Miscarriage Care: The Collateral Damage of Abortion Bans
Stricter abortion laws across the United States are impacting how and when healthcare for miscarriages can take place, traumatizing patients and putting lives at risk.
Abortion access has been dominating the news since the leak of the Supreme Court decision that ultimately overturned Roe v. Wade. For some, reproductive rights are a paramount concern.
Yet for many people, it's a non-issue, because they wouldn’t ever think about having an abortion.
But even if you're actively trying to expand your family, abortion bans being passed by Republican-dominated legislatures across the country could affect you and your family deeply.
That’s because the reach of these invasive, oppressive laws goes far beyond abortion. We explore why that is, today in The Big Picture.
— George Takei
In 2021, a Texas woman identified only as Amanda suffered a miscarriage during her first trimester of pregnancy. A doctor at Baylor Scott & White Medical Center performed a dilation and curettage—D&C—to remove tissue left after the failed pregnancy.
Amanda told The New York Times she received a card and gift of sympathy from hospital staff for her loss.
But only eight months later, in January 2022, Amanda experienced another first-trimester miscarriage. She arrived at the same hospital, screaming in extreme pain.
But the hospital refused to perform a D&C because, in September, Texas Republicans enacted a law banning almost all abortions after six weeks of pregnancy. Amanda was sent home and told only to come back if she hemorrhaged or became septic—both life threatening conditions.
For Amanda, the law means she and her partner will either stop trying to have a child or leave the state.
Amanda said:
"We don't feel like it's safe in Texas to continue to try after what we went through."
Where Miscarriages And Abortion Collide
The propaganda behind abortion restrictions typically uses a narrative of viable pregnancies where abortion is a form of “birth control.” But the loss of planned and desired pregnancies by miscarriage are also being impacted once the resulting laws are enacted.
That’s because the procedures and drugs used after a miscarriage overlap with those used for abortions of both nonviable and viable fetuses.
Texas's law bans abortions after six weeks, including in cases of rape and incest. It also awards $10,000 to anyone who sues someone suspected of helping a person get the procedure and makes performing an abortion a felony.
With so much at stake and the overlap between miscarriage and abortion, medical professionals are understandably concerned about the appearance of performing any procedure that could result in their being reported, investigated or sued.
The result of these one-size-fits-all laws, written and passed by people with no medical knowledge, are punishing—even endangering—people for having a miscarriage.
It's Not A Minor Concern
An estimated 10%-15% of known pregnancies end in miscarriage in the first trimester–or the first 12 weeks–of pregnancy.
In the second trimester, 1%-5% of pregnancies end in miscarriage.
An additional 1%-5% of pregnancies miscarry before the person is even aware they're pregnant.
Miscarriage rates in the United States exceed cancer rates.
While miscarriage rates have improved, they're still common enough that everyone likely knows someone who has miscarried or has personally experienced a miscarriage.
Miscarriage Treatment And Abortion Cannot Be Separated
Both abortions and miscarriage treatment involve the removal of fetal tissue. As such, the procedures and medications overlap.
When uninformed, medically-illiterate, Evangelical Christian organizations and right-wing lawmakers write abortion bans that target medical procedures and drugs used for abortions, they also outlaw miscarriage treatment.
The treatment for the miscarriage then must jump through the same hoops as a legal abortion. The most common allowance for medical treatment in these cookie-cutter abortion bans involves the "life of the mother" hurdle.
As with Amanda, women who suffer miscarriages in states where these laws are enacted must await treatment until their life is in jeopardy due to hemorrhage or sepsis—in other words, if they're bleeding to death, or until the dead tissue they're carrying rots enough to poison their blood.
For families trying and hoping for a child only to lose it, this response is simply cruel and inhumane.
Even for states with miscarriage exceptions, hospital lawyers must weigh in on whether and when to provide treatment so the hospital and doctors aren't criminally liable. As expected, most still default to the life-of-the-mother litmus test to avoid felony prosecution by overzealous right-wing prosecutors with political aspirations.
Banned Drugs Have No Exceptions
In March, Wyoming became the first state to ban abortion pills, making prescribing or selling them illegal. Violating the law is punishable by up to six months in jail and a $9,000 fine.
These same drugs are used for the treatment of miscarriages, leaving only invasive or surgical procedures—which carry higher risks—as an option.
But the ignorance-fueled attacks on mislabeled "abortion drugs" goes beyond state borders. National pharmacy chains such as Walgreens have already decided it isn't worth their potential liability to carry targeted reproductive healthcare drugs.
Potential criminal charges have again effectively negated any miscarriage exceptions.
Texas Judge Matthew Kacsmaryk—an appointee of former President Donald Trump, whose judicial appointees were all selected for him by Evangelical Christian organizations—is expected to rule on whether a commonly used reproductive healthcare drug, mifepristone, can be sold in the United States.
His expected ruling would end access nationwide.
According to a 2018 study in the New England Journal of Medicine:
"...adding mifepristone to the medication misoprostol was more effective for the management of early miscarriage than taking misoprostol alone and reduced the likelihood of patients needing an additional procedure."
According to research compiled by Planned Parenthood:
"Mifepristone has been safe and legal in the United States since the U.S. Food and Drug Administration (FDA) approved the brand name Mifeprex nearly 20 years ago."
"In April 2019, the FDA approved the first generic form of mifepristone, following a review of the evidence that medication abortion is a safe, effective way to end an early pregnancy—with a safety record of over 99%."
Mifepristone is also used for management of 2nd and 3rd trimester pregnancies when the fetus died before birth.
It Goes Beyond Miscarriages
In Idaho, hospitals are closing their labor and delivery departments—citing the political climate—over liability concerns created by that state's attacks on reproductive freedom.
Medical experts are neither consulted before nor acknowledged after these abortion bans are crafted. Most are coming from the same source: the Christian nationalist-backed organizations Americans United for Life and the National Right to Life Committee.
In 2019, an Ohio Republican legislator introduced a bill to ban abortion and require doctors to "reimplant" ectopic pregnancies in the uterus. This is a medical procedure that doesn't exist.
Ectopic pregnancies—when a fertilized egg implants anywhere outside the uterus, most often in the fallopian tube—are always not viable. Left untreated the pregnancy can be fatal, and when treated too late it can result in infertility.
Despite the medical pushback against the absurd requirement for a non-existent medical treatment, a GOP legislator added the same “reimplant” demand in a Missouri abortion ban law in 2022.
It is a sad reality that not every labor and delivery has a positive outcome. Hospitals are rightfully concerned they and their doctors are exposed to criminal liability under these medically illiterate abortion laws.
While a rational review would recognize an abortion and fetal death during labor and delivery are not the same thing, there is nothing medically rational about the laws. It's highly unlikely they'll be applied with any level of logic.
Medical schools are also reporting refusals by students to do obstetrics and gynecology rotations or learn some procedures over concerns of future liability, along with a significant drop in specialization in those fields. Hospitals and clinics nationwide report shortages in obstetricians and gynecologists as a result.
But for a profession on whose backs the religious right has literally placed a target, who can blame them?
Reproductive healthcare has become increasingly difficult to access as a result.
For more and more women, Planned Parenthood is their only option for cancer screenings, pregnancy testing, neonatal care, treatment after a miscarriage and diagnosis and treatment for menstrual, perimenopause and menopause issues.
Even in very “blue” regions of the country, women trying to have a baby often can’t receive treatment at a hospital. Planned Parenthood then becomes the only option.
Planned Parenthood has long been vilified by uninformed, anti-abortion zealots and the legislators in their pockets. Republicans routinely attempt to defund and eliminate the organization with attacks claiming they are nothing more than an abortion provider despite the many vital services offered by the organization worldwide.
People Are Going To Die
As outlined by the case of Amanda in Texas, abortion ban laws are forcing families to deliberately put lives at risk 12%-25% of the time—the overall miscarriage rate in the United States.
Eventually families will start losing that lottery.
Can they sue their state GOP or the Christian nationalist organizations that drafted the laws for medical malpractice? Or should legislators and their bill drafters be given an immunity to practice medicine without a license—or in too many cases even basic knowledge of reproduction?
This dilemma hit home for me. A friend in Florida suffered a miscarriage late in her pregnancy. Their child was named and wanted, and the family was devastated by the loss.
Like Amanda she was told to go home to wait until she was dying.
She wrote about her experience here in "The Dead Son in My Womb Had More Rights Than I Did." I highly recommend reading it.
What Can We Do?
Most importantly, register then vote. In every election, at every level.
Educate others on the realities of these so-called abortion bans, and how it could affect them even if they aren’t planning to get an abortion. Then get them to vote.
Vocally and actively support Planned Parenthood with your family, friends, elected officials and political candidates. If you can, support them with your dollars.
People who want children will have miscarriages. People who are opposed to abortion will have miscarriages. Everyone, including people who are celibate, will need reproductive healthcare. People who love them will need to watch them suffer or die unnecessarily.
It's time to face reality.
These abortion bans are taking our reproductive healthcare away from all of us. The target is not just on abortion providers or people who have an elective abortion.
The target is on all of our backs.
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In addition to The Big Picture, Amelia writes Auntie Mavis’ Musings
Some 30 years ago, a former coworker of mine was pregnant, with a much-wanted child - her first pregnancy. She went in for a 6 month-check, and was told that the fetus had died in utero, and the fetal tissue and placenta would need to be removed. But it was a Catholic hospital, as were all the hospitals in our insurance network at the time, and they wouldn't perform the D&C until her life was actually in danger. So they instructed her in the signs of sepsis and sent her home, with instructions to come back as soon as she saw any - with fever being the most likely. By the time she showed signs of sepsis, a serious infection had set in, and the hospital ended up having to perform a hysterectomy to save her life. She and her husband wanted kids, but they could no longer have children of her own. Not only did this policy prevent her from receiving appropriate care for that pregnancy, it prevented any future pregnancies.
This is the reality for far too many women in our current political climate. It's not about saving babies; it's about controlling women. The same red states that outlawed abortion also make access to contraception difficult and refuse to provide proper support to children in their states. This is not pro-life; it's pro-birth.
"I do not believe that just because you are opposed to abortion, that that makes you pro-life. In fact, I think in many cases, your morality is deeply lacking if all you want is a child born but not a child fed, a child educated, a child housed. And why would I think that you don't? Because you don't want any tax money to go there. That's not pro-life. That's pro-birth. We need a much broader conversation on what the morality of pro-life is." - Sister Joan Chittester, 2004 (interview with Bill Moyers)
Anti-abortion activists are linked to numerous religious organizations. These organizations have always treated women as second class citizens and are part of the patriarchy. The anti-abortion laws are designed to control women by taking away their rights to their own bodies. When passing these laws state legislators use their religious views to justify their votes violating separation of church and state. Punishing doctors and hospitals is used to control how women are treated. VOTE these people out of office. These are the same people who are against gun control laws so don't think for a minute that they are pro-life. We should begin describing them as anti-women.