I’ll never forget the shock to my core I felt when I saw my medical chart while pregnant with my third child. It read “Abortions: 1, Live Births: 1,” with the fates of my first two pregnancies (and the lives of my first two children) laid out neatly in a table. I balked, and called it to the attention of the nurse doing my intake paperwork that I had never had an abortion–rather, my first pregnancy had ended in miscarriage at 8 weeks gestation. However, as the nurse informed me, it’s an unfortunate quirk of medical terminology that any pregnancy that meets an untimely end is called an “abortion,” albeit a “spontaneous” one if it’s the result of a miscarriage. The medical establishment uses the term “elective abortion” for those performed at the choice of the mother. Here, when I use the term “abortion” I refer to elective abortions.
The lack of nuance in medical terminology is unfortunate for more than one reason. For starters, it’s a shock for women like me to hear the devastating, premature ending of a wanted pregnancy referred to as an “abortion.” For another, there are individuals and organizations currently taking advantage of the confusion in terms to deliberately foment fear surrounding miscarriage care, now that matters of (induced) abortion have been returned to the states after the recent overturn of Roe v Wade.
Headlines abound from irresponsible news sources claiming that a woman’s ability to get miscarriage care is now in jeopardy, thanks to the Supreme Court’s decision in Dobbs. Of course, nothing could be further from the truth, as miscarriage care is not an abortion (and vice-versa). I recently spoke with Laura, a woman who unfortunately miscarried her 6th pregnancy at 12 weeks, but did not realize it until week 14 (a phenomenon known as a “missed miscarriage”), and ultimately required medical and surgical intervention to resolve the no-longer-viable pregnancy.
Laura’s story is especially illustrative, because she lives in Ohio, which has a “heartbeat law” (the Human Rights and Heartbeat Protection Act) that went into effect after Roe was overturned. Furthermore, she received her miscarriage care in a Catholic hospital (which did not allow abortions, even prior to Roe’s overturn). As readers will see, neither of these two facts impeded Laura from receiving necessary care in the wake of her miscarriage.
Laura’s Story
Laura, 36, and her husband were thrilled when they got the positive test for what was her sixth pregnancy. At first, everything seemed normal, similar to her other pregnancies. This time though, during week 14, Laura started noticing fewer classic pregnancy symptoms. This wasn’t a huge red flag for her initially, because, as many women know, it’s fairly normal for first trimester symptoms (like nausea and heightened sensitivity to smell) to start lessening once a woman reaches her second trimester of pregnancy.
The moment she learned something was wrong
But when Laura went in for her 14-week checkup, something was off. After chatting normally with the PA, who at the close of the appointment said, “let’s listen to the heartbeat and we’ll get you out of here,” Laura was shocked when the PA informed her that she couldn’t find a heartbeat with the Doppler. The PA then proceeded to call in the ultrasound technician, who had a handheld ultrasound device. But the ultrasound tech also had a difficult time finding the heartbeat, and wondered aloud if the lighting in the room “just wasn’t good enough.”
Laura and the team then made the decision to go to the ultrasound room to do a full scan. It was only during this third and final attempt that Laura learned the news she’d been dreading to hear: her baby no longer had a heartbeat.
With the baby measuring at only 12 weeks gestation, it became clear that the baby had passed away two weeks prior, unbeknownst to Laura. “I lost it,” says Laura, “more than I would have expected to, I just completely broke down.” Soon afterwards, the doctor was brought in to speak with Laura about her options, beginning with expectant management, and, if necessary, medical management or surgical management.
Ohio’s “heartbeat law” did not impact Laura’s after-miscarriage treatment
When I asked Laura if there was any holdup or obstacles to receiving after-miscarriage care, or if she had ever been worried about that possibility for any reason, Laura said “there was absolutely no discussion about any kind of difficulty I might have in choosing any of those options.” “We could go any route we wanted,” she continues, “and they [the hospital] could easily accommodate that,” even though, as Laura points out, “we live in Ohio, and do have a heartbeat law.”
Laura, who has read the full text of Ohio’s heartbeat law, notes that it “does not apply to miscarriage care,” and that it only restricts terminating a pregnancy in non-emergency circumstances without first attempting to find a heartbeat (or after detecting a heartbeat)*, so she “knew for a fact that there was no legal reason why I wouldn’t be able to receive miscarriage care.”
After Laura talked things over with her husband later that day, she called her doctor and informed him that they had decided to opt for medical management (misoprostol, also known as Cytotec, which both dilates the cervix and induces contractions). With the advice of her doctor, Laura and her husband reasoned that since the baby had passed at 12 weeks, there was a greater chance of retained placenta than if the baby had passed earlier on. Expectant management, therefore, could be risky. At the time, they also did not want to go the surgical route (known as a dilation & curettage, or a D&C), since Laura wanted to deliver her baby whole and intact, if possible.
Induction to preserve the health of the mother is not an abortion
On the day of her induction, Laura checked into the hospital and was able to deliver her baby after several more doses of misoprostol. She and her husband were given time to spend holding their sixth child. After a while, however, complications arose, and Laura started passing large clots and bleeding excessively. An ultrasound revealed that most of the placenta had not yet been delivered, and a D&C would be necessary to remove it. Laura’s doctor quickly performed the D&C, and her bleeding resolved.
Thanks to the expedient action taken by her medical team, Laura is physically recovering from her ordeal, even as she and her family are heartbroken at the loss of her child. Laura and her husband are grateful they had the time to hold their baby, even for a short amount of time. Their child’s brief life was honored and its body was buried with dignity, just as any other member of their family who had passed away would have been.
What Laura’s story teaches us about miscarriage care in a post-Roe world
Now, it is true that misoprostol is often used to induce the abortion of an early viable pregnancy–a topic we have covered extensively at Natural Womanhood. It’s true, too, that the D&C procedure Laura had is also used for first-trimester surgical abortions (and likewise, a D&E or dilation and extraction procedure that may be necessary to manage second-trimester miscarriages is also used for second-trimester abortions). However, these medications and procedures clearly have a place outside of induced abortion, and can truly be life-saving in situations like Laura’s—which the Ohio law, and others like it, recognize and allow.
Because miscarriage treatment isn’t an abortion, laws that restrict abortion do not impact miscarriage management
Regardless of a state’s stance on abortion, treatments for life-threatening circumstances like ectopic pregnancies, premature rupture of membranes (PROM), and missed or incomplete miscarriages (to name a few), are often explicitly stated as being protected procedures, and are categorically different from induced abortions of viable pregnancies. Laura’s story corroborates the fact that miscarriage treatment is not an abortion. “There was no talk about any obstacles, or any talk of extra legal waivers,” says Laura, “it was just ‘let’s get you into surgery, let’s get you cared for…’ At no point was there any trouble getting medication or getting into surgery.”
Laura’s doctor knew what many other good doctors know: Miscarriage care is fundamentally different than an abortion, and laws aimed at curtailing abortion do not apply to cases like Laura’s, where the baby has already died (or even when the baby is not dead but will die, and the only life that can be saved is that of the mother, such as with ectopic pregnancies or PROM). Laura’s experience, while undoubtedly tragic, is an excellent example of the care that has been–and still is–available to women facing miscarriage. Those claiming that this kind of care is now in jeopardy do women facing these tragic circumstances no favors, only adding to their confusion and heartbreak.
*Note that per Section 2919.193 of Ohio’s Human Rights and Heartbeat Protection Act, medical providers need not check for a heartbeat before providing treatment in a medical emergency.
Additional Reading:
5 ways the medical community can support women who experience miscarriage
Healing after the loneliness and heartbreak of a miscarriage
Four things everyone needs to know about miscarriage
How to chart your cycle and figure out when you will ovulate after a miscarriage
Progesterone helps prevent miscarriage: good news for moms and babies
Your treatment options for an ectopic pregnancy, and why the overturn of Roe hasn’t affected them
