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 | | Eleanor Davis |
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Roe v. Wade is in peril. That could make miscarriages more dangerous. |
When you have your first bad sonogram, you fall into an abyss of maternity care. If you haven't experienced it, you might not know the contours of this purgatory, but I can tell you what it's like. Almost exactly seven years ago, the face of my obstetrician fell while performing an ultrasound for a very wanted pregnancy, and our collective mood shifted in an instant from buoyant to somber. |
I learned that day that it appeared that my pregnancy was not progressing, because my doctor couldn't find a heartbeat. But he couldn't be certain; my period was quite irregular, and it was possible that he misdated the pregnancy and that it was still viable. So I had to wait. One week, then two. Dragging myself into the radiologist's office every few days to see if there was a heartbeat while attempting to work and parent my then-2-year-old and desperately trying not to cry most of my waking moments. |
When my doctors were finally certain that the pregnancy would not go forward, I was given three options: I could continue to wait and see if my body would miscarry on its own without intervention, I could take medication and end the pregnancy at home, or I could have a surgical procedure to empty my uterus, known colloquially as a D. and C. (The last two options are the same choices offered to abortion patients.) |
I chose the D. and C., mainly because I wanted to get this awful experience over with as soon as possible. |
Years later, I am at peace with the pregnancy loss; the fetus had a chromosomal issue called Turner syndrome, which "may cause up to 10 percent of all first-trimester miscarriages," according to the National Institutes of Health. I know now that miscarriages are common. An estimated one-quarter of all pregnancies and around 10 percent of known pregnancies end in miscarriage before 20 weeks. Thankfully, I was able to have another healthy child later. But that two-week wait remains painful to think about. |
And yet I'm thinking about it in the aftermath of the Supreme Court's ruling on Friday allowing federal court challenges to Texas' restrictive abortion law, S.B. 8, but leaving the law in effect, essentially outlawing abortions after six weeks in that state. That's because in countries where elective abortion is outlawed or extremely restricted, women are not given the choices I had when they miscarry. |
Abortion restrictions create a chilling effect on medical professionals who are understandably concerned about being prosecuted for anything resembling elective abortion. And so doctors in countries with restrictive laws "don't always provide all the relevant information concerning the pregnancy, especially if they see there are complications and they're afraid women can take drastic measures," said Irene Donadio, a senior adviser at the International Planned Parenthood Federation. |
I asked Dr. Isabel Stabile, a gynecologist in private practice in Malta and an abortion-rights activist, what first-trimester miscarriage care looks like in her country, where there is a total ban on abortion, with no exceptions. "The short answer to this question is in Malta it's always a wait and see. Women are never given the immediate option of being hospitalized and having a D. and C. nor having pills so we can proceed with a spontaneous miscarriage. The medical and surgical options are never offered as a first line," she said. |
She said that in Malta, if your body is holding on to a miscarriage for three or four weeks, you may eventually be given pills to end the pregnancy. By that time, Dr. Stabile said, you may be at greater risk of a rare but serious blood-clotting complication called disseminated intravascular coagulation, which can be avoided by ending a miscarriage earlier. "It's known as a complication. One should at least be monitored," Dr. Stabile said. But in general, the drawn-out nature and "uncertainty of the wait" are the biggest stresses for Maltese women, she said. "You have no idea how long that will be. Will it be one day, one week or one month?" |
In cases like mine, when there is no detectable heartbeat, the trauma may primarily be to women's mental health. But when there is a detectable heartbeat and there are other pregnancy complications, there are physiological stakes, including that women can and have died. In Poland, which has some of the strictest abortion laws in Europe, a 30-year-old woman named Izabela died of septic shock this year in Pszczyna after doctors declined to intervene to save her life. The fetus's heart was still beating, so physicians may have been afraid to break the country's laws because the penalty is spending three years in prison, according to reporting in The Guardian. |
Izabela isn't the only one. In 2012, before Irish abortion restrictions were rolled back in 2018, a 31-year-old woman named Savita Halappanavar died in similar circumstances. In 2016 in Italy, where abortion is legal until about the 12th week, a woman named Valentina Milluzzo died of sepsis because her doctor refused to help her end her twin pregnancy, even after one twin no longer had a heartbeat. "According to the woman's relatives, the gynecologist, who was a conscientious objector" — something that's legal under Italy's abortion law — "refused to perform an abortion of the second twin after the loss of the first fetus. He remarked that 'as long as it [the fetus] is alive, I will not intervene,'" wrote Elena Caruso in the academic journal Feminist Legal Studies. |
In September, Ghazaleh Moayedi, an obstetrician-gynecologist in Texas, sounded the alarm in these pages. "Pregnancies that face complications will now be at greater risk. Under this new law, the only abortion exception allowed is for a medical emergency. That might mean if a woman will imminently lose an organ or die without intervention. But how we judge that risk will play out individually with each hospital's policy, in each clinic," she wrote. "I can think of no other area of health care in which we would wait for someone to worsen nearly to the point of death before we offered intervention. It's just unconscionable." |
When I read some of the testimony of reproductive choice opponents, I think about how certain they sound about what life is. Situations like mine, which existed in a liminal state for weeks, defy easy categorization and require intimate and informed medical care, not blunt force laws that don't consider these delicate scenarios. |
And when I look at polls in which a low percentage of American voters list abortion rights as a top issue, I wonder if those voters have considered how a lack of access to these procedures may affect them, even if they would never have an elective abortion. Those two weeks were among the worst of my life, and thinking about anyone having to prolong that kind of purgatory just about breaks my heart. |
Want More on Managing Loss? |
| Parenting can be a grind. Let's celebrate the tiny victories. |
I had a challenging workday. When I picked my son up from school, he could tell that I was preoccupied and asked me what was wrong. After telling him in brief what was going on, he launched into how he would give me a hug or go on a walk with me to make me feel better. I said, "Honey, that is really nice of you. Remember, it is not your job to fix me when I feel sad or frustrated." He replied, "Well, you've kept me alive for 11 years. That deserves something." — Sarah Piper, Atlanta |
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