In late October, Dr. George Delgado addressed an annual gathering of doctors at a west-end Ottawa hotel. The 150 members of Canadian Physicians for Life in attendance greeted the San Diego doctors presentation on his Abortion Pill Reversal Protocol, with great enthusiasm.

According to Delgado, a medical abortion can be rewound once started, should a woman change her mind halfway through the process.

The reversal involves injecting or prescribing large doses of progesterone to women who have taken the first of two abortion medications, but not yet the second.

The highly controversial experimental practice is behind a creeping number of abortion reversal bills being introduced in the U.S. laws that compel doctors, on pain of civil or criminal penalties, to inform women that it may be possible to undo a medication-induced (but not surgical) abortion once started, a claim the American Medical Association and other leading medical groups say is patently false and wholly unsupported by scientific evidence.

We know that not all women know about this because its still relatively under-publicized

Critics say state laws as well as pro-life groups promoting reversal on the internet are playing into old political and social narratives that women cant be trusted to make choices on their own, that they choose abortion hastily and that, once the choice is made, many regret it. It introduces this feeling that women need to be protected from their own decision, which is, of course, completely untrue, said Dr. Alice Mark, medical director of the National Abortion Federation. Studies have shown that that vast majority of women who choose abortion are certain about their choice their decisional certainty is higher than for almost any other medical procedure, Mark said. They do not end up in an abortion clinic by mistake.

According to Delgado, more than 900 babies, including Canadian babies, have been born after a successful reversal since he and co-author Mary Davenport first reported a tiny case series in 2012 involving just six women. Another 100 women, he claimed, are currently pregnant. The figures, he said, are based on calls to Abortion Pill Rescue, a network of physicians prepared to initiate reversal protocols when a woman contacts the toll-free hotline. Canadian doctors are among them.

I know of one physician (in Canada) who has taken four women already through to successful births, said Canadian Physicians for Life executive director Nicole Scheidl.

We also know that not all women know about this because its still relatively under-publicized, Delgado told the National Post. And so I imagine that if every woman who started the process of medical abortion knew about the possibility of reversal there would probably be more women who would be requesting reversal.

Weve had several many anecdotal reports of women calling these abortion centres and being told that reversal is not possible, or your baby is sure to have birth defects, which is a lie.

But experts say medical abortion isnt considered a reversible procedure in any country where the two-pill abortion regimen is legal and that abortion reversal bills, which have faced successful legal challenges, are ideology wrapped in bad science government-mandated messaging that violates physicians First Amendment rights to freedom of speech, as well as their ethical duties, by forcing them to give women information about an unproven therapy.

In addition to the obvious ethical issue of claiming a treatment for which the science hasnt proven it, the bigger issue is that it once again raises suspicion about the role of abortion providers and the safety of abortion, said Dr. Dustin Costescu, a family planning specialist at McMaster University and a principal author of Canadian guidelines on the abortion pill.

Suggesting that medical abortions can be undone with treatment could also have the contradictory consequence of encouraging woman who arent certain they want to abort to take the abortion medicines, unrealistically thinking they might reverse later, said Dr. Wendy Norman, a leading researcher in reproductive health at the University of British Columbia.

Here, in theory, is how Delgados protocol works: Approved in Canada three years ago, the two-step abortion drug the unwieldy-named Mifegymiso pairs one drug, mifepristone with a second, misoprostol.

Taken first, mifepristone blocks the hormone progesterone, which normally helps prepare the lining of the uterus for a pregnancy. The lining becomes less stable, breaks down and sheds, similar to what happens during a womans menstrual period. Misoprostol, taken 24 to 48 hours later, causes the uterus to contract, expelling the pregnancy.

Under Delgados method, within 72 hours after taking mifepristone, the first pill, a woman can be prescribed progesterone to keep mifepristone from binding to progesterone receptors. Flooding the body with progesterone blunts or outcompetes the mifepristone, reversing its effects, Delgado said.

On pro-life websites in Canada, women who take the first pill are told the process CAN be reversed, but that time is of the essence. Canadian Physicians for Life tells women that if you would like to keep your baby, they have two options: contact the abortion reversal hotline to be connected to a local doctor, or, if there isnt a doctor registered with the network in their area, to take a Dear Colleague form letter immediately to their family doctor or nearest walk-in clinic for the supplemental progesterone.

Of Delgados six-case study of abortion reversal with progesterone published in in 2012, four of six women carried their pregnancies to term.

People who might be opposed to abortion pill rescue seem to have forgotten their entire purpose of promoting choice for women

More recently, the California doctor published a retrospective review in Issues in Law and Medicine, a journal co-sponsored by a pro-life organization, based on data from the abortion rescue hotline. The study initially involved 754 women who took progesterone in an effort to reverse the abortion. After excluding a quarter of the women for different reasons, Delgado and colleagues reported an overall rate of reversal of 48 per cent, rising to 64 per cent among women given progesterone via injection. There was no apparent increased risk in birth defects, they said.

Among the many troubling problems he has with the study (including the number of women excluded or lost to follow-up), Costescu pointed out that mifepristone alone is not an effective abortion-inducing drug. In studies of women who stopped after taking mifepristone only, the continuing pregnancy rate ranged from eight, to 46 per cent.

You need the second medication that brings on the actual contractions that allow for expulsion or delivery of the fetus, Costescu said. As Dr. Daniel Grossman of the University of California, San Francisco and Kari White of the University of Alabama at Birmingham wrote in the New England Journal of Medicine, There is no evidence that treatment (with progesterone) is superior to doing nothing at all. Laws promoting reversal, they wrote, essentially encourage women to participate in an unmonitored research experiment.

There is no evidence that treatment is superior to doing nothing at all

Although progesterone is considered low-risk its often given to women at danger of miscarrying the hormone has been associated with depression, high blood pressure and other problems. Progesterone also hasnt been approved in either the U.S. or Canada for use in reversing the effects of the abortion drugs.

Abortion interruption bills arent going unchallenged: Just days before Delgados presentation to the Ottawa gathering of doctors, an Oklahoma judge temporarily halted a law that threatens doctors with felony charges if they dont inform women about reversal treatment.

A North Dakota judge issued a similar ruling in September, calling that states reversal law devoid of scientific support.

Dr. Will Johnston, a Vancouver family doctor and past president of Physicians for Life, said he doesnt believe in getting laws involved in ensuring informed consent. Its an intrusion, he said, that comes too close to compelled speech.

However, women simply deserve to know whats available to them, Johnston said. If there is any chance that the progesterone could help and its not harmful, why this vociferous opposition to it, he said.

People who might be opposed to abortion pill rescue seem to have forgotten their entire purpose of promoting choice for women. Why would you say that once a woman takes a pill I approve of that she loses her choice to try to reverse its effect if she changes her mind? Its just illogical, and its unfeeling and uncaring toward women.

Mark, of the abortion federation, said reversal proponents are creating a problem where none exists, because vanishingly few women who take the first abortion pill decide not to take the second. According to data obtained by Grossman and White, (the authors of that New England Journal of Medicine article) from the American manufacturer of mifepristone, less than 0.004 per cent of patients who took the drug between 2000 and 2012 ended up deciding to continue their pregnancies.

If women are second-guessing their decision they can benefit from other forms of counselling that we can provide, Costescu said. But the medical answer would be to wait and to see what happens after taking that first medication. (Mifepristone, the first pill, is not known to cause birth defects. Misoprostol, however, has clearly been shown to cause fetal malformations.)

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This U.S. doctor says he can 'reverse' a medical abortion and experimental practice is used in Canada - National Post

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