Brought to you by SCOTUS and the Republican Legislature. And Greg Abbott and Dan Patrick and Ken Paxton, too.
Before states banned abortion, one of the gravest outcomes of early miscarriage could easily be avoided: Doctors could offer a dilation and curettage procedure, which quickly empties the uterus and allows it to close, protecting against a life-threatening hemorrhage.
But because the procedures, known as D&Cs, are also used to end pregnancies, they have gotten tangled up in state legislation that restricts abortion. Reports now abound of doctors hesitating to provide them and women who are bleeding heavily being discharged from emergency rooms without care, only to return in such dire condition that they need blood transfusions to survive. As ProPublica reported last year, one woman died of hemorrhage after 10 hours in a Houston hospital that didn’t perform the procedure.
Now, a new ProPublica data analysis adds empirical weight to the mounting evidence that abortion bans have made the common experience of miscarriage — which occurs in up to 30% of pregnancies — far more dangerous. It is based on hospital discharge data from Texas, the largest state to ban abortion, and captures emergency department visits from 2017 to 2023, the most recent year available.
After Texas made performing abortions a felony in August 2022, ProPublica found, the number of blood transfusions during emergency room visits for first-trimester miscarriage shot up by 54%.
The number of emergency room visits for early miscarriage also rose, by 25%, compared with the three years before the COVID-19 pandemic — a sign that women who didn’t receive D&Cs initially may be returning to hospitals in worse condition, more than a dozen experts told ProPublica.
While that phenomenon can’t be confirmed by the discharge data, which tracks visits rather than individuals, doctors and researchers who reviewed ProPublica’s findings say these spikes, along with the stories patients have shared, paint a troubling picture of the harm that results from unnecessary delays in care.
“This is striking,” said Dr. Elliott Main, a hemorrhage expert and former medical director for the California Maternal Quality Care Collaborative. “The trend is very clear.”
The data mirrors a sharp rise in cases of sepsis — a life-threatening reaction to infection — ProPublica previously identified during second-trimester miscarriage in Texas.
Blood loss is expected during early miscarriage, which usually ends without complication. Some cases, however, can turn deadly very quickly. Main said ProPublica’s analysis suggested to him that “physicians are sitting on nonviable pregnancies longer and longer before they’re doing a D&C — until patients are really bleeding.”
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While they can be lifesaving, transfusions do not stop the bleeding, experts told ProPublica, and they can introduce complications, such as severe allergic reactions, autoimmune disorders or, in rare events, blood cancer. The dangers of hemorrhage are far greater, from organ failure to kidney damage to loss of sensation in the fingers and toes. “There’s a finite amount of blood,” said Dr. Sarah Prager, a professor of obstetrics and gynecology at the University of Washington. “And when it all comes out, you’re dead.”
ProPublica’s findings about the rise in blood transfusions make clear that women who experience early miscarriages in abortion ban states are living in a more dangerous medical climate than many believe, said Amanda Nagle, a doctoral student investigating the same blood transfusion data for a forthcoming paper in the American Journal of Public Health.
“If people are seeking care at an emergency department,” Nagle said, “there are serious health risks to delaying that care.”
See here for more on the sepsis situation, and there’s also the post-partum mortality problem. It’s possible, I suppose, that the just-passed “abortion exceptions” law could help things a little, but I wouldn’t expect more than that. I hope we keep studying the issue regardless, as maybe eventually it will make a difference in how we vote. We both know what the solution is, so I’ll just note that more abortion restrictions are on the special session agenda and leave it at that.
What is one woman compared to the thousands of babies saved?
Her death is unnecessary and preventable. These are doomed pregnancies with zero chance of producing a baby. No excuses for this other than cruelty and the desire for control.
How would you write a law that could have both outcomes, Fly?
You get rid of this increased legal liability on physicians. The presence of a fetal heartbeat should be irrelevant to imposing limitations on treatment decisions when a woman is hemorrhaging or in sepsis. Let the doctors act on their medical judgment and the patient’s wishes as to the best treatment. If you want to claim someone might try gaming the system, there is already a process in place for reporting/ investigating/ punishing malpractice. Stick to that.