Information about the administration of Mifepristone (Mifegyne)

  • Reference Number: HEY-491/2018
  • Departments: Maternity Services

Introduction

This leaflet has been produced to give you general information about what will happen now you have made the difficult decision to end your pregnancy.  Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your doctor or midwife, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is Mifepristone?

Mifepristone is a tablet which acts by blocking the effects of progesterone, a hormone which is needed for a pregnancy to continue. It makes the uterus (womb) sensitive to contractions and helps in the next process of inducing labour, by softening the cervix (neck of the womb).

It is important to inform you that Mifepristone does not have a UK licence for use in pregnancy but is a recognised and approved drug of choice for ending a pregnancy. It is proven to work effectively. This can be discussed fully with your doctor or midwife.

Can there be any complications or risks?

In some circumstances this treatment may be unsuitable for you so please tell the doctor if:

  • You have a heart complaint
  • You have risk factors for heart disease such as high blood pressure or cholesterol (increased fat levels in your blood)
  • You suffer from asthma
  • You suffer from an illness that may affect the clotting of your blood
  • You have kidney or liver disease

Some medicines containing the following ingredients can interfere with the action of the mifepristone therefore please tell the doctor if you are taking or have recently taken any of the following:

  • Corticosteroids (used in the treatment of asthma or other inflammatory treatments)
  • Erythromycin, Rifampicin (antibiotics)
  • St John’s Wort (natural remedy used in the treatment of mild depression)
  • Phenytoin, phenobarbital, carbamazepine (used in the treatment of seizures: epilepsy)
  • Ketoconazole, Contractile (used in antifungal treatment) 

Do not take any anti-inflammatory pain killers after taking mifepristone such as:

  • Ibuprofen (Nurofen)
  • Aspirin
  • Diclofenac

 Diet – Grapefruit juice should not be taken when you are treated with mifepristone.

Possible Side Effects

Like all medicines, mifepristone can cause side effects, although not everybody gets them.

What will happen?

At the Antenatal Clinic

A midwife will check your personal details, document any allergies and discuss any concerns or queries you may have.  It is important to say if you are unsure about anything at this point.  The midwife will then take your blood pressure, temperature, pulse and respirations (vital signs).

Taking Mifepristone tablets

The mifepristone tablets can be swallowed with water. Sometimes mifepristone can make you feel sick and nauseous, so it is important to remain in the department for up to an hour after taking the tablets. The midwife will recheck your vital signs before you go home.

Admission to the Labour and Delivery Suite

The midwife will give you a date and estimated time to come into the Labour and Delivery Suite for the second part of the process which is usually around 48 hours after taking the Mifepristone. We ask that you ring the Labour and Delivery Suite in advance of your admission, to confirm a mutually suitable time for you to come in.

Pleased be assured that a designated midwife will be available at all times to support you during your time on the Labour and Delivery Suite. Additionally the bereavement midwife  will be available to provide support during your time in hospital and following your discharge home.

What happens after taking the Mifepristone?

If you are sick within two hours of taking the tablets, please telephone the Antenatal Clinic, Antenatal Day Unit, or the Labour and Delivery Suite for advice. The telephone numbers are on the back of this leaflet.

You may experience some backache or mild period type pains prior to your admission to the Labour and Delivery Suite. This can be helped by taking paracetamol.  If the discomfort worsens or if you have any bleeding from the vagina, telephone the Labour and Delivery Suite and ask to speak to the Labour Ward Coordinator who will have your details and will be able to give you advice.

Whilst at home eat and drink as normal, try and rest and pack the things that you will need for your stay in hospital. The induction process can take anything from hours to a few days before the birth. Your family can come and visit/support you during this time.

Your admission onto the Labour Ward

The Labour & Delivery Suite is located on the second floor of the Women & Children’s Hospital.

You will be welcomed by a midwife who will be caring for you and your birth partner for the duration of your stay.  You will be taken to a room where you and your birth partner will be given time to settle in. We have a dedicated suite however on rare occasions this may be occupied by another family and every endeavour will be made to find a suitable alternative room.

What will happen?

Following your arrival and when you feel ready your midwife will obtain a brief history and determine your options for care. They will confirm with you that your personal details are correct and will check your blood pressure, pulse, respirations and temperature.

It is important to tell the midwife or doctor is you are unsure about anything or if your wishes have changed.

Your midwife will discuss any relevant blood tests and their importance and may need to take blood from you prior to your treatment starting. A vaginal swab will be taken prior to commencing treatment if required.

When you feel ready, your midwife will continue the process of induction of labour. This is done using Misoprostol tablets which may be taken by allowing a tablet to dissolve in the side of your mouth or by placing the tablet high up in the vagina near the cervix (neck of the womb). The midwife will discuss fully with you the two options for administration. The action of the Misoprostol is to soften the cervix in preparation for labour.

It is important to inform you that Mifepristone does not have a UK license for use in pregnancy but is a recognised and an approved drug of choice for ending a pregnancy. It is proven to work effectively. This can be discussed fully with your obstetrician or midwife.

It is important to realise that you will probably not go into labour straightaway although this does sometimes happen. The tablets are given every six hours over a 24 hour period. A maximum of 4 tablets are given. If you have not given birth after 24 hours a senior doctor will make a further plan. The usual practice is to allow you to rest for a 24 hour period then repeat the process.

Sometimes you may need to have additional medicines to induce labour, if this is the case your midwife and doctor will discuss this thoroughly with you and your birth partner. The midwives and doctors will not be able to tell you exactly how long the process will take.

A full range of pain relief is available and your midwife will discuss options.  Sometimes there are complications following delivery and the doctor may need to carry out additional procedures to ensure that your womb is completely empty (manual removal of placenta) or to control heavy bleeding (post-partum haemorrhage) these will be fully explained to you if they become necessary.

Your midwife will also talk to you about the birth of your baby and your wishes following the birth. This may include a post mortem but this will only be carried out with your informed consent. We will provide a booklet produced by Sheffield as all postmortems take place in Sheffield at a specialist centre.

You do not have to make any decisions immediately your midwife and the doctors will allow you as much time as you feel you need. You will be given the opportunity to make memories if you wish to do so, the midwife will support with the choices available. This is a very individual decision and all your choices will be fully respected.

You will also be supported to make a decision with regard to funeral arrangements for your baby. A further patient information leaflet is available to inform you of your choices and to aid discussion your midwife.

The Bereavement Midwife will contact you prior to or after the birth. She will be able to give you advice and support with regard to care in labour and on-going help and guidance following the birth. Her contact details are listed below.

You will remain at the Labour & Delivery Suite throughout your stay, which may extend for more than one day. Visiting is unrestricted but will be guided by how you feel. The midwives will provide you with support throughout this time.  Our Hospital Chaplaincy service can offer both religious and non-religious support to all faiths.

 If you have any questions you can telephone the Bereavement Midwife Monday-Friday 08.00hrs -16.00hrs or the Labour & Delivery Suite for advice at any time.   UNSURE ABOUT ANYTHING OR IF YOUR WISHES HAVE CHANGED.  USEFUL INFORMATION AND TELEPHONE NUMBERS

Please discuss with the midwife caring for you a parking permit which is available to you during your stay in hospital

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact:

Labour and Delivery Suite on (01482) 604480 or 604390.

Antenatal Clinic (01482) 382623

Antenatal Day Unit (01482) 382729

Community Midwifes (01482) 382758

Bereavement Midwife (01482) 608962 or Mobile 07990800223

Other useful contact information

Stillbirth and Neonatal Death Society: SANDS
National Helpline: (0207) 436 5881
Local Contact: 07989425271

Email: info@hull-sands.org.uk

Antenatal Results and Choices: ARC
National Helpline: (0207) 6310285

Child Bereavement Trust
Support Line: (0845) 357 100

Crisis Pregnancy Centre
310 Newland Avenue
Tel (01482) 492929
www.crisispregnancy.co.uk

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.