I wish to terminate my pregnancy by medical means.
I understand the risks of medical abortion, which include infection, bleeding profusely, requiring emergency services at a hospital, blood transfusion, incomplete passage of the pregnancy requiring emergency surgery, and in very rare cases even death. I understand that medical abortion is unpredictable, and in some cases may not work at all, thereby requiring surgical abortion.
I understand that an abortion pill only works and is FDA-approved for up to 10 weeks of pregnancy gestation, as calculated by the Last Menstrual Period, or as estimated by ultrasound. I believe I am under 10 weeks gestation.
I understand that the abortion pill does not work if the pregnancy is located in the tubes, called an ectopic pregnancy, and I have no reason to believe that I have an ectopic pregnancy.
I understand I will be given a medication called misoprostol, which can cause birth defects in a pregnancy that subsequently continues. Since medical abortion does not work sometimes, if it does not work in my case, I will obtain a surgical abortion. Continuing a failed medical abortion could result in a complicated pregnancy and birth defects.