Last year, a 35-year-old woman named Amanda, who lives in the Dallas / Fort Worth area, had a miscarriage early in her pregnancy. In large hospitals, doctors have performed surgical procedures that are often used as a safe and rapid way to remove tissue from a failed pregnancy.
She awoke from anesthesia and found a nurse-signed card and a small pink and blue bracelet with a butterfly charm. This is a gift from the hospital to show compassion for her loss. “It was so difficult that it was so sweet,” Amanda said.
Eight months later, in January, Amanda, who asked her to be identified by her name to protect her privacy, experienced another early pregnancy miscarriage. She went to the same hospital, Baylor Scott & White Medical Center, and she said she doubled with her pain and screams as she passed a large blood clot.
But when she requested dilation and curettage, or the same surgical evacuation procedure called D & C, she said the hospital told her no.
D & C is the same procedure used for some abortions. In September 2021, between Amanda’s two miscarriages, Texas enacted a law banning almost all abortions after six weeks of gestation.
Following the reversal of the Roe v. Wade case, many states have imposed abortion bans or strict restrictions. Although the law is technically intended to apply only to abortions, some patients report hurdles to receiving standard surgical procedures or medications for the loss of the desired pregnancy.
Amanda said the hospital did not mention the abortion law, but sent home instructions to return home only if the bleeding was severe and the diaper was filled with blood more than once an hour. .. According to hospital records Amanda shared with the New York Times, her embryos had no heart activity during their visit and on ultrasonography a week ago. She “reports that she has a lot of pain,” and “she appears to be suffering,” her record said.
“This looks like an ongoing miscarriage,” the record said, but suggested waiting for confirmation and advised follow-up within seven days.
Upon returning home, Amanda sat in the bathroom and dug “traces of my wall’s nails” out of pain. Then she moved to the bathtub, where both her husbands crying and squeezed their hands. “The water in the tub is bright red,” Amanda recalled. “For 48 hours, it was like constant heavy bleeding and a large clot.”
She added, “Their first experience they were so wonderful and so comforting was now very different from just being lonely and scared.”
Read more about the end of the Roe v. Wade case
The hospital refused to discuss whether the Texas abortion law had any effect on its medical care. In a statement, the hospital said, “Privacy law does not allow us to talk about individual cases, but our team of interdisciplinary clinicians will work together to determine the appropriate treatment plan for each individual case. Health and safety are our top priorities. “
John Seago, president of Texas Right to Life, said he considers all the disabilities encountered by miscarriage patients to be “very serious situations.” He blamed such a problem on “the collapse of the transmission of the law, not the law itself,” and clarified that “I saw reports that doctors were confused, but that was the failure of our medical association.” Did not provide any guidance.
The uncertain climate has made some doctors and hospitals worried that they will be accused of promoting abortion. This also caused some pharmacists to refuse or delay prescribing medicines to complete the miscarriage, providers and patients say. Last week, if the Biden administration refused to prescribe medicines containing medicines needed to manage miscarriage and abortion complications, these medicines could also be used for abortion, so pharmacies have sex. The basis of. “
Delayed drainage of tissue from an no longer viable pregnancy can lead to bleeding, infections, and sometimes life-threatening sepsis, obstetricians say.
“In this post-low world, miscarriage women can die,” said Dr. Monica Saxena, an emergency physician at Stanford Hospital.
Health professionals define abortion As a pregnancy that ends spontaneously 20 weeks before pregnancy. Most miscarriages occur in the first 13 weeks. Loss of pregnancy after 20 weeks is considered stillbirth. Miscarriage occurs in about one-tenth of known pregnancies and can occur in one-quarter if you include miscarriage that occurs before the patient becomes aware that she is pregnant.
In medical terms, miscarriage is often referred to as “spontaneous miscarriage.” This is a name that may raise the concern of patients or healthcare providers about being subject to an abortion ban. Medical records also labeled Amanda’s second miscarriage as “the threat of abortion: established and exacerbated.”
Dr. Sarah Prager, a professor of obstetrics and gynecology at the University of Washington School of Medicine, needs to provide patients with three options for draining tissue when cardiac activity ceases in a typical early miscarriage. Said.
D & C is recommended if the patient is bleeding heavily, is anemic, has blood clotting problems, or has certain conditions that make him medically vulnerable. Some other patients also choose doctrines and covenants, considering that they are emotionally easier than the protracted process at home.
Another option is medication. Mifepristone, which usually weakens the membrane that lines the uterus and softens the cervix, followed by misoprostol, which causes subsequent contractions. These same tablets are used for drug abortions.
The third option is “watchful waiting”. Waiting for the tissue to pass naturally. This can take several weeks. Dr. Prager, co-author of Miscarriage Management, said it was unsuccessful because 20% of patients require surgery or dosing. Guidelines For the American College of Obstetrics and Gynecology.
According to doctors and patients, lack of choice exacerbates the trauma of losing the desired pregnancy, so patients should be able to choose a method if possible.
In Wisconsin, a 173-year-old ban on abortion could soon be re-enforced, a gynecologist, Dr. Curly Zeal, said she had bleeding in a hospital shortly after her right to abortion was revoked. Was treated. She determined she had a miscarriage, but she told her that “they could not make doctrines and covenants because of the law.” Her hospital also did not provide her miscarriage medication and advised her to find her obstetrician and gynecologist. By the time she found Dr. Zeal, who had been given mifepristone and misoprostol, the woman had intermittent bleeding for several days, leaving her at an “increased risk of bleeding and infection.”
“Even in these simple cases of basic obstetrics and gynecology, the law leaves the provider with doubts and fears,” said Dr. Zeal. “These laws have already hurt my patients.”
Doctors say that in the case of an “unavoidable miscarriage” where the fetal heart activity is still present, an even greater risk may occur, but the patient’s water is too early for pregnancy to be feasible. Glia Donley, an assistant professor at the university, said Pittsburgh School.
Study from Two hospitals in Dallas 22 weeks gestation, water rupture or other serious complications, Texas law requires medical intervention until life-threatening “imminent threat” or fetal cardiac activity ceases We reported on 28 patients who did not. Patients waited an average of 9 days, 57% had serious infections, bleeding, or other medical problems, according to the report.another paperThe New England Journal of Medicine said similar patients returned with signs of sepsis after a doctor or hospital determined that Texas’s abortion law prohibited early intervention.
In such cases, Texas Right to Life Dr. Sigo said the abortion ban may need to delay intervention. He said that what he characterized as a doctor was banned, “I believe I will eventually die, so I want to kill my child today.” He acknowledged that such delays could cause medical complications in women, but said that “severe” complications could be legally treated immediately.
Mifepristone, one of the miscarriage medicines, must be prescribed by an authorized provider and cannot be dispensed at regular pharmacies. The certification process is simple, but Dr. Lauren Tuxton, an assistant professor of women’s health at the University of Texas at Austin’s School of Women’s Health, said some hospitals said, “Is this drug also used for miscarriage? It can’t make the seed look bad. “
Therefore, in some states, doctors prescribe misoprostol only for miscarriage. This may work on its own, but it doesn’t work very well. It is also used for other medical conditions and should be readily available at pharmacies, but some people refuse to fill out a miscarriage patient’s misoprostol prescription or request additional documentation from their doctor, Dr. Taxton said. Etc. are stated.
Kathy, a Houston woman who was asked to identify her by her first name, had a miscarriage on the day of the Roe v. Wade overthrow when a doctor detected blood in her womb and no heart activity. Said that he knew.
She was prescribed misoprostol, but Walgreens said she had to wait a day for “additional approval” from headquarters.
“When I went to pick it up, then I had to talk to a pharmacist, and even if they knew that my doctor prescribed it, it wasn’t for abortion. They had to say it again, “Kathy said.
A Walgreens spokesman said some abortion laws “require additional steps to dispense a particular prescription and apply to all pharmacies, including Walgreens.” In these states, pharmacists work closely with prescribers as needed to create legal and clinically relevant prescriptions. “
Dr. Taxon said that if the pharmacy delays the dispensing of misoprostol, some patients will not be able to return to the drug economically or logistically on another day. Instead, she visited a doctor a few days later and said she was holding pregnant tissue or “has serious bleeding that needs urgent management.”
In March of Missouri, where abortion was banned after the Roe v. Wade incident, Gabriella asked to identify by her name, but said she had dead eggs and fertilized eggs were transplanted into the uterus but did not develop. rice field. “My body didn’t release it,” she said.
Her doctor prescribed misoprostol, but it didn’t work well. When she asked for Mifepristone, the doctor said it would be difficult to get there, according to a doctor’s memo shared by Gabriella with the Times.
The doctor ordered a second misoprostol, but Gabriella said: I was able to stutter that I was miscarriage, and she gave me it. She couldn’t help crying in front of all the people in Walgreens because she felt like she was being treated like a bad guy by taking medicine to prevent infection. “
Dr. Prager said some Texas miscarriage patients were allegedly rejected by doctors who were worried that they might actually have taken an abortion drug that did not expel their pregnancy.
“There is a system of unreliable relationships between doctors and patients. Patients may choose not to go to the hospital because they are afraid of something like a miscarriage,” Dr. Prager said. rice field.
Some women who have a miscarriage and are at risk of future loss say they are considering moving from a state that prohibits abortion or are rethinking their life plans.
“We don’t think about it anymore,” Amanda said. “We don’t feel safe to continue to challenge after what we have experienced in Texas.”