Yes, Surgical Abortion Is Healthcare. Ask Me How I Know.
TRIGGER WARNING- DISCUSSES MISCARRIAGE AND EARLY PREGNANCY LOSS
By Julie Wilson
Listening For The Heartbeat
I was fifteen weeks pregnant and excited to hear my baby’s heartbeat again as I had at my seven-and eleven-week appointments. I had just emerged, thankfully, from the fatigue and nausea of the first trimester, or so I thought. I’d even gone for a run the day before for the first time in weeks. I felt strong and healthy as the doctor rubbed cold goop on my swollen belly. When he slid the Doppler stethoscope across my stomach, I waited in expectant awe.
I listened for the happy whooshing sound I’d been looking forward to hearing for the past month. Moments passed when we didn’t hear anything. Uncomfortable moments. Each second when I didn’t hear the heartbeat felt like hours. I looked at my doctor, who wore an uncharacteristic strained look on his face. My excitement turned to confusion and concern when he left the room to get a different Doppler machine, and then a third.
“I can’t find the heartbeat,” he said, finally. “I’m sorry.”
I couldn’t quite take that in. The doctor’s office made an emergency sonogram appointment for me at an imaging facility twenty minutes away to confirm what the doctor suspected, that my baby was no more. They also suggested I call my husband to go to the appointment with me, since he hadn’t come to what was supposed to be a routine check-up. Making that phone call reminded me to call my boss, although I wasn’t sure what to say other than I wouldn’t be in to the office that morning as expected.
My husband and I drove to the imaging facility together, the day of happiness and hope having turned into something dark we hadn’t expected. I remember feeling mostly dread but also a faint hope that the baby was still alive. I placed both hands on my stomach as if I could hold the baby and fix whatever what was going wrong.
Sonogram and Options For Miscarriage Care
When we arrived, I had a hard time figuring out the words to say as my introduction. I, a woman who’d been euphoric not two hours ago, was probably no longer pregnant. The technician took the sonogram images but wouldn’t meet our eyes. We had many questions. But she said only that the radiologist would be in soon to talk to us. As we waited, my husband and I barely spoke, which is unusual, at least for me. Neither of us wanted to give voice to our fears. I languished, feeling cold, and awful.
The radiologist confirmed that our baby had died, two weeks earlier. Two weeks during which I’d been sharing the happy news with friends and family and starting to prepare our 2 year-old son for his new sibling – all while carrying around a baby that had already died. My husband and I reeled with shock as we began to process this news.
It sounds naïve, but I hadn’t really considered miscarriage as a possibility this time. I’d had an easy, successful first pregnancy and this second pregnancy had seemed normal as well. I didn’t realize how common miscarriage is, mainly because I hadn’t heard anyone talking about it happening to them. We drove back to the Ob/Gyn’s office to talk about what would happen next, and to ask all the questions swirling in our heads. We wondered why this had happened, and what the chances were of it happening again.
I kept asking myself if something I had done, or hadn’t done, had caused the baby to die. I still remember the warmth of the hug the nurse gave me when she said, “You know, running had nothing to do with this. This was not your fault.”
My doctor explained that the best way to ensure my health and ability to bear children in the future would be for him to perform a surgical procedure known as a D&C (Dilation and Curettage). This procedure can also be used to perform an abortion of a fetus that has not died. Both procedures involve “surgical abortion”. During a D&C, or surgical abortion, the cervix is dilated, and any pregnancy-related tissue is gently scraped or suctioned out of the uterus.
While that sounded kind of horrible, the alternative was to wait until my body attempted this same process on its own. But if we waited, I might not be able to have children in the future. I also might suffer an infection or heavy bleeding. I come from a happy family of four, and I desperately wanted to have more children.
We agreed to the surgery. The doctor scheduled the procedure for early the next morning. As traumatized as I was, it was a relief to not have to wait any longer with a dead baby inside me.
A Happy Ending For Me After Heartache And Pain
I am not the only one to have suffered a miscarriage or many miscarriages. Between 10% and 20% of all known pregnancies end in miscarriage, 80% of them in the first 13 weeks of pregnancy. D&C surgery, was then and is now, the only option of medical care for the mother when a miscarriage occurs beyond 10 weeks’ gestation. The FDA approval of mifepristone (the relatively new medical abortion drug) is limited to pregnancies of up to ten weeks.
I had later miscarriages at 11 weeks, and again at 13 weeks. Each time, my doctor performed a D&C. Each time, my body was able to heal quickly, although my heart did not.
In between the second and third miscarriages, I had a full-term pregnancy. I was thrilled to give birth to a beautiful baby girl, who appears in the photographs accompanying this blog. That successful pregnancy was only possible because I received the best available medical care for my early pregnancy losses.
When I see what’s going on around the country now, I am reminded of how lucky I was even during those unlucky and emotional times, that I had access to care that focused on my health, and my future fertility. If not for my doctor, and the laws in place back then, my daughter possibly would not have been born. I also could have died or had bad illnesses and bleeding.
What If What Happened To Me Then Happened Today?
My miscarriages occurred during the 11th, 13th, and 15th weeks. Today, these sad medical events would be treated differently than they were in the 1990’s, differently depending on the state in which a woman lives, and in some cases a miscarriage in the 11th week differently from one in the 13th or 15th week. Everything changed two years ago when the Supreme Court overturned Roe v. Wade in the Dobbs decision.
Since Dobbs, fourteen states have enacted near total abortion bans (Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, and West Virginia); four others prohibit abortions after six weeks, a time when many women don’t even realize they are pregnant (Florida, Georgia, Iowa, South Carolina); and two states restrict abortions after twelve weeks (Nebraska, North Carolina). If I lived in one of those 20 states, I hate to imagine what my miscarriage experiences would be like today. My daughter might not well have been born if I miscarried in one of those states today.
My daughter and me. So grateful for her and to my doctor for helping her to join the world.
Miscarriage Care Changes Since Dobbs
Today, perhaps, my daughter would not be born if I had suffered an earlier miscarriage. In its practice bulletin on early pregnancy loss, the American College of Obstetricians and Gynecologists (ACOG) emphasizes the importance of considering patient preference for the three miscarriage treatment options: miscarrying naturally; a medical abortion achieved by taking a combination of mifepristone and misoprostol pills; or a surgical abortion by having a D&C. Surgery “results in faster and more predictable complete evacuation”, and therefore enables future births.
But because the same surgical procedure for removing a living fetus can be used to remove a dead fetus, doctors and hospitals in states that have enacted strict anti-abortion laws worry they’ll be prosecuted for performing an abortion even when they are providing miscarriage care. In some cases, they’ve refused to perform miscarriage care and care for life-threatening ectopic pregnancies for fear of legal action taken against them.
Map showing abortion laws across the US since Dobbs.
My miscarriages were treated in accordance with the best medical practices at the time, my obstetrician’s decades of experience, and his many years of medical education and training. My doctor consulted with my husband and me. You know who wasn’t in the room and who didn’t have a say as to what would be best for my health? My state’s politicians.
Now that abortion is banned or restricted in numerous states, many women experiencing pregnancy complications are not guaranteed the medical care they need. Many have to wait through administrative delays and additional tests such as a second sonogram in order to receive necessary medical care.
If you ask me, women experiencing pregnancy loss are facing enough trauma; it’s not like trying to schedule gallstone surgery and being required to submit to another blood test or scan.
Sadly, My Daughter Has Fewer Rights And Options Than I Did
Because my unsustainable pregnancies happened over 20 years ago, not only were we able to get a D&C, we did not need to navigate additional obstacles like getting a second sonogram at a different facility before scheduling medically necessary surgery, without which I might have become infertile, seriously ill, or died. I was able to go home and rest. I was able to cry in private and not in an uncomfortable waiting room, just to hear the same by-now obvious, horrible news again.
I’m anxious for the women whose health and fertility these restrictive state laws compromise. When I imagine what my miscarriages could have been like had they happened today, I’m traumatized all over again. What I went through was bad enough, but I now realize that it could have been a lot worse, and is a lot worse now.
The baby girl I gave birth to in the 1990s just graduated from law school. I look at her and remember how it felt like a miracle when she was born. I’m so happy that the care I received made her life, and our joy, possible. It’s still hard to believe she has fewer rights with respect to reproduction than I did when I was her age.
So proud to attend my daughter's law school graduation: all the sadness turned to joy.
My Wish For My Daughter, And Everybody’s Daughters
I don’t want things to be worse for my daughter, our sisters, neighbors, friends, or any other woman anywhere. I believe that essential healthcare should be the same for women everywhere, across these United States, and my heart breaks that this is no longer the case.