A Pennsylvania woman who works at a nursing home awaits arraignment on charges of "recklessly" performing an illegal abortion without a medical license on a 16-year-old by giving her commonly used pills that caused a miscarriage and medical complications.
Jennifer Whalen, 38, allegedly paid $45 for two drugs she ordered online from an overseas pharmacy without a prescription in January 2012, according to the criminal complaint filed in the Court of Common Pleas of Montour County on Dec. 9, 2013. It also charges that she performed the abortion without a medical license.
Taken together, the drugs Whalen ordered -- misoprostol and mifepristone -- are safely used to induce miscarriage and are widely used around the world where surgical abortions are not readily available. In the United States, the drugs are available by prescription only, and are to be administered only under a doctor's supervision.
Whalen has been charged on felony and misdemeanor counts and just this week waived her right to appear at a March 11 arraignment, according to her lawyer, Matthew Bingham Banks. He would not say if the teen was Whalen's daughter.
"I think it's inappropriate to make comments now when this is ongoing," Banks told ABCNews.com. "Should we go to trial at all, the facts will come out."
In Pennsylvania, women under 18 must get parental permission before receiving an abortion, according to the Guttmacher Institute, which advocates for women's reproductive health including abortion rights. Women must also receive counseling and wait 24 hours before a procedure is provided.
Under state health exchange rules under the Affordable Care Act, abortion is only covered when a woman's life is endangered or in cases of rape or incest.
Whalen lives in Washingtonville, a rural town in the smallest county in the state. According to court papers, the teenager did not have health insurance and did not want to go to the hospital for the abortion.
Whalen allegedly discussed buying the pills from on online pharmacy with the teen, according to court papers. "She didn't think they would be any different from the pills she would get at the hospital," child welfare authorities told police.
"Under the law, an abortion cannot be performed except by a physician … and that is a violation of the law," Montour County District Attorney Rebecca Warren, who waited more than a year to file charges, told ABCNews.com.
The teen began menstruating after taking the pills, but early in the morning on Feb. 6, 2012, she began to have severe stomach pains and was taken to the emergency room at Geisinger Medical Center in Danville where she had a miscarriage, according to court papers. Authorities reported the incident to child protective services, according to Warren.
Geisinger spokesperson Mike Ferlazzo told ABCNews.com "We really don't have anything to say on the case."
Mifepristone, used together with misoprostol, was approved by the Food and Drug Administration for use in medical abortions in 2000. It must be used within 49 days within of the start of the woman's last menstrual period and used under the supervision of a medical practitioner.
But used at home, the drug combination can be risky, according to Dr. Jennifer Ashton, an ob/gyn and an ABC News senior medical contributor.
"The problem with women using or buying these drugs online is that they don't know if they are pure or contaminated," she said. "They are also not counseled regarding risks of failure – some don't complete the abortion – and risks of infection or excessive bleeding and then they may not have a medical doctor that can care for them if these side effects occur."
The drug combination has been associated with some adverse reactions, including several deaths from infection, according to the FDA.
"Sepsis is a known risk related to any type of abortion," says the FDA on its website. "We do not know whether using mifepristone and misoprostol caused these deaths."
"Patients should contact a healthcare practitioner right away if they have taken these medications for medical abortion and develop stomach pain or discomfort, or have weakness, nausea, vomiting or diarrhea with or without fever, more than 24 hours after taking the misoprostol," says the FDA.
Mifepristone works by changing the uterine lining and softening the opening of the cervix. It also increases the uterine sensitivity to misoprostol, which causes the uterus to contract and helps the pregnancy tissue to expel the fetus.
Dr. Dan Grossman, who served on a committee to revise recommendations for use of the drugs in medical abortion for the American College of Obstetricians and Gynecologists, said there are no age restrictions on the use of the drugs and "only a handful of conditions" where they are contraindicated.
"It's very safe and effective and a method women really like and prefer here in the United States," he said. "It's most commonly used up to nine or 10 weeks of pregnancy and can be used later as well."
But Grossman, who is executive director of the pro-abortion rights reproductive health organization IBIS, said he does not recommend ordering these drugs online.
"The biggest risk is that you never know what you are getting and there is no way to ensure that they are actually these drugs," said Grossman. "The other risk is you don't know exactly how far along you are without a physician or midwife evaluating the woman."
Another risk, as with the Whalen case, is that a woman does not get proper follow up. In a "small percentage" of cases, the abortion is incomplete or the pregnancy continues to develop.
"I don't know all the details of this case, but other research on done on self-induced abortion, generally women do this because they either can't get to an abortion clinic or they don't know where to access abortion or they don't have the money," said Grossman.
"It may also be a stigma issue," he said. "Access barriers play a role in pushing women to do these things."