Miscarriages And Abortion Laws: Overlapping Boundaries?

The legal status of abortion has been left to individual US states since the Supreme Court struck down Roe v. Wade. In the wake of this decision, 14 states have near-total bans on abortion, and many more have attempted to restrict access to abortion. While all of these bans have an exception to prevent the death of the pregnant person, the laws are often vague, and physicians have been reluctant to provide treatment for miscarriages, even when the pregnant person's life is at risk.

In Texas, for example, abortion is illegal after a fetal heartbeat is detected, unless it is necessary to prevent the death of the pregnant person or a serious risk of substantial impairment of a major bodily function. However, the law does not define reasonable medical judgment or major bodily function, and doctors have been hesitant to intervene in cases of miscarriage, even when the pregnant person is experiencing severe pain and bleeding.

The situation is further complicated by the fact that, in many states, miscarriage management care can look similar to interventions used to provide elective abortions. As a result, physicians have delayed providing treatment for miscarriages, even when the pregnant person's life is at risk, for fear of criminal prosecution and loss of their medical license. This has left those experiencing miscarriages in a dangerous legal limbo, unsure of what to do and afraid of the potential consequences.

Miscarrying patients are potentially making decisions about fetal remains at home, alone

In the UK, if a miscarriage happens at home, the decision about what to do with the fetal remains is often left to the patient. This can be a very difficult decision to make, and it is made even harder by the fact that there is often a lack of clear guidance and support from medical institutions.

In England and Wales, it is legal to flush the remains away down the toilet, and many people do this automatically. However, some people may want to see and keep the remains of their baby, and this can be very upsetting. It is natural to want to remove the remains for a closer look, or to bring them to a GP or hospital for confirmation of the miscarriage or for testing. In these cases, it is important to keep the remains cool until you can find out if testing is possible.

If you want to bury or cremate the remains, you can make your own arrangements, either by using a funeral director or specialist cremation service, or by burying the remains at home. In England and Wales, hospitals are allowed to incinerate fetal remains, particularly those lost in early pregnancy. However, this is not allowed in Scotland, where different guidance states that incineration is not acceptable.

In the US, anti-abortion laws have created a "nightmare" situation for people experiencing miscarriage, as they are often unable to get the medical care they need. For example, in Texas, abortion is illegal after a fetal heartbeat is detected, unless a "reasonable medical judgment" determines that there is a greater risk of the pregnant person dying or impairment of a major bodily function. However, the law does not define what constitutes "reasonable medical judgment" or "major bodily function". This vague language has led to situations where people experiencing miscarriage have been denied care, even when they are experiencing severe pain and bleeding.

Overall, the decision about what to do with fetal remains after a miscarriage can be extremely difficult, and it is made even harder by the lack of clear guidance and support, especially in states with restrictive abortion laws.

Doctors treating miscarriages can get caught in a legal bind

Doctors who treat miscarriages can get caught in a legal bind. The law can be vague on the topic of miscarriages and their aftermath, leaving women desperate and stoking fears of criminal consequences.

In the US, abortion is illegal in 14 states, and the laws on miscarriage are vague. This has led to concerns about criminal consequences and left women unsure of how to handle the remains of their miscarriages. For example, in Ohio, a woman was charged with "abuse of a corpse" after she miscarried into her toilet at home. Although a grand jury declined to indict her, the case brought attention to the legal uncertainty surrounding miscarriage.

The treatment of miscarriage can be similar to interventions used to provide elective abortions. As a result, in states with strict anti-abortion laws, doctors may be reluctant to offer "miscarriage management" for fear of being prosecuted for performing an illegal abortion. This can lead to women being denied the medical care they need to manage their miscarriages.

In Texas, for example, abortion is illegal after a fetal heartbeat is detected unless there is a "reasonable medical judgment" that the pregnant person's life is at risk or there is a risk of impairment of a major bodily function. However, the law does not define what constitutes "reasonable medical judgment" or "major bodily function." This vagueness can make it difficult for doctors to determine when they can legally intervene in a miscarriage.

To assist healthcare providers and dispel misinformation, organisations like the American College of Obstetricians and Gynecologists (ACOG) have provided comprehensive guidance for the management of obstetric and gynecologic conditions, including miscarriage. This guidance can help doctors understand when and how they can intervene in a miscarriage without risking legal consequences.

Overall, the legal landscape surrounding miscarriage is complex and varies from state to state. Doctors who treat miscarriages must navigate this landscape while also providing essential medical care to their patients.

Miscarriage management can be similar to interventions used to provide elective abortion

Misoprostol is the primary drug used to manage early pregnancy loss. It is typically administered vaginally as a single dose of 800 mcg. If the expulsion of the products of conception does not occur, the dose may be repeated once, any time from 3 hours to 7 days after the first dose.

Mifepristone is often used in conjunction with misoprostol to manage early pregnancy loss. When used together, mifepristone is administered as a single oral dose of 200 mg, 24 hours before the first dose of misoprostol. This combination results in a higher success rate than misoprostol alone and has been shown to lead to improved efficacy compared with misoprostol alone in several studies.

The management of miscarriage can be expectant, medical, or surgical. Expectant management involves waiting for the miscarriage to pass on its own without any medical intervention. Medical management involves the use of medications, such as misoprostol and mifepristone, to induce the miscarriage. Surgical management involves uterine aspiration or dilation and suction curettage, which may be performed in an operating room or office setting.

The choice of management strategy depends on various factors, such as patient preference, the presence of comorbidities, and the type of pregnancy loss. All three management options are generally considered equally effective, and patients are more satisfied with their care and have better mental health outcomes when managed according to their preferences.

Miscarriage treatment is not prohibited by law

The American College of Obstetricians and Gynecologists (ACOG) provides comprehensive guidance for the management of obstetric and gynecologic conditions. According to ACOG, accepted treatment options for early pregnancy loss include expectant management, medical treatment, or surgical evacuation. ACOG recommends that patients are counselled about the risks and benefits of each option.

In the case of a miscarriage in the first trimester, ACOG advises that expectant management should be limited due to concerns about hemorrhage. For patients who are miscarrying and present with hemorrhage, hemodynamic instability, or signs of infection, ACOG recommends urgent surgical uterine evacuation.

For medical management of early pregnancy loss, ACOG recommends the use of vaginal misoprostol, with a repeat dose as needed. The addition of a dose of mifepristone before misoprostol administration can improve treatment efficacy. However, mifepristone requires a provider to be registered to prescribe it, and it is not widely available.

It is important to note that the terminology surrounding abortion can be confusing. A "spontaneous abortion" refers to a miscarriage, while an "induced abortion" indicates that the pregnancy was intentionally terminated. "Termination of pregnancy" and "medically indicated separation" refer to separating the mother from the fetus, which can result in a live or dead baby depending on the method used.

While abortion laws may not explicitly mention miscarriage treatment, it is important to clarify that such treatment is not prohibited. The laws reviewed do not prevent mothers from receiving necessary medical care during a miscarriage.

In summary, miscarriage management is an essential aspect of healthcare, and it is not prohibited by abortion laws. Treatment options include expectant management, medical treatment, and surgical evacuation, with the specific approach depending on the patient's condition and the gestational age of the fetus.

Doctors have been reluctant to offer miscarriage management

In Texas, for example, abortion is illegal after a fetal heartbeat is detected unless it is determined that there is a greater risk of the pregnant person dying or impairment of a major bodily function. However, the law does not clearly define "reasonable medical judgment" or "major bodily function," leaving doctors hesitant to intervene. Similar stories have emerged from other states with strict abortion laws, where doctors are worried about criminal prosecution and the loss of their medical licenses if they are perceived to be performing illegal abortions.

The reluctance of doctors to offer miscarriage management has had devastating consequences for women experiencing miscarriages. In one case, a woman in Texas fainted from blood loss after being denied medical care during her miscarriage. In another instance, a woman in Ohio was charged with "abuse of a corpse" after experiencing a miscarriage and flushing the remains, sparking fears among reproductive rights groups about the legal definition of a fetus as a human body.

The ambiguity surrounding abortion laws and their exceptions has created a dangerous legal limbo for women who miscarry, leaving them unsure of how to handle the remains of their pregnancies and whether they can even seek medical help. This uncertainty, combined with the reluctance of doctors to provide miscarriage management, has resulted in women suffering physically and emotionally during what is already a traumatic experience.

To address this issue, abortion bans must include clear and workable exceptions that allow doctors to provide evidence-based care without fear of prosecution. Additionally, there needs to be greater clarity and consistency in the laws surrounding the handling of fetal remains to ensure that women who miscarry can make informed decisions without fear of criminal consequences.

Frequently asked questions