January 19th, 2023:

Here’s another thing most of us have not had to think much about in the past when abortion was generally legal.

[A uterine aspiration (also commonly known as a D&C) or the removal of tissue from the uterus via suction] is a standard method for treatment of miscarriage and can be a life-saving intervention if a woman is hemorrhaging. But uterine aspiration is also routinely used to perform early abortions, and that’s one reason many emergency departments have historically resisted efforts to make the option available to patients who come in for miscarriage-related care.

That care already accounts for more than 900,000 emergency room visits every year, according to the most recent estimates. Now, as states move to restrict access to abortion in the wake of the Supreme Court’s decision in June to overturn Roe v. Wade, experts say that number is likely to surge even higher.

“Fewer abortions will mean more pregnancies, and more pregnancies will mean more miscarriages,” said Dr. Sarah Prager, a professor of obstetrics and gynecology at the University of Washington and a co-author of the guidelines on miscarriage management for the American College of Obstetricians and Gynecologists.

Around 15% of known pregnancies end in miscarriage, and the first medical professional many of those patients see will be in an emergency room. Yet, by and large, she says, “emergency medicine physicians aren’t trained in managing miscarriage and don’t see it as something they should own.”

For more than a decade, Prager has been trying to change that through her work with the TEAMM Project, the nonprofit she co-founded on the premise that “many people experience miscarriage before they’re established with an OB-GYN.” Short for Training, Education and Advocacy in Miscarriage Management, TEAMM has conducted in-person workshops for clinicians at more than 100 sites in 19 states on all aspects of miscarriage care — everything from the use of ultrasound to diagnose fetal death to the three treatment options miscarrying patients should be offered when they come in for care.

A uterine aspiration is recommended when patients are bleeding heavily, are anemic, or are medically fragile, and many patients prefer the procedure because it can resolve a miscarriage most quickly. Another option is medication — usually mifepristone followed by misoprostol — which can help the body expel pregnancy tissue in a matter of hours. And the third is “expectant management”: waiting for the tissue to pass on its own. The latter can take several weeks and is unsuccessful for about 20% of patients, who remain at risk for hemorrhage and have to return to the hospital for surgery or medication.

In many emergency departments, expectant management has long been the only option made available. But now, amid the legal uncertainty unleashed by the fall of Roe, Prager and colleagues say they’ve been inundated with inquiries from emergency departments across the country. Doctors in states that have since criminalized abortion face stiff penalties, including felony charges, prison time, and the loss of their medical license and livelihoods.

“I think they’re scared,” says Prager. “They want to be able to know, with 100% certainty, that a pregnancy is no longer viable.”

This is why I say it’s just a matter of time before some nice white suburban lady who already has kids dies because she isn’t treated for a pregnancy-related emergency in a timely fashion. The corollary to this is that some doctor who performs a life-saving D&C on a patient will be arrested and charged with murder for it. I don’t want to see these things happen. It’s just that the conditions in our state, and in too many other states, are absolutely ripe for it. I really hope I’m wrong.