Overturning Roe will make miscarriage care worse

The worst day of your life could become more painful and more dangerous.

Read online Subscriber-Only Newsletter December 15, 2021 Continue reading the main story SUPPORTED BY Newsletter Preview Hello again. We thought you might be missing Jessica Grose's On Parenting newsletter. It's now available exclusively to Times subscribers, but this week we are offering you a preview. We hope you find it valuable. Subscribe to The New York Times to keep getting this newsletter, which will help you untangle the mysteries of parenting, and offer expert analysis on the health, economics and culture of the American family today. Your subscription will also give you access to an exclusive selection of newsletters reserved for subscribers only and unlimited access to Times journalism online and in the app. Eleanor Davis Roe v. Wade is in peril. That could make miscarriages more dangerous. By Jessica Grose 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. If you think this wouldn't happen in the United States, think again, because there is evidence that it is already happening. At Catholic hospitals, which are expected to follow directives set by the U.S. Conference of Catholic Bishops to never allow abortion services, women may not be getting the full slate of medical options when they present with an ectopic pregnancy. 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? Politics may be preventing some miscarrying women from accessing mifepristone, a medication that may help make the process quicker and less painful. In 2019, The Times ran a guide about recognizing symptoms of miscarriage and coping with the aftermath. In 2020, Meghan, the Duchess of Sussex, wrote about her miscarriage and how to comfort those grieving all sorts of losses. Tiny Victories 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 Thanks for reading this newsletter. Subscribe to keep getting it. The Jessica Grose On Parenting newsletter is available exclusively to Times subscribers. Subscribe to The Times for $1/week to receive this newsletter in your inbox twice weekly. Your support allows us to provide all the parenting news and evidence-based research that helps you and your children thrive. With a Times subscription, you'll also get: Full access to the Jessica Grose On Parenting newsletter, which covers topics such as paid family leave, premature births and sleep habits Full access to our entire suite of subscriber-only newsletters, including new offerings from Jane Coaston, Tressie McMillan Cottom and others Unlimited access to our journalism including articles, videos and podcasts Subscribe now. Need help? Review our newsletter help page or contact us for assistance. You received this email because you signed up for Jessica Grose On Parenting from The New York Times. To stop receiving these emails, unsubscribe or manage your email preferences. 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The T List: Five things we recommend this week

A brassy new Miami brasserie, an ode to Parisian artisans — and more.

View in browser|nytimes.com Continue reading the main story December 15, 2021 Welcome to the T List, a newsletter from the editors of T Magazine. Each week, we share things we're eating, wearing, listening to or coveting now. Sign up here to find us in your inbox every Wednesday. And you can always reach us at tlist@nytimes.com. EAT THIS Scenesters, Rejoice Left: Damien Hirst's wall-mounted sculpture of crystallized marlins and squid at Sexy Fish in Miami. Right: otoro sashimi and caviar.Courtesy of Sexy Fish By Gabe Ulla T Contributor Continue reading the main story ADVERTISEMENT London-based restaurateur Richard Caring (the Ivy, Annabel's) is the latest to join in Miami's boom, unveiling an outpost of his big-box fusion brasserie Sexy Fish just in time for the holidays. Designed in collaboration with Swedish architect Martin Brudnizki, the restaurant's maximalist features include an illuminated floor, plenty of coral leather and onyx and a fanciful outdoor garden. Inside, diners will find ten sculptures by Damien Hirst; an installation of 26 shimmering fish suspended from the ceiling, courtesy of the architect Frank Gehry; and DJs spinning under a giant octopus. The magnates might be harder to spot — there's a private dining room with seating for 30 and a wall-length fish tank. "Miami will cool down to some extent in the future," says Caring, "but I have a feeling we'll be the last man standing." sexyfishmiami.com. READ THIS The Spirit of the Atelier Left: the cover of "Timeless Paris: Ateliers, Emporiums, Savoir Faire," by Marin Montagut. Right: Deyrolle, a nearly 200-year-old taxidermy shop in Paris.Left: © Romain Ricard. Right: © Ludovic Balay from "Timeless Paris: Ateliers, Emporiums, Savoir Faire," by Marin Montagut, Flammarion 2021 By Lindsey Tramuta T Contributor A year after the French watercolor artist-illustrator Marin Montagut opened his first shop in Paris, he has immortalized the hidden ateliers, emporiums and hubs of vanishing trades that have long inspired his work in a new book. "Timeless Paris," released this fall by Flammarion, is an enchanting visual ode to the city's artisanal heritage and its few remaining redoubts of old-world craftsmanship. Through archival drawings, collages and photographs, Montagut celebrates what he calls the "soul" of Paris: from the historic bookseller Jousseaume, tucked away in the glass-covered Galerie Vivienne, to the monumental woodworking of Féau & Cie to La Maison du Pastel's hand-blended pigments. "These places are what's left to resist the sameness of the modern city," says Montagut. "I think they're worth celebrating." $40, rizzoliusa.com. Continue reading the main story ADVERTISEMENT SEE THIS Homage to a Brazilian Modernist Master Isaac Julien's "Um maravihoso emaranhado / A Marvelous Entanglement (Lina Bo Bardi — A Marvelous Entanglement)," 2019.© Isaac Julien. Courtesy of the artist and Jessica Silverman Gallery By M.H. Miller After encountering the work of modernist architect Lina Bo Bardi during trips to Brazil, the renowned video artist Isaac Julien "became a kind of Lina Bo Bardi groupie," he says of the designer of iconic buildings such as the São Paulo Museum of Art, a brutalist masterpiece from 1968. His fondness for Bo Bardi, who was born in Italy but spent most of her career working in Brazil until her death in 1992, has culminated in a fascinating show at the Bechtler Museum of Modern Art in Charlotte, N.C., that considers her legacy through a series of video installations that amount to a poetic meditation on her life and work. The legendary Brazilian actress Fernanda Montenegro plays the older Bo Bardi, and her real-life daughter Fernanda Torres plays a younger version, an aesthetic decision that, like Bo Bardi's prescient work, seems to set past, present and future in dialogue. "Isaac Julien: Lina Bo Bardi — A Marvelous Entanglement" is on view through Feb. 27. SHOP THIS Scents of the Subcontinent From Left: LilaNur Parfums Davana Cèdre Eau de Parfum, $275, lilanur.com. Ranavat Flawless Veil Resurfacing Saffron Gel Masque, $75, ranavat.com. Byredo Mumbai Noise Eau de Parfum, $190/150ml, byredo.com. Prakti MahaMask, $44, praktibeauty.com.Courtesy of the brands By Caitie Kelly Continue reading the main story ADVERTISMENT India has historically been relegated to the role of exotic other and repository of raw materials by the beauty industry, but a new generation of Indian entrepreneurs is flipping the script with products that channel their makers' experiences of home. Ranavat's Resurfacing Saffron Masque, which utilizes an alpha hydroxy acid blend along with calming saffron, reminds founder Michelle Ranavat, a first-generation South Asian American, of "childhood visits to India when we would instantly smell saffron as we walked into a temple." Ben Gorham, who grew up visiting his grandmother in Mumbai, evokes the city's pungent contrasts in his newest fragrance, Mumbai Noise, with its notes of coffee, sandalwood and davana, a fruity-smelling herb native to India. Lilanur, a new fragrance line launched this year by Anita Lal, founder of luxury retailer Good Earth, pairs Indian and French perfume traditions with scents like Davana Cèdre, which was crafted by master perfumer Honorine Blanc and blends davana and cedar with pink pepper, angelique, cassis and musk. Before starting Prakti, her beauty brand, Pritika Swarup grew up making masks inspired by Ayurvedic medicine with her mother. Her nourishing MahaMask uses rich turmeric butter and amla oil, derived from the Indian gooseberry tree, to hydrate parched skin. BUY THIS Lamp Lust Left: Palefire Buoy pendant light in Citrine finish. Right: Palefire Pavilion table lamp in Axis finish.Photographs by Kim Lightbody. Styled by Rachel Vere of Monday Club By Alice Newell-Hanson While working at the London design store 8 Holland Street, which she helped establish in 2018, Rowena Morgan-Cox would admire the shop's sculptural mid-century Italian sconces and pendants. But when it came time to decorate her home, she discovered that it was difficult to find lamps, beyond vintage treasures, that were functional, unusual and affordable. Her new line, Palefire, grew out of this realization and from a desire — after a stint working at London's Fine Art Society — to make something with her own hands. The studio's inaugural collection comprises eight styles of lamp, including a 1950s-inflected diabolo-shaped uplighter and an Art Nouveau-esque table light with a dramatic oversize shade, each of which can be made to order in various solid colors and patterns inspired by the work of female designers such as Sonia Delaunay and Marion Dorn. While they have the pleasingly imperfect texture of ceramic, the pieces are in fact made from recycled paper pulp. From $245, palefirestudio.com. FROM T'S INSTAGRAM A Moroccan Oasis The salon of Jamie Creel and Marco Scarani's home in Tangiers, Morocco.Simon Watson This 300-year-old house in Tangiers — owned by Jamie Creel and Marco Scarani — has become a palimpsest of ideas and aesthetics, one that both subverts and respects the city's own colorful legacy. The salon, part of Creel and Scarani's extension, features fabrics from Lisa Fine and pillows by Carolina Irving, while the aubergine slipper chairs are by Madeleine Castaing. On the back wall, a Qajar painting of a woman hangs beside a cabinet de curiosités niche designed by Scarani. To read Christopher Garis's article, visit us at tmagazine.com, and follow us on Instagram. Correction: Last week's newsletter misidentified one of the scent notes of Ember incense by Vyrao; it is cistus, not citrus. It also misidentified the state where Nearest Green was born; it was Maryland, not Tennessee. And if you read one thing on tmagazine.com this week, make it: Continue reading the main story Need help? Review our newsletter help page or contact us for assistance. You received this email because you signed up for The T List from The New York Times. To stop receiving these emails, unsubscribe or manage your email preferences. Subscribe to The TimesGet The New York Times app Connect with us on: Change Your EmailPrivacy PolicyContact UsCalifornia Notices The New York Times Company. 620 Eighth Avenue New York, NY 10018

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Kentucky on my mind

On states that bite the hand that feeds them.

Read online Subscriber-Only Newsletter December 14, 2021 Outside a post office in the aftermath of a tornado in Mayfield, Ky., on Sunday.Adrees Latif/Reuters By Paul Krugman Opinion Columnist On Friday, a devastating swarm of tornadoes swept through Kentucky. The state's leading figures appealed for federal aid, which was promptly granted — and rightly so. Helping people and communities in need is what nations are supposed to do. Observers couldn't help noticing, however, that some of the Kentucky politicians asking for aid — notably Senator Rand Paul — had in the past not only opposed aid for other disaster-struck states but sneered at their pleas. What should we make of this hypocrisy? The truth is that it runs deeper than "aid for me but not for thee." Remarkably, if you look at how the federal budget affects U.S. regions, there's a consistent pattern in which conservative states that preach the importance of self-reliance are in fact heavily subsidized by liberal states, especially in the Northeast. The Rockefeller Institute publishes regular estimates of states' "federal balance of payments" — the difference between the amount the feds spend in a state and the amount they collect in taxes. In Virginia and Maryland a lot of federal spending consists of the salaries of government workers. Elsewhere, however, it's mainly Social Security, Medicare and Medicaid, plus some military spending. Here's what the map of per capita balances of payments looked like in 2019: Acelaland pays the bills.Rockefeller Institute Topping the list of net beneficiaries was, yes, Kentucky, where residents received an average of $14,000 more from Washington than they paid in taxes. To put this in perspective, Kentucky's 2019 net inflow of federal funds — $63 billion — was roughly 30 percent of the state's G.D.P. that year. Economic geographers often interpret regional economies using the "base-multiplier model." The idea is that what drives a local economy is its "export base," the stuff it sells to other places; the income generated by that export sector in turn supports jobs in local services, from health care to restaurants. The economy of New York City, for example, is largely driven by the financial industry; the money earned there directly or indirectly supports most of the city's other jobs. So what is Kentucky's export base? Not the traditional industries: In 2019, the state, which has more than four million residents, had fewer than 6,000 coal miners, while the distilling industry — which, to be fair, has been growing — employed only about 5,000 people. On the other hand, more than 250,000 Kentuckians worked in health care and social assistance — and who do you think paid for a lot of that? So, in a real sense … Need help? Review our newsletter help page or contact us for assistance. You received this email because you signed up for Paul Krugman from The New York Times. To stop receiving these emails, unsubscribe or manage your email preferences. Explore more subscriber-only newsletters.Get The New York Times app Connect with us on: Change Your EmailPrivacy PolicyContact UsCalifornia Notices The New York Times Company. 620 Eighth Avenue New York, NY 10018

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