Last year, a 35-year-old woman named Amanda, who lives in the Dallas-Fort Worth area, had a miscarriage during the first trimester of her pregnancy. In a large hospital, a doctor performed a surgical procedure that is often used as a safe and quick method to remove tissue from a failed pregnancy.
He woke up from the anesthesia and found a card signed by the nurses and a small pink and blue bracelet with a butterfly charm, a gift from the hospital to express compassion for his loss. “It was so sweet because it’s so hard to pass up,” Amanda said.
Eight months later, in January, Amanda, who asked to be identified by her name to protect her privacy, suffered another miscarriage in the first trimester. He said he went to the same hospital, Baylor Scott & White Medical Center, bent over in pain and screaming as he passed a large blood clot.
But when he asked for the same surgical evacuation procedure, called dilation and curettage, or D&C, he said the hospital told him no.
A D&C is the same procedure used for some abortions. In September 2021, between Amanda’s two miscarriages, Texas implemented a law banning almost all abortions after six weeks of pregnancy.
After the revocation of Roe v. Wade, many states are enacting strong bans or restrictions on abortion. Although technically the laws are intended to apply only to abortions, some patients have reported problems receiving standard surgical procedures or medications for the loss of desired pregnancies.
Amanda said the hospital did not mention the abortion law, but sent her home with instructions to return only if she was bleeding so excessively that her blood filled a diaper more than once an hour. Hospital records Amanda shared with The New York Times noted that her embryo had no cardiac activity during that visit and on an ultrasound a week earlier. “She complains that she is in a lot of pain” and “she looks distressed,” records say.
“This appears to be a miscarriage in progress,” records noted, but suggested waiting to be confirmed and advised follow-up in seven days.
Once home, Amanda said, she sat on the toilet digging “nail marks on my wall” for pain. She then moved to the bathtub, where her husband held her hand while they both cried. “The water in the tub is just dark red,” Amanda recalled. “For 48 hours, it was like heavy, constant bleeding and large clots.”
She added: “It was so different from my first experience where they were so nice and so comforting, to feel lonely and terrified now.”
Read more about the end of Roe v. Wade
The hospital declined to discuss whether Texas abortion laws have had any impact on their health care. In a statement, the hospital said: “While we cannot talk about a person’s case due to privacy laws, our multidisciplinary team of physicians work together to determine the appropriate individual case-by-case treatment plan. “The health and safety of our patients is our top priority.”
John Seago, president of Texas Right to Life, said he considers any obstacle faced by patients with miscarriage to be “very serious situations.” He blamed these problems on “a failure to communicate the law, not the law itself,” and added “I’ve seen reports of confused doctors, but this is a failure of our medical associations” to provide clear guidance. .
The climate of uncertainty has caused some doctors and hospitals to worry about being accused of facilitating an abortion, a fear that has also led some pharmacists to deny or delay filling medication prescriptions to complete abortions, say providers and patients. . Last week, the Biden administration warned that if a pharmacy refuses to fill prescriptions for pills “including medications needed to manage a miscarriage or complications of pregnancy loss, because those medications can also be use to terminate the pregnancy, the pharmacy may be discriminating on the basis of sex.
Obstetricians say delays in the expulsion of tissue from a pregnancy that is no longer viable can lead to bleeding, infections, and sometimes life-threatening sepsis.
“In this post-Roe world, women with miscarriages can die,” said Dr. Monica Saxena, an emergency physician at Stanford Hospital.
Medical experts define miscarriage as a pregnancy that ends naturally before 20 weeks of gestation. Most abortions occur in the first 13 weeks; Pregnancy losses after 20 weeks are considered stillbirths. Miscarriage occurs in about one in 10 known pregnancies and can occur in up to one in four if you include miscarriages that occur before patients realize they are pregnant.
Medical terminology often calls miscarriage a “miscarriage,” a designation that may increase patients ’or providers’ concerns about being the target of abortion prohibitions. In medical records, Amanda’s second miscarriage was also labeled a “threat of abortion: established and worsening.”
In typical early miscarriages, when cardiac activity has stopped, patients should be offered three options for expelling the tissue, said Dr. Sarah Prager, a professor of obstetrics and gynecology at the School of Medicine. University of Washington.
D&C is recommended when patients bleed heavily, are anemic, have blood clotting problems, or certain conditions that make them medically fragile, Dr. Prager. Some other patients also choose D&C, considering them emotionally easier than a persistent process at home.
Another option is medication, usually mifepristone, which weakens the membrane that covers the uterus and softens the cervix, followed by misoprostol, which causes contractions. These same pills are used for medication abortion.
The third option is “expectant management”: waiting for the tissue to pass alone, which can take weeks. It is unsuccessful for 20 percent of patients, who then need surgery or medication, said Dr. Prager, who co-authored the abortion management guidelines for the American College of Obstetricians and Gynecologists.
Whenever possible, patients should be able to choose the method because lack of choice increases the trauma of losing a desired pregnancy, doctors and patients said.
In Wisconsin, where a 173-year-old abortion ban could be reinstated soon, Dr. Carley Zeal, an obstetrician-gynecologist, treated a woman who said that just after revoking her right to abortion. ‘abortion, he appeared bleeding in a hospital, which determined he had aborted, but told him “they couldn’t do a D&C because of the laws.” The hospital also did not offer him medication for a miscarriage, and advised him to find an obstetrician-gynecologist to help him. When she found Dr. Zeal, who gave her mifepristone and misoprostol, the woman had been bleeding intermittently for days, putting her at “an increased risk of bleeding or infection.”
“Even in these simple cases of basic obstetrics / gynecology practice, the laws leave providers questioned and scared,” Dr. Zeal said. “These laws are already harming my patients.”
Doctors say even greater risks can occur with cases of “inevitable miscarriage,” where there is still fetal cardiac activity, but the patient’s water has broken too soon for the pregnancy to be viable, he said. Greer Donley, assistant professor at the University of Pittsburgh Law School.
A study from two Dallas hospitals reported 28 patients whose water was broken or who had other serious complications before 22 weeks of gestation and who, due to Texas laws, did not receive medical intervention. until there was an “immediate threat” to their lives. or cessation of fetal cardiac activity. On average, patients waited nine days and 57 percent ended up with serious infections, bleeding or other medical problems, according to the report. Another article, in the New England Journal of Medicine, said similar patients returned with signs of sepsis after doctors or hospitals decided that Texas abortion law prevented them from intervening earlier.
In these cases, Dr. Seago of Texas Right to Life said a ban on abortion could require delayed intervention. What characterized him as a doctor who said “‘ I want to cause the child’s death today because I think they will eventually die, ’” he said. He acknowledged that these delays could cause medical complications for women, but said “serious” complications could be legally treated immediately.
One of the anti-abortion medications, mifepristone, must be prescribed by certified providers and cannot be dispensed by typical pharmacies. Although the certification process is simple, Dr. Lauren Thaxton, an adjunct professor in the Department of Women’s Health at the University of Texas at Dell Medical School in Austin, said some hospitals have expressed “concern that this drug it is also used for abortion and whether or not this could create a kind of bad appearance “.
Therefore, in some states, doctors only prescribe misoprostol for miscarriages, which may work on their own, but less well. It is also used for other medical conditions and should be easily obtained from pharmacies, but some have refused to fill misoprostol prescriptions from patients with miscarriage or have required additional documentation from doctors, the doctor said. Thaxton and others.
Cassie, a Houston woman who asked to be identified by her name, said she learned she had had a miscarriage the day Roe v. Wade rolled over, when his doctor detected blood in his uterus and no cardiac activity.
She was prescribed misoprostol, but said a Walgreens made her wait a day to get “additional approval” from her corporate office.
“When I went to pick him up, I had to talk to the pharmacist and I had to re-state, even though they knew my doctor prescribed it, that it wasn’t for an abortion,” Cassie said.
A Walgreens spokesman said some abortion laws “require additional steps to dispense certain prescriptions and apply to all pharmacies, including Walgreens. In these states, our …