Miscarriages could become more dangerous in a post-Roe world

Miscarriages could become more dangerous in a post-Roe world thumbnail

The Supreme Court will decide in the next few weeks in a case that could uphold Roe v. Wade, and demolish constitutional rights to an abortion .

If this happens, experts warn that it would have devastating and far-reaching consequences on all aspects of reproductive health care, including miscarriages. Because miscarriages can also be treated with the same medicines and surgical procedures that are used in abortions, people in many states will not have as many options to manage unexpected losses.

” For those of us on ground who care for pregnant women regardless of their outcome, our hands are tied” says Courtney Schreiber an OB-GYN chief of Penn Medicine’s division of family planning.

The US already has an “abysmal” public health record compared to similarly wealthy countries severe problems and deaths among pregnant people, according to Aileen Gariepy (an OB-GYN, director of complex family planning at Weill Cornell Medicine, New York). This problem will only get worse if Roe v. Wade is reversed, as will the inability to access care for miscarriages.

[Related: What science tells us about abortion bans]

Miscarriages occur when a fetus dies before the 20th week of pregnancy (the loss of a pregnancy after this point is known as a stillbirth). Most happen in the first trimester, and an estimated 10 to 20 percent of known pregnancies end with miscarriages. Schreiber states that it is the most common pregnancy problem.

” We can’t assume that everything will go well, perfectly and result in a healthy baby after a woman is pregnant,” she says.

When a woman miscarries in their first trimester they have three options. The first is to wait and see if the body recovers from the miscarriage. Another option is to have a minor surgery called a suction and curettage to empty your uterus. Gariepy states that this procedure can be used if the placenta gets stuck after a full-term, normal vaginal birth.

The third option is to take medication which causes the uterus contraction and pushes its contents out via bleeding and cramping. Garipey states that women who need medical management may prefer privacy in their own homes and being surrounded by loved ones.

In these cases, the miscarrying woman receives a pair misoprostol and mifepristone. Misoprostol was used to be prescribed by doctors on its own. However, Schreiber and her colleagues reported in a 2018 paper in the New England Journal of Medicine that the drug is significantly more likely to clear the uterus when paired with mifepristone–as is done in medical abortions.

“By reducing access to these medications, the care of miscarriage patients also will be affected,” she stresses.

“That burden will be physiologic; it might be psychological; it could be socioeconomic.”

Aileen Gariepy, OB-GYN at Weill Cornell Medicine

For women in their first trimester, there is limited access to medical miscarriage treatment options that are effective and not life-threatening. It does mean that pregnant women will need to endure more bleeding and cramping, and may require a surgical procedure. (This is already happening in Texas, which banned most abortion care last September). Gariepy says that the burden will be physiologic, psychological, and socioeconomic. If you have to take days off work, it could be both.

Losing a pregnancy in the first trimester can make it more dangerous. After the first trimester, it is possible to induce labor or perform dilation and evacuation. Women can become very sick if they wait for Mother Nature’s uterus to empty. Gariepy states that they can become septic, lose their uterus, and even die. “But if the fetus has a heartbeat, any intervention that we make at that point is an abortion–so if abortions are illegal and criminalized, more women will die .”

This is exactly what happened to a woman named Savita Halappanavar in Galway, Ireland, in 2012. After being denied timely treatment when she began to miscarry 17 weeks into her pregnancy, Halappanavar developed an infection and died. Her case became a rallying point, and in 2018, Ireland passed legislation loosening some restrictions on abortion.

In the US, patients at certain religious hospitals have also become seriously ill after being refused treatment for miscarriages.

” We already see in states that have implemented abortion restrictions that… pregnant women and patients are getting sicker, possibly with sepsis or severe blood loss before they can receive treatment,” Schreiber said. “People will take more time off work, require more childcare and emotional support after these incidents because of how traumatizing we as a society have made them,” Schreiber says.

[Related: A simple blood test could save new mothers. Why aren’t more doctors using it?]

In the future, there may be a shortage in physicians who are qualified to provide these services. Schreiber predicts that fewer medical students will opt to study obstetrics or gynecology. They might not be permitted to provide proper care to their patients. Medical students in some places are already not being trained to treat abortions–and miscarriages.

” The variety of legal restrictions that exist in each state is extremely confusing and laborious. It is also difficult for patients and providers to know what is legal and what is illegal. Schreiber states that it is important to understand the legal system and work within it in order provide safe care.

In states with particularly restrictive laws, people who miscarry will face an additional danger: being prosecuted on suspicion of having a self-induced abortion.

” If you are having miscarriages at home and are bleeding profusely and don’t want your baby to be taken to the hospital, you might be more inclined to stay home,” Gariepy said. “And that could be dangerous.”

Reproductive rights advocates and doctors are currently planning for a “patchwork” of protection across the US. “Where some women will have autonomy and health upheld, and their dignity preserved, and others will need to seek out care elsewhere,” Gariepy says.

” There is a reason the doctor-patient relationship happens between the doctor, patient, and legislator. Interfering with medical care will cause harm, she states.

Schreiber also points out that the repeal of reproductive rights occurs at a time when early pregnancy loss is better understood and treated. She says, “The problem is being capable of delivering that evidence-based care.”

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