Last year, a 35-year-old woman named Amanda living in the Dallas-Fort Worth area had a miscarriage in her first trimester of pregnancy. In a large hospital, a doctor performed an often used surgical procedure as a safe and quick method to remove tissue from a failed pregnancy.
She awoke from anesthesia to find a card signed by nurses and a small pink and blue bracelet with butterfly charms, a gift from the hospital to express compassion for her loss. “It was so sweet because it’s hard to go through,” Amanda said.
Eight months later, in January, Amanda, who asked to be identified by her first name to protect her privacy, experienced another first trimester miscarriage. She said she went to the same hospital, Baylor Scott & White Medical Center, doubling down in pain and screaming as she passed a large blood clot.
But when she requested the same surgical evacuation procedure called dilation and curettage, or D&C, she said the hospital didn’t tell her.
A D&C is the same procedure used for some abortions. In September 2021, between Amanda’s two miscarriages, Texas enacted a law banning nearly all abortions after six weeks of gestation.
Following the Roe v. Wade reversal, many states are banning or strict banning abortions. While the laws are technically intended to apply only to abortion, some patients have reported barriers to standard surgical procedures or receiving medication for the loss of a desired pregnancy.
Amanda said the hospital did not refer to the abortion law, but sent her home with instructions to return home if she was bleeding so much that her blood filled a diaper more than once an hour. Hospital records that Amanda shared with The New York Times show that there was no heart activity of her fetus during that visit and on ultrasound the week before. “She reports being in a lot of pain” and “she appears distressed,” the record said.
“It appears to be a miscarriage in process,” the record noted, but suggested waiting to be confirmed and advised follow-up at seven days.
Once at home, Amanda said, she painfully sat down on the toilet, digging “nails in my wall.” She then went into the bathtub, where her husband held her hand as both of them cried. “The bathtub water is just deep red,” Amanda recalled. “For 48 hours, it was like constant heavy bleeding and big clots.”
She continued, “It was so different from my first experience where they were so nice and so comforting, now just feeling lonely and intimidated.”
Read more about the ending of Roe v. Wade
The hospital declined to discuss whether Texas abortion laws had any effect on her medical care. In a statement, the hospital said, “While we are not able to speak to an individual case due to privacy laws, our multidisciplinary team of physicians will be able to determine an appropriate treatment plan on an individual case-by-case basis.” The health and safety of our patients is our top priority.”
John Seago, president of Texas Right to Life, said he considers any obstacle facing abortion patients to be a “very serious situation.” He attributed such problems to a “malfunction in the communication of the law, not the law itself”, adding “I have seen reports of doctors being confused, but it is a failure of our medical associations to provide clear guidance”.
The uncertain climate has led some doctors and hospitals to worry about being charged with facilitating abortions, a fear that has led to some pharmacists refusing to fill drug prescriptions to complete abortions, providers and patients say. Last week, the Biden administration warned that if a pharmacy refuses to fill prescriptions for pills “including those needed to manage complications from miscarriage or pregnancy loss, because these drugs are used to terminate a pregnancy.” Can also be done – pharmacy can discriminate on the basis of sex.”
Delays in taking out tissue from a pregnancy that is no longer viable can lead to bleeding, infection, and sometimes life-threatening sepsis, obstetricians say.
“In this post-cry world, women with miscarriages can die,” said Dr. Monica Saxena, an emergency medicine doctor at Stanford Hospital.
Medical experts define a miscarriage as a pregnancy that ends naturally before 20 weeks of gestation. Most miscarriages occur in the first 13 weeks; A pregnancy loss after 20 weeks is considered a stillbirth. Miscarriage occurs in about one in 10 known pregnancies, and can occur in one in four when abortions are involved that occur before patients become pregnant.
Medical terminology often refers to abortion as “spontaneous abortion,” a designation that may raise concerns of patients or providers about being targeted under abortion restrictions. In the medical records, Amanda’s second miscarriage was also called “Abortion Threat: Established and Worsening”.
Sarah Prager, MD, an obstetrics and gynecology professor at the University of Washington School of Medicine, said in a typical early miscarriage, when cardiac activity has stopped, patients should be offered three options for tissue removal.
D&Cs are recommended when patients are bleeding heavily, have anemia, have problems with blood clotting or have certain conditions that make them medically fragile, Dr. Prager said. Some other patients also choose to have a D&C, finding them emotionally easier than a lengthy procedure at home.
Another option is medication – usually mifepristone, which weakens the membrane lining the uterus and softens the cervix, followed by misoprostol, which causes contractions. These pills are used for abortion medicine.
The third option is “anticipatory management”: waiting for the tissue to pass on its own, which can take weeks. This is unsuccessful for 20 percent of patients, who then require surgery or medication, Dr. Prager, who co-authored the abortion management guidelines for the American College of Obstetricians and Gynecologists.
When possible, patients should be allowed to choose the method because the lack of choice adds to the trauma of losing the desired pregnancy, doctors and patients said.
In Wisconsin, where a 173-year-old abortion ban may soon be re-imposed, Dr. Carly Ziel, an obstetrician-gynecologist, treated a woman who said she bleed in the hospital after her abortion rights ended. Raha showed up, who determined she had had an abortion, but told her “they can’t do a D&C because of the laws.” The hospital did not even give her abortion medicine, advising her to find an obstetrician-gynecologist for help. By the time she received Dr. Zeil, who gave her mifepristone and misoprostol, the woman had been bleeding intermittently for several days, giving her “an increased risk of bleeding or infection.”
“Even in these straightforward cases of basic OB/GYN practice, law providers leave questioning and intimidation,” Dr. Ziel said. “These laws are already harming my patients.”
Doctors say there may be an even greater risk in cases of “compulsive abortion,” where there is still fetal cardiac activity, but the patient’s waters have broken too early for the pregnancy to be viable, according to the University of Washington. Greer Donnelly, an assistant professor, said. Pittsburgh Law School.
A study from two hospitals in Dallas reported on 28 patients who broke water or who had other serious complications before 22 weeks of gestation, and who did not receive medical intervention until the end of their lives, due to Texas laws. Don’t be an “immediate threat”. Or the fetal heart activity stopped. On average, patients waited nine days, and 57 percent ended up with serious infections, bleeding or other medical problems, the report said. Another article in the New England Journal of Medicine noted that similar patients returned with sepsis symptoms after doctors or hospitals decided Texas’ abortion law had previously barred them from intervening.
In such cases, Dr. Seego of Texas Right to Life said that the abortion ban may require delayed intervention. “I want to be the cause of the child’s death today because I believe they will eventually die,” he said, as a doctor who is forbidden, he said. He acknowledged that such delays could lead to medical complications for women, but added that “serious” complications can be legally treated immediately.
One of the abortion drugs, mifepristone, must be prescribed by certified providers and cannot be given by generic pharmacies. Although the certification process is simple, Dr. Lauren Thaxton, assistant professor in the Department of Women’s Health at the University of Texas at Austin’s Dell Medical School, said that some hospitals “have expressed concern about this drug even being used for abortion.” And whether or not that can create some kind of bad image.”
Therefore, in some states, doctors only prescribe misoprostol for abortion, which may work on its own, but is less good. It is also used for other medical conditions and can be easily obtained at pharmacies, but some refuse to fill misoprostol prescriptions of abortion patients or require additional documentation from doctors, Dr. Thaxton and others said.
Cassie, a Houston woman who asked to be identified by her first name, said she learned the day Roe v. Wade was reversed, having had a miscarriage the day her doctor detected blood in her uterus and no heart activity.
She was prescribed misoprostol, but said a Walgreens made her wait a day for “additional approval” from their corporate office.
“When I went to get it, I had to talk to the pharmacist and re-tell, even though they knew my doctor prescribed it, that it wasn’t meant for abortion,” Cassie said.
A Walgreens spokesperson said that some abortion laws “require additional steps to dispense certain prescriptions and apply to all pharmacies, including Walgreens. In these states, our pharmacists can fill valid, medically appropriate prescriptions as needed.” Work closely with the prescriber.”
Dr. Thaxton said that when pharmacies delay delivering misoprostol, some patients are financially or logistically unable to take the drug for another day. Instead, go to doctors a few days later, still retain pregnancy tissue or have “significant bleeding that needs to be managed urgently,” she said.
In March in Missouri, where Roe abortions are now banned, Gabriella, who asked to be identified by her first name, said she had a bloated ovum, in which a fertilized egg implants in the uterus but does not develop. “My body won’t release it,” she said.
Her doctor prescribed misoprostol, but it didn’t work well enough. When she asked for mifepristone, the doctor said it was difficult to get there, according to a doctor’s note Gabriella shared with The Times.
The doctor ordered a second round of misoprostol, but Gabriella said, “The Walgreens pharmacist told me she couldn’t give it to me if I was pregnant. I was able to stutter that I was having a miscarriage, and she I couldn’t help but cry in front of everyone at Walgreens because I felt like I was being treated like a bad person for taking medicine to prevent infection.
Dr. Praeger said she was told that some Texas abortion patients were turned away by doctors, who worried the patients might have actually taken abortion pills, which expelled the pregnancy. did not, two conditions that appear clinically identical.
“There’s a system being built where there’s no trust between physicians and patients, and patients are potentially going to choose not to go to the hospital even with something like an abortion, because they’re afraid,” Dr. Prager said.
Some women who have had abortions and are at risk of future harm say they are considering moving from states that ban abortions or reconsidering life plans.
“We’re not going to try to conceive anymore,” Amanda said. “We don’t feel like it’s safe in Texas to continue trying after what we’ve done.”
(This story has not been edited by seemayo staff and is published from a rss feed)