What Now

A World Without Roe v. Wade Will Make Miscarriage More Dangerous

A few short years ago, I had excellent miscarriage care, unburdened by worries about legalities. Will it be that way again?

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The moment Roe v. Wade was overturned, I flashed back to my own miscarriage, when I was offered multiple choices for how to proceed next through the toughest moments of my life. I was offered a pill to complete my miscarriage, a surgery called a D&C, or time to see if it would pass on its own. My pregnancy had already been unviable for weeks without my knowing it, and I wanted the quickest option possible. Every additional second felt like 100 years.

I had the luxury, just a few short years ago, to control this one choice in a very out-of-control situation. My excellent miscarriage care was part of the reason I decided to try to conceive again, and was able to eventually carry my fourth son — my rainbow baby — to term.

My best friend, Lauren Downs, endured another type of miscarriage a few years ago, an ectopic pregnancy, which is always unviable and always dangerous to the mother, and in the wake of the Dobbs decision she has posted publicly on social media about it 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.”

At the time of our procedures, neither one of us worried about checking legalities, following rules, or anyone really aside from my partner, myself and my doctor.

But thanks to the Supreme Court’s recent ruling in Dobbs vs. Jackson Women’s Health Organization, many people will no longer have that experience. 26% of pregnancies (10% of known pregnancies) end in miscarriage, and miscarriage care is sometimes abortion care. Restricted abortion access will reduce access to miscarriage care and make a harrowing situation more dangerous. Here’s how, and why it matters to almost every child-bearing aged American — and those who care about them.

Where miscarriage care stands after Roe’s overturn

Let’s start with terminology: a miscarriage is also called a “spontaneous abortion” before the pregnancy is 20 weeks along (after that it’s called a stillbirth). I was shocked to see all my paperwork, including my note to an employer, stating I’d had an abortion. Inherently, as Dr. Cindy Duke, OBGYN at Nevada Fertility Institute told me, “Abortion in the medical term refers to even when the body is spontaneously aborting the pregnancy. So I know there’s a lot of misconception out there that the word abortion suggests it’s not being actively terminated by someone, but that’s not true.” This means that medically, abortions also include miscarriages at times, such as when your body naturally “aborts” a baby. And so when politicians start interfering with or blocking abortion care, that has big implications for miscarriage care.

Miscarriage can be dangerous to the pregnant person in multiple instances, but not all states with abortion restrictions have exceptions for the parent’s health. Even in states that do allow abortion care when the pregnant person’s life is in jeopardy, there’s no clear definition for what that means, Duke points out. That means that banning abortion makes pregnancy inherently more dangerous: One study predicts that a total abortion ban would spike pregnancy-related deaths by 21%, such as in my home state of Ohio, where currently I have to be dying to get miscarriage care in some cases, like these.

Restrictions and bans have also increasingly criminalized miscarriage. As the New Yorker reports, sometimes formerly pregnant people are prosecuted as miscarriage and abortion are not so easily distinguishable in some cases. Fear of legal implications, even inaccurate accusations, might prevent pregnant people from seeking prenatal health care, resulting in even more maternal and fetal deaths. The idea that on top of processing the devastation of a miscarriage I might have had to navigate “proving” what’s happening in my own uterus to a lawmaker or police investigation is incomprehensible.

What defines a pregnancy?

Legislators often seem to be clueless about the basic medical facts. Doctors have struggled to educate politicians that a pregnancy that implants outside of the womb, such as in the abdominal cavity, on the cervix, or on a fallopian tube, is not an “intrauterine” pregnancy, and therefore shouldn’t be restricted by abortion laws. (These pregnancies are also, by definition, never viable.) But politicians periodically decide that they know better, such as the 2018 Ohio politician who ordered doctors to “reimplant” them in the uterus, which is medically impossible.

Their ignorance has absolutely horrifying potential ramifications.

Specific Pregnancy Issues

Every ectopic pregnancy eventually becomes an emergency if it's not removed. Restricted abortion laws force providers to delay care until a pregnant person is in a life-threatening emergency to remove their ectopic pregnancy. This creates significant danger for them, and potential long-term damage that isn’t necessary.

In Lauren’s case, she had life-saving surgery to end her ectopic pregnancy. She lost one of her fallopian tubes in the process. Duke says she’s had patients up to 12 weeks into an ectopic pregnancy with a fetus who had a heartbeat, causing a life-threatening scenario for the mother.

Then there are cases where the fetus might technically have a heartbeat, but the pregnancy has become “septic.” That means the fetus is infected and the toxic infection is spreading beyond the uterus, and if left untreated it will kill the pregnant person. The treatment is to remove the infected fetus, the source of the infection. “In states where if the heartbeat is there, you can’t do it, this person could potentially die,” Duke says. She points to a famous 2012 case in Ireland where 31-year-old dentist Savita Halappanavar died of sepsis after being denied a life-saving abortion.

At this point, you might say, “But don’t most states have protection for a pregnant person’s health being endangered?” Some of them, yes. But some don’t. The other issue is the delay while legal teams and doctors negotiate the vague language of the new laws they are dealing with — just what constitutes dying? How dangerous is dangerous enough for doctors and hospital systems concerned about legal fallout?

Health care professionals posted on social media just hours after Roe was overturned, telling stories of people bleeding while their doctors awaited guidance. If my friend Lauren’s miscarriage happened today, in our home state of Ohio, or other restrictive states, would she have gotten lifesaving care fast enough? I don’t know.

Requiring that people be on the brink of death before providing miscarriage care means “lives will be lost,” Duke says. “Lives will be lost because people had to take a gamble and the person was so unstable that they didn’t recover. Lives will be lost because they just won’t go to the hospital because they’re like ‘I won’t get any help, so why go’ and we saw that with COVID,” she says, adding that others will die trying to get abortions outside of hospitals. “We will lose people, we will. And that’s what really is very upsetting.”

Fewer choices can lead to increased mental health problems in miscarriage care

Though my miscarriage didn’t involve terminating a fetus with a beating heart, it did involve choices — medication, a D&C, or waiting for it to pass. But if my baby had a slowing heartbeat for weeks, in states with harsh abortion restrictions I definitely would have to wait for the heart to stop before moving forward with treatment. The fact that I was able to access a D&C with my preferred provider just hours after finding out about my loss made it bearable, and I believe played a major factor in my emotional recovery.

What Now?

After seven years of trying to conceive, Lauren is reconsidering whether it’s safe for her to do so now, as she’s at an increased risk of having another ectopic in a state that might not help her until she’s in serious harm. As a Type 1 Diabetic, she also isn’t able to simply cross state lines to find a whole new medical team who would be supporting her here through pregnancy with diabetes. Others face this, and additional financial and access barriers that make traveling impossible (and it’s yet to be clearly determined whether they might face legal consequences upon return).

As she wrote in her Facebook post: “I fear for what that journey will look like now. Will we legally have access to IVF if needed? Will I legally be forced to continue a pregnancy that’s not viable and could take my life? Will my doctors have the legal right to care for me if something happens? These questions are terrifying to ask but a reality we are facing and it has to change.”

Duke says now is the time to talk to your current OBGYN about their beliefs, and their ability to support you through these instances and, if necessary, to find another doctor more aligned with your beliefs.

This is the sobering reality of miscarriage care in a post-Dobbs world, where pregnant people worry about state regulations instead of processing their own grief and physically recovering in one of the most difficult moments of their lives. In one of the “most developed countries” in the world, this is unacceptable.

Alexandra Frost is a Cincinnati-based freelance journalist, content marketing writer, copywriter, and editor focusing on health and wellness, parenting, real estate, business, education, and lifestyle. Away from the keyboard, Alex is also mom to her four sons under age 7, who keep things chaotic, fun, and interesting. For over a decade she has been helping publications and companies connect with readers and bring high-quality information and research to them in a relatable voice. She has been published in the Washington Post, Huffington Post, Glamour, Shape, Today's Parent, Reader's Digest, Parents, Women's Health, and Insider.

Alex has a Master of Arts in Teaching, and a Bachelor of Arts in Mass Communications/Journalism, both from Miami University. She has also taught high school for 10 years, specializing in media education.