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A few years ago, I experienced a miscarriage with access to comprehensive care, free of legal concerns. Now, I wonder if that will ever be the case again.
When Roe v. Wade was overturned, I was reminded of my own miscarriage, during which I had options to navigate a profoundly painful time. I could choose a medication to assist with the miscarriage, undergo a D&C, or wait to see if it would resolve naturally. My pregnancy had been nonviable for weeks without my knowledge, and I yearned for the quickest resolution. Every moment felt like an eternity.
Just a few years back, I had the privilege of making choices in a chaotic situation. This quality of care played a significant role in my decision to try for another child, ultimately enabling me to carry my fourth son—a rainbow baby—to term.
My close friend, Mia Thompson, faced a different type of miscarriage a few years ago—an ectopic pregnancy, which is always dangerous and never viable. Following the Dobbs decision, she shared her story on social media for the first time: “I had an abortion, and it saved my life… I had choices. I had THE RIGHT to make the choice that saved my life.”
During our procedures, neither of us was concerned about legalities or regulations; our focus was solely on our health and well-being.
However, the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization means many others may not share this experience. Statistics show that 26% of pregnancies (10% of known pregnancies) end in miscarriage, and the care associated with miscarriage is often intertwined with abortion care. With restricted access to abortion, the support available for miscarriage care will diminish, endangering those navigating this already traumatic experience.
What Miscarriage Care Looks Like After Roe’s Overturn
To clarify, a miscarriage is also referred to as a “spontaneous abortion” before 20 weeks of pregnancy (after which it is termed a stillbirth). I was taken aback to see my medical documentation label my experience as an abortion. As Dr. Lisa Martin, an OBGYN at the Health Institute, explained, “Abortion, in medical terms, refers to any situation when a pregnancy is lost, including spontaneous cases.” This means that medically, miscarriages can be classified as abortions. Thus, when lawmakers interfere with abortion care, they inadvertently complicate miscarriage management.
Miscarriages can pose significant risks to the individual, and not all states with abortion restrictions allow for exceptions based on the parent’s health. Even in states that permit abortion when the pregnant person’s life is at risk, the definitions of such situations are often vague. This ambiguity means that restrictive abortion laws inherently make pregnancy riskier. One study suggests that a total abortion ban could increase pregnancy-related deaths by 21%. In my home state of Ohio, there are instances where I would need to be near death to receive proper miscarriage care.
Moreover, restrictions and bans have led to the criminalization of miscarriage. As reported by the New Yorker, some individuals have faced prosecution, as the lines between miscarriage and abortion can become blurred. Fear of legal repercussions—even for unfounded accusations—might deter people from seeking essential prenatal care, further increasing the risks of maternal and fetal loss. The thought of having to justify my medical needs to a lawmaker or undergo a police investigation while grappling with a miscarriage is unimaginable.
Understanding Pregnancy Definitions
Lawmakers often seem unaware of fundamental medical facts. Doctors frequently struggle to educate politicians on issues such as ectopic pregnancies, which occur outside the uterus and are always nonviable. However, some politicians remain adamant in their misguided beliefs, like the Ohio politician in 2018 who suggested doctors “reimplant” ectopic pregnancies, a procedure that is medically impossible.
Such ignorance can have terrifying consequences.
Specific Pregnancy Complications
Every ectopic pregnancy becomes an emergency if not treated promptly. Abortion restrictions compel healthcare providers to delay care until the patient’s life is at risk, creating unnecessary danger and potential long-term health consequences. Mia underwent life-saving surgery for her ectopic pregnancy, resulting in the loss of a fallopian tube. Dr. Martin has treated patients with ectopic pregnancies that have progressed to 12 weeks, where the fetus had a heartbeat, leading to life-threatening situations for the mother.
There are also cases where a fetus may have a heartbeat, yet the pregnancy has become septic, meaning the fetus is infected and the infection is spreading beyond the uterus. Left untreated, this can be fatal for the pregnant person. The standard treatment involves removing the infected fetus, but in states where the presence of a heartbeat complicates care, lives could be at risk. Dr. Martin recalls the tragic case of Savita Halappanavar, a 31-year-old dentist in Ireland who died of sepsis after being denied a life-saving abortion in 2012.
You might think, “Don’t most states have protections for the health of the pregnant individual?” Some do, but many do not. Additionally, delays arise as doctors and legal teams navigate the ambiguous language of new laws—just what constitutes a life-threatening situation? How severe must the danger be?
Healthcare professionals began sharing stories on social media just hours after Roe was overturned, revealing patients bleeding while doctors awaited guidance. If Mia’s ectopic pregnancy occurred today in Ohio or other restrictive states, would she have received timely care? It’s uncertain.
Requiring individuals to be on the brink of death before providing miscarriage care means “lives will be lost,” warns Dr. Martin. “Lives will be lost because people had to take a gamble, and the person was too unstable to recover. Lives will be lost because they may choose not to go to the hospital, thinking they won’t receive help, as we saw during COVID. Others may die trying to access care outside of hospitals. We will lose people, and that is incredibly distressing.”
Limited Choices and Mental Health Impact
While my miscarriage did not involve terminating a fetus with a heartbeat, I still had choices—medication, a D&C, or waiting for a natural resolution. However, in states with strict abortion laws, if my baby’s heartbeat slowed for weeks, I would likely have to wait until it stopped completely before treatment could begin. My ability to access a D&C with my chosen provider shortly after learning of my loss made the experience more manageable and significantly aided my emotional recovery.
What Lies Ahead?
After seven years of attempting to conceive, Mia is now questioning whether it is safe for her to try again, given her increased risk of another ectopic pregnancy in a state where she may not receive timely assistance. As a Type 1 Diabetic, she cannot easily seek care across state lines, nor can many others who face financial and logistical barriers, not to mention the potential legal repercussions upon returning.
In her recent social media post, Mia expressed her fears: “What will my journey look like now? Will IVF be legally accessible if needed? Will I be forced to continue a pregnancy that isn’t viable and could endanger my life? Will my doctors have the legal right to provide necessary care if complications arise? These questions are terrifying but represent the reality we are facing, and it must change.”
Dr. Martin emphasizes the importance of discussing these issues with your current OBGYN to understand their stance and ability to support you in such situations. If necessary, finding a doctor who aligns with your beliefs is crucial.
This is the stark reality of miscarriage care in a post-Dobbs world, where individuals must focus on navigating state regulations instead of allowing themselves to grieve and heal during one of life’s most challenging moments. In one of the most developed countries in the world, this situation is unacceptable.
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Summary:
The overturning of Roe v. Wade threatens the safety and accessibility of miscarriage care, particularly in states with restrictive abortion laws. Such laws can lead to dangerous delays in treatment, complicating both miscarriage management and the overall health of pregnant individuals. The ramifications of these restrictions extend to mental health, as fewer choices can exacerbate the emotional toll of miscarriage. Women like Mia Thompson find themselves questioning their reproductive futures in a landscape where legal concerns overshadow care. It is crucial for individuals to discuss these issues with their healthcare providers and seek support that aligns with their needs.