Ask Dr. Nandi: The potential impact on miscarriage treatment since the overturning of Roe v. Wade

Conversations you should now have with your OBGYN
Posted at 12:07 PM, Jun 25, 2022
and last updated 2022-06-25 12:07:15-04

Miscarriage care could certainly be impacted by the overturning of Roe v. Wade, it's already happening in Texas.  

A miscarriage is defined as the spontaneous loss of a fetus before the 20th week of pregnancy.

It makes sense that people think of miscarriage as something that you have no control over. That can be true, but it can also be something that people have to make decisions about. Not all women can let miscarriage progress naturally. It can take three or four weeks for expulsion. As a result, medical or surgical treatment may be needed, especially, if there are signs of infection. 

Currently, the standard of care for treating a miscarriage is almost identical to the standard of care for providing an abortion. There's nothing in these laws that says if there's a miscarriage somebody has to prove it, but there are reports about some doctors questioning patients about medications they might have taken or how they might have caused a miscarriage to happen.

In practical terms, getting the right treatment, on time, without barriers or questioning, might be challenging.

How will IVF be affected now that abortion is banned?
The short answer is yes. In vitro fertilization, or IVF, could be affected by these legislative changes. That's because the way certain words are defined in many of these new laws often don't match medical definitions.

In Texas, the law in place says that pregnancy begins with "fertilization," when a single sperm and an egg meet. But, in medicine, pregnancy is defined as beginning after that fertilized egg divides, grows and implants in the uterus. Whether IVF will be limited through these or future laws is still up in the air.

Are hospitals ready for this change?
That's an important question. Rural areas, even before COVID-19, were facing lots of hospital closures, particularly of labor and delivery wards. Some have had to travel long distances to receive a variety of care. In addition, women's health providers are leaving rural areas. But, many hospitals will be as ready as possible to meet the needs of patients who need care.