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The Threats to Safe and Effective Miscarriage Care in the US

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Learn about the state of miscarriage care in the US and the threats it faces from political interference and legal restrictions. Understand the causes of miscarriage, how it is diagnosed, and the treatment options available. Discover how laws and lawsuits impact the ability of healthcare providers to offer safe and effective care, and what you can do to protect access.

When you first learned about pregnancy, you probably didn't learn that up to one in three pregnancies end in a miscarriage. Miscarriage is a pregnancy loss before 20 weeks, counting from the first day of the last menstrual period. It is a common occurrence, but what causes it, how is it treated, and why is miscarriage care under scrutiny in the US?

What is miscarriage?

Miscarriage is a term used to describe the loss of a pregnancy before 20 weeks. It happens in as many as one in three pregnancies, but the risk decreases as pregnancy progresses. By 20 weeks, it occurs in fewer than one in 100 pregnancies.

What causes miscarriage?

Usually, there is no obvious or single cause for miscarriage. However, several factors can raise the risk, including pregnancy at older ages, autoimmune disorders, certain illnesses, certain conditions in the uterus, previous miscarriages, and certain medicines. It's safest to plan pregnancy and receive pre-pregnancy counseling if you have a chronic illness or condition.

How is miscarriage diagnosed?

Before early pregnancy ultrasounds became widely available, many miscarriages were diagnosed based on symptoms like bleeding and cramping. Now, people may be diagnosed with a miscarriage or early pregnancy loss on a routine ultrasound before they notice any symptoms.

How is miscarriage treated?

When there are no complications and the miscarriage occurs during the first trimester, the options are taking no action, taking medication, or using a procedure. The choice may depend on personal preference, medical history, and gestational age. If a miscarriage occurs during the second trimester, a procedure may be necessary.

Red flags: When to ask for help during a miscarriage

If you experience heavy bleeding combined with dizziness, fever above 100.4°F, or severe abdominal pain not relieved by over-the-counter pain medicine during the first 13 weeks of pregnancy, contact your health care provider or go to the emergency department immediately. After 13 weeks, contact your health care provider or go to the emergency department immediately if you experience any of the listed symptoms.

How is care for miscarriages changing?

Unfortunately, political interference has had a significant impact on safe, effective miscarriage care. Some states have banned a procedure used to treat second-trimester miscarriage called dilation and evacuation (D&E), and federal and state lawsuits or laws banning or seeking to ban mifepristone for abortion care directly limit access to a safe, effective drug approved for miscarriage care. Many laws and lawsuits that interfere with miscarriage care offer an exception to save the life of a pregnant patient. However, miscarriage complications may develop unexpectedly and worsen quickly, making it hard to ensure that people will receive prompt care in life-threatening situations.

States that ban or restrict abortion are less likely to have doctors trained to perform a full range of miscarriage care procedures. Clinicians in training, such as resident physicians and medical students, may never learn how to perform a potentially lifesaving procedure.

Ultimately, laws and lawsuits that ban or restrict abortion care will decrease the ability of doctors and nurses to provide the highest quality miscarriage care. Medical professionals must be able to offer the full range of treatments for miscarriage without fear of legal repercussions, and patients must have access to safe and effective care when they need it. We can all help protect access to miscarriage care by advocating for policies prioritizing reproductive health and supporting organizations providing education and resources on this issue.

One such organization is the Miscarriage Care Initiative, which aims to improve the quality of care for people experiencing pregnancy loss. The initiative offers educational resources for clinicians and medical students, as well as guidance for hospitals and health systems to implement best practices in miscarriage care. By supporting organizations like this one, we can help ensure that people who experience miscarriage receive the care and support they need during a difficult time.

In conclusion, miscarriage is a common occurrence in pregnancy, but it is not always discussed openly or understood fully. When it comes to miscarriage care, political interference and legal restrictions threaten access to safe and effective treatments. We must advocate for policies that prioritize reproductive health and support organizations that provide education and resources on miscarriage care. With the right support and resources, we can ensure that people who experience miscarriage receive the care and support they need.

Caroline Buckee

Caroline Flannigan is an epidemiologist. She is an Associate Professor of Epidemiology and is the Associate Director of the Center for Communicable Disease Dynamics.

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