When the U.S. Supreme Court overturned the federal right to an abortion on June 24, the medical landscape shifted in a way that opened a range of questions for healthcare providers, including one that’s often overlooked amid the polarizing political conversations: how abortion restrictions may impact people who have a miscarriage.
The Cleveland Clinic reports that about “10% to 20% of people who know they are pregnant will miscarry,” which is often defined as the unexpected ending of a pregnancy. Most occur before the 20-week mark, and about one-third to one-half of all pregnancies end in a miscarriage before someone even knows about it (usually through a missed period).
Dr. Partha Nandi, chief health editor for Detroit’s WXYZ News, explained that miscarriage care could be impacted as a result of the overturning of Roe v. Wade because, “the standard of care for treating a miscarriage is almost identical to the standard of care for providing an abortion.”
“It makes sense that people think of miscarriage as something that you have no control over,” Nandi wrote in a recent column. “That can be true, but it can also be something that people have to make decisions about. Not all women can let miscarriage progress naturally. It can take three or four weeks for expulsion. As a result, medical or surgical treatment may be needed, especially if there are signs of infection.”
With abortion bans in place, doctors might not be able to offer a miscarrying patient the two-drug combination of mifepristone (known as the abortion pill) and misoprostol, which can aid this expulsion process, nor a medical procedure called dilation and evacuation.
Dr. Anju Khattar, a Washington-based physician who travels to treat patients, told Bloomberg that a few years ago, when he was working in Oklahoma, he was the only doctor in town who could provide one of these procedures for a hospitalized patient who needed it.
“I did the procedure in 15 minutes,” Khattar told Bloomberg. “I remember asking the provider, ‘What would you have done if I hadn’t been in the state?’ They would have probably removed her uterus.”
Timing Of Miscarriage Treatment Is Everything
Even before the June 24 ruling, states across the country were enacting abortion laws with strict time limits. One high-profile instance came in September 2021, when Texas Governor Greg Abbot signed Senate Bill 8 into law. This law bans abortion “once a doctor can detect fetal cardiac activity,” according to Time, which can develop less than six weeks into a pregnancy.
In some cases, if a complication arises during early pregnancy that will likely lead to miscarriage, a doctor can offer medical alternatives, including drugs and/or surgery to remove the fetal tissue that might otherwise pose a serious health risk to the mother, such as in an ectopic pregnancy. But the timing of the treatment would be key under some state’s laws.
“Until there is no absolute heartbeat we are not being to be able to intervene in some states,” Dr. Holli Jakalow, a New York-based obstetrician and gynecologist, told Bloomberg.
Traveling For Miscarriage Treatment Can Cause Dangerous Delays
If someone who is miscarrying needs intervention and cannot receive treatment in their home state, the only viable option to breaking a law could be traveling to another state. However, some doctors worry this could create a dangerous scenario.
“When you’re talking about access to care, it can be dangerous if the patient does not have quick access to an ER or their own doctor,” Dr. Nicole Williams, owner of the Gynecology Institute of Chicago, explained to Parents. “If there are still products remaining [in the mother’s body following miscarriage], it could lead to a resurgence in bleeding or infection.”
For Dr. Ghazaleh Moayedi, an OB-GYN based in Texas, abortion restrictions simply mean lackluster care for all pregnant patients. She talked with Baltimore-based NPR affiliate WYPR about the delays pregnant people are facing getting in for gynecological care due to the domino effect of the Texas abortion ban — delays that are likely to be longer now.
When asked about treating pregnancy complications such as miscarriage, Moayedi noted that she was involved in research on this topic that was recently published in the New England Journal of Medicine.
“What we found is that people are being offered substandard care because of how abortion restrictions also regulate the care of pregnancy in general,” Moavedi told the radio station. She offered an example: “People were told, with ruptured membranes — so a miscarriage, but later in pregnancy, prior to viability — their bag of water has broken, there is no way to save the pregnancy, but they were told that they were better off leaving the hospital, getting on a plane, and flying to another state. And it’s unconscionable that physicians are being forced — health care providers are being forced — to provide substandard pregnancy care in our state because of abortion laws.”
A 2021 study from the Guttmacher Institute looked at the impact of the Texas abortion ban on patient access to abortion and miscarriage care based on travel distance. Its findings showed a change in driving distance to reach the closet abortion clinic outside of Texas leaped from 17 miles to 247 miles each way. That means patients there will need to make more than a four-hour trip just to reach a healthcare center that’s legally able to treat them.
With travel expenses, including record-high gas prices, driving a long distance to get proper medical treatment during a difficult time such as miscarriage can be cost-prohibitive.