A SINGLE PILL in a paper cup upended Rebekah Buell’s life.

In 2013, the 18-year-old college freshman sat in a Planned Parenthood office near Sacramento, Calif., staring at an abortion pill formulated to end the life of the 8-week-old baby in her womb.

Buell already had an infant son from an unplanned pregnancy. Her brief marriage was ending. She couldn’t imagine raising a second child alone. Buell grew up Baptist and knew abortion was wrong but says she thought, “God’s just going to have to forgive me.”

But sitting across from a Planned Parenthood worker, Buell felt tears welling up in her eyes. She says the worker told her, “Just because you’re sad doesn’t mean you’re making the wrong decision.” Buell says she also warned, “Once you take this, there’s no going back.”

Buell swallowed the pill. A few million women have done the same since the Food and Drug Administration (FDA) approved the abortion drug mifepristone in 2000. Mifepristone aims to kill an unborn baby by blocking the progesterone hormone needed to sustain the pregnancy. A second drug—misoprostol—induces contractions and expels the unborn child.

A woman takes the first pill at an abortion center or physician’s office. She takes the second drug at home. A common piece of advice abortionists give pregnant women: If you pass a blood clot larger than a lemon, call us.

Bottles of abortion-inducing drugs Charlie Neibergall/AP

Buell planned to abort her baby in secret at her parents’ home. With the pills, she could avoid surgery and anesthesia. She says it seemed “convenient and easy to hide.” No one would have to know.

It’s a common scenario: This year nearly as many women may end their pregnancies through chemical abortions as through surgical ones. The pro-abortion Guttmacher Institute has estimated some 25 percent of pregnancies end in chemical abortions, but Planned Parenthood—the nation’s largest performer of abortion—reported last year nearly 43 percent of the abortions at its centers were drug-based.

Despite documented risks of heavy bleeding, hemorrhaging, and even a handful of deaths, the FDA loosened its protocol for the abortion pill regimen early last year. The agency approved use of the drugs for up to 10 weeks of pregnancy (instead of seven), and reduced the number of suggested doctor visits from three to two.

Many abortionists already followed the looser protocol, but three states had required physicians to follow the FDA’s stricter recommendations: Since the agency relaxed standards last March, officials in Ohio, Texas, and North Dakota say requests for chemical abortions have tripled.

Pro-abortion forces have pushed hard, and the FDA has responded: Last year the agency allowed a clinical trial to send abortion drugs to women in four states via U.S. mail. The mothers still had to obtain an ultrasound to confirm their pregnancies; but their abortion consultations happened over their computers, and the abortion pills arrived in their mailboxes.

Esther Priegue of the Choices Women’s Medical Center in Queens, New York, marveled at the possibilities for the pregnant women in the packed waiting room of her abortion center last spring: “Imagine if they could do it all from home, and never have to step into the clinic for even for a moment.”

“IMAGINE.” In Iowa in 2008, staffers at Planned Parenthood centers without a physician on site used their imaginations to devise a shrewd plan: abortion by television. Such “telemedicine” works this way: A woman thinks she’s pregnant, a technician performs an ultrasound to confirm, and the mother then speaks with a physician off-site via webcam. The physician clicks a link on his computer. A drawer pops open in front of the woman. Inside: enough pills to end her baby’s life.

Sixty-four percent of abortions in Iowa are now via abortion pills. Nineteen states ban abortion via telemedicine, but even without high-tech options, thousands of women are willing to visit abortion centers to obtain the pills.

For many women, it’s a heavy burden to bear alone: The pills taken at home induce heavy bleeding and cramping to expel the unborn child and may leave some mothers self-diagnosing whether their experiences are typical or treacherous.

In 2003, 18-year-old Holly Patterson died after obtaining abortion drugs from a Planned Parenthood center in California. An emergency room physician sent Patterson home after she arrived suffering from severe cramping and bleeding.

Three days later, she returned to the ER. She was unable to walk. When her father, Monty Patterson, arrived at the hospital, physicians told him Holly had a massive infection from an incomplete abortion. He didn’t know abortion pills existed.

Staffers pushed the stunned dad from the room while Holly’s vital signs plummeted. Patterson remembers yelling from the hall: “Don’t give up! We love you, Holly!” It was too late. Holly died just before 2:00 p.m. on Sept. 17, 2003.

Monty Patterson holds a photograph of his daughter, Holly. Michael Macor/San Francisco Chronicle/AP

The makers of mifepristone insist the drug is safe. But in 2009, a study published in the journal Obstetrics and Gynecology showed a chemical abortion has four times more adverse effects than a surgical abortion.

In 2011, the FDA reported at least 339 women had suffered blood loss requiring transfusions. At least 250 suffered infections. Fourteen women who took the drug later died.

Often, the longest-lasting damage isn’t physical.

In 2013, Leslie Wolbert testified in an affidavit to the Supreme Court about her experience using abortion pills in 2006. She said she suffered “the worst pain I’ve ever felt in my life.”

After vomiting and severe bleeding, Wolbert took a shower and saw a large blood clot clogging the drain. She flushed the tissue down the toilet and realized, “I was flushing what was left of the life of the child that was growing inside of me.”

She called her emotional pain “almost unbearable” and said, “This was all done in my own home, in the family bathroom, the family shower, the place where I had to live after this experience.”

Wolbert said she found forgiveness from Christ but talks about her experience because “I hate that they say it’s safe or simple. I hate that they don’t tell you what you really experience and the extreme loss and heartache you will feel.”

EVEN AS AT LEAST 15 states have passed 20-week abortion bans—and a GOP Congress considers a similar federal measure—the abortion battle is shifting to the earliest stages of pregnancy. The swelling numbers of chemical abortions—and the FDA’s experiment with mailing the poison pills—reveals a shrewd push toward making painful and traumatic abortions more secretive and detached from a doctor—and more difficult for pro-life forces to stop.

Are they ready? How do pregnancy resource centers reach women pursuing increasingly secretive abortions, especially when they are up against the billion-dollar budget Planned Parenthood enjoys each year?

One of the front lines may be online—in the first moments a woman searches for information. The pro-life marketing research firm Heroic Media works to point women to the websites of about 50 local pregnancy care centers that hear from a high percentage of abortion-minded women.

Brett Attebery, the company’s vice president of marketing, says in the last year searches for abortion pills have surged: up 50 percent in New Orleans and 36 percent in Philadelphia. A 2015 study by the pro-life Charlotte Lozier Institute showed 46 percent of the women surveyed said they were aware of a pregnancy resource center in their area. Sixty-two percent said they were aware of a Planned Parenthood facility nearby. (Ninety-three percent of women had heard of the abortion giant.)

Heroic Media buys Google ads to try to steer women searching for abortion pills to pro-life care centers in their area. Care Net—a nationwide network of pregnancy care centers—also uses Google keyword ads to direct women to its pregnancy decision hotline.

Cindy Hopkins of Care Net says many women asking about abortion pills often misunderstand how the drugs work: Some women think they take a pill and the baby dissolves. Cindi Boston of Heartbeat International—another network of care centers—says women calling the group’s Option Line ask similar questions.

So far, it doesn’t appear pro-life groups have narrowed their focus to specific campaigns aimed at abortion pill prevention. Attebery of Heroic Media says his group’s strategy is the same as intervening before a surgical abortion: Women seeking abortion pills are abortion-minded, and the goal is to connect them with a local pregnancy care center.

Astrid Bennett Gutierrez of Los Angeles Pregnancy Services says her care center has seen an increase of women seeking abortion pills in the low-income, predominantly Hispanic community she serves. The center’s staff members explain the process—and offer alternatives to abortion—but it’s an uphill battle: There are nine abortion centers nearby.

Since a baby’s heartbeat is usually visible by 6 weeks in the womb, ultrasounds are helpful even at early stages. But women may seek chemical abortions as early as 3 weeks, when the ultrasound images may be harder to discern.

In the FDA’s recent mail-order experiment, women obtained ultrasounds (and blood tests), but a webcam abortionist then mailed the abortion pills to the woman’s home. That meant a woman could visit physicians or medical technicians who offer ultrasounds but don’t stock abortion pills.

It also raised a chilling question: In the future, could a woman use a pro-life, pregnancy care center’s free ultrasound services to later obtain abortion pills via mail? It’s unclear if the process could evolve to include that option, but it’s a disturbing possibility worth following.

REBEKAH BUELL SAYS she was deeply disturbed before she reached the parking lot after taking the mifepristone pill at the Planned Parenthood near Sacramento in 2013. She panicked: “What have I done? What is the pill doing to my baby right now?”

Earlier, when she planned her abortion, she knew about the five Planned Parenthood centers within a 20-minute drive of her house. Three pro-life, pregnancy care centers were within a similar distance. Buell hadn’t heard of any of them.

By the time Buell swallowed mifepristone at the Planned Parenthood office, her baby was approaching 9 weeks in the womb. According to the website BabyCenter, a 9-week-old, unborn baby’s heart has finished dividing into four chambers, and the valves start to form—so do tiny teeth. The baby’s eyes are fully formed, and he has tiny earlobes. His basic physiology is in place, though he is still very tiny: “Your baby is about the size of a grape.”

Buell couldn’t bear the thought of her tiny baby dying in her womb because of a pill she had just swallowed. In the parking lot of the Planned Parenthood center she prayed, “If there’s a way out, please help me.”

Then she started googling. She learned that it may be possible to reverse a chemical abortion after a woman takes the mifepristone pill—and she found a hotline for abortion reversal.

A nurse from the Culture of Life Family Services answered. She explained the process that pro-life doctor George Delgado helped pioneer: Since mifepristone blocks a woman’s progesterone hormones to kill her unborn baby, giving the mother progesterone treatments may counteract the abortion—if given soon after the mifepristone pill. (Doctors have prescribed progesterone to women for infertility for years.)

It’s still early in development, but Delgado says 225 women who changed their minds after ingesting the first abortion pill have delivered their babies after taking the abortion reversal treatment. Another 157 are pregnant. Abortion reversal doesn’t work for everyone: Delgado says he’s seen about a 50 percent success rate, though he says the rate goes up to 65 to 75 percent with the dosage protocols he’s identified as most effective.

Buell was willing to try it. She drove a couple of hours away to the nearest physician offering the treatment. An ultrasound showed Buell’s baby was still alive, and the physician administered progesterone injections. He sent her home with a prescription to continue the injections for a few weeks.

On Oct. 20, 2013, Buell went into labor. She delivered a healthy newborn son. In the hospital, Buell thanked God for her child, and she chose a name for the baby boy whom others had encouraged her to forget. She calls him Zechariah—a name that means “God remembered.”

Buell with Zechariah Gary Fong/Genesis Photos

Buell now works at her local pregnancy care center as a director of outreach. She tells women about her abortion reversal story, but she also helps encourage women to avoid having an abortion at all.

It’s a climate Planned Parenthood anticipates. On its website at the end of the year, the billion-dollar business asked for donations and warned that it faced “unprecedented dangers” in an increasingly pro-life climate.

Buell is thankful her son, Zechariah, escaped the deadly danger of the abortion pill she ingested in 2013. “I’m so grateful just to be able to know him and be his mom,” she says. “This is grace. I didn’t deserve him. This is the very definition of a second chance at life.”

Bottles of abortion-inducing drugs Charlie Neibergall/AP

The abortion pill: a whirlwind history

In 1988, a French pharmaceutical company began marketing the abortion drug mifepristone—also known as RU-486—to women in France. A year later, the FDA (under President George H.W. Bush) banned the drug’s use in the United States, citing safety concerns. In 1993, President Bill Clinton used an executive order to lift the ban on his third day in office.

The FDA declared mifepristone safe in 1996, but officially approved it in 2000. Danco Laboratories—a for-profit company with close ties to Planned Parenthood—emerged to distribute the drug. The secretive company used a lab in China to produce the drug’s compound.

Many private physicians balked at offering women the controversial pills. Most women still visit an abortion center to obtain the drugs. That’s a boon for Planned Parenthood: The abortion giant often charges as much for a chemical abortion as for a surgical one. —J.D.

A doctor gives out RU-486 pills at a Paris hospital in 2000. Manoocher Deghati/AFP/Getty Images

How effective is abortion reversal?

Dr. George Delgado published an initial study of abortion reversal with six participants in 2012, but he plans to submit another report for publication early this year, showing that 382 women have delivered babies or remain pregnant after abortion reversal treatment, out of 704 attempts.

Delgado’s critics say mifepristone alone doesn’t always end a pregnancy, and that it’s possible the women may have continued their pregnancies without the progesterone treatments.

The American Association of Pro-Life Obstetricians and Gynecologists has endorsed the abortion reversal process. More than 350 physicians offer the treatment to mothers seeking help.

Delgado hopes as more pro-life physicians and nurses learn about the treatment they’ll be more willing to offer it. Delgado sends participating doctors a training module and is available for follow-up, consultation, and additional training.

The doctor also hopes more pregnancy care centers will get involved. Nearly 200 care centers are a part of the group’s network to help women seeking abortion reversals.

Three states have passed Abortion Reversal Information Acts, requiring abortionists to inform women about the possibility of reversing their abortions if they change their minds after the first pill. (Arizona repealed its law last year after facing a court challenge by Planned Parenthood and the ACLU.) Americans United for Life has drafted model legislation for states to use when considering similar measures. —J.D.