Doctor calls for stop of 'demeaning' practice of watching women swallow Mifegymiso 'abortion pill'

A doctor and professor says physicians should stop the practice of watching women swallow the Mifegymiso abortion pill because Health Canada says it's not necessary.

Not required in Canada, but doctors at Regina General Hospital still do it

Mifegymiso is a two drug medication used for medical abortion. (CBC)

Doctors should stop the "demeaning" practice of supervising a woman while she swallows the Mifegymiso abortion pill, a professor says.

Dr. Wendy Norman teaches at the University of British Columbia and chairs family planning research for the Public Health Agency of Canada and Canadian Institutes of Health Research.

She said a myth exists that physicians are required to watch a patient ingest mifepristone — one of a two-drug combination packed together as Mifegymiso, for medical abortions.

"The evidence is clear that having the practitioner observe the woman is demeaning. It's inappropriate. There's no other medication where the practitioner is required to observe a normal healthy woman taking a medicine," said Norman, adding that methadone may be the only exception.

'Absolutely astounding'

Saskatchewan's College of Physicians and Surgeons — the licensing body for doctors — issued a statement to members in the spring clarifying that a physician is not required to watch a patient ingest the medication and patients have a choice to take the medication in a doctor's office or at home.

Despite that, physicians at the Regina General Hospital who prescribe the medication are instructed to watch women ingest the medication.

"The requirement to watch a patient take the medication has changed, however our protocol is that the patient is watched by the physician," Anne Lindemann, Regina Qu'Appelle Health Region spokesperson, wrote in a recent email to CBC.

"This is one clinic's process of how Mifegymiso is accessed by patients in Saskatchewan. How other private medical offices choose to administer I am not entirely sure of."

Norman said that's "absolutely astounding."

How Mifegymiso works:

Mifegymiso, a type of abortion pill, is two-drug combination of mifepristone and misoprostol.

Mifepristone blocks the hormone progesterone from preparing a woman's uterine lining for pregnancy, then misoprostol induces contractions.

Saskatoon's Dr. Brian Fern explains the procedure as an induced miscarriage.

Started with a mix-up

Health Canada approved the sale of the medication in July 2015 after a two-and-a-half year review.

Initially, the approved parameters stipulated a woman should be watched by a physician as she ingests the mifepristone tablet.

Norman said she and other researchers brought forward evidence against the need for that provision to the recently elected Liberal government.

Wrong packaging sent out

In October 2016, Health Canada reviewed the stipulation and amended it. According to a spokesperson for the federal health department, the product monograph — an information sheet which comes with a prescription — was clarified so that a patient can take the medication either in a doctor's office, at home or under the supervision of another health professional. 

 New product labelling was approved, however, it was not printed when Mifegymiso hit the Canadian market in 2017.

Dr. Wendy Norman is an associate professor at the University of British Columbia. (University of British Columbia)

"Up until now the company has been shipping out and selling this original lot that was printed before the October [2016] rule change, so doctors and pharmacists are reading on the box that women have to be observed by the doctor swallowing the pill when that has not been true for almost a year."

Norman said boxes delivered after July 20 should have the correct labelling.

In May, the Canadian distributor, Celopharma, issued a message saying the box labels and packaging currently being distributed "may not accurately reflect the information found on the product monograph."

The updated information states that a patient takes the mifepristone tablet, then take the misoprostol tablets 24-48 hours after taking the first tablet.

Celopharma has not yet responded to CBC News's request for comment


Stephanie Taylor

Reporter/The Canadian Press

Stephanie Taylor is a Canadian Press reporter based in Ottawa. Before that, she wrote out of Saskatchewan.