation in 2016, but it didn’t make it out of the Assembly Health Committee.
Amy Everitt, state director of advocacy group NARAL Pro-Choice California, said the unproven procedure is just another anti-abortion play from crisis pregnancy centers, or faith-based organizations that provide pregnancy counseling, as well as ultrasounds, sexually transmitted disease counseling and other services.
“(Reversal therapy) is another vehicle for putting pressure and shame on women,” Everitt said. “What you’re saying is ‘You probably haven’t thought about this enough, so there’s an option halfway through to rethink.’ That disrespects women’s decision-making processes.”
Delgado said he has treated roughly 250 women who were able to birth healthy babies after undergoing reversal therapy, plus another 100 who are currently pregnant and taking progesterone. He has not published research on those patients but estimates the success rate of the therapy is somewhere between 60 and 70 percent.
“I don’t know why there’s controversy and criticism,” he said. “It seems like a no-brainer. If these women change their minds, they should know that this exists.”
Buell, who underwent Delgado’s therapy and went on to deliver a healthy baby boy, said she’s grateful to have had a second chance to save her child. Her decision to abort, made in the aftermath of an abusive relationship, was driven purely by fear, she said.
“I’ve never felt more desperate and hurt than I did after taking that pill,” she said. “There was no other feeling, no worse of a situation I could have been in right then and there, thinking I’d made the biggest mistake of my life.”
She called the Abortion Pill Reversal hotline, established by Delgado and others in 2012, and got connected to Delgado’s brother Dr. Julian Delgado, a family practice physician in Colusa who has performed about 10 abortion reversals. His patients come from all over Northern California, he said.
Now 23, Buell splits her time between parenting Zechariah, 3, and his brother Eli, 5, and speaking publicly about abortion reversal at schools, churches and conventions.
“It’s so important for me to speak out,” she said. “For women to know they’re not alone, that they’re not crazy for making a decision of fear and then changing their mind.”