Medical care for pregnancy loss could be affected if Roe v. Wade is overturned
AYESHA RASCOE, HOST:
If the Supreme Court ends federal protection for abortion rights, about two dozen states are poised to make most abortions illegal. And that could complicate the treatment of miscarriages and ectopic pregnancies. Dr. Lauren Thaxton is an OB-GYN in Texas, where state laws already have the effect of limiting access to abortion. She's a complex family planning subspecialist at the Dell Medical School at UT Austin, and she joins us now. Dr. Thaxton, thanks for being with us.
LAUREN THAXTON: Thank you for having me.
RASCOE: Miscarriages are extremely common. And a lot of times, people don't talk about them, but they happen a lot, right?
THAXTON: Absolutely. Miscarriage is extremely common. About 1 in 10 pregnancies that are clinically recognized ends in miscarriage. And that number might actually be higher. When I say clinically recognized, what I mean is these are patients that come to see a provider in a clinic. Many more people may have a positive pregnancy test at home and not seek care necessarily and have a miscarriage on their own.
RASCOE: Can you tell us more about what the medical treatment for miscarriages looks like and how it's similar to the treatment for abortions?
THAXTON: So the two treatment options that we have to complete a first trimester miscarriage are medications, where we use mifepristone and misoprostol. Those medications, taken together, cause the patient to cramp and bleed and pass pregnancy tissue. The second option that we have is a procedure called a dilation and curettage, or D&C. This is a procedure where we use suction to remove pregnancy tissue from the uterus.
In the case of second trimester pregnancy loss - stillbirth - the treatment options are induction of labor or a second trimester procedure called dilation and evacuation. These are all functionally exactly the same processes that we use for abortion for a different indication.
RASCOE: Is there an overlap for that and the treatment of ectopic pregnancies? And can you just quickly explain what an ectopic pregnancy is for those who may not know?
THAXTON: Yeah, ectopic pregnancy is a condition where the pregnancy develops outside the uterus - most commonly in the fallopian tube. This is a potentially life-threatening emergency. In the case of ectopic pregnancy, the most common treatments that we use are a medication called methotrexate or surgery, where we remove the pregnancy tissue.
RASCOE: Because the treatments are so similar, if the Supreme Court does remove federal protections for abortion rights, how could that be sorted out?
THAXTON: I would say that the association between abortion and miscarriage - even before some of this most recent news - has limited treatment options for miscarriage. As an example, the medication mifepristone is under an FDA program called the REMS, or Risk Evaluation Mitigation Strategy. And this creates a significant barrier to systems being able to incorporate this medication into their practice - hospital systems, clinic systems.
When we also look at some of the policy that we've seen here in Texas, we have since seen and heard stories of patients being unable to access their misoprostol. And these patients have been unable to access their medication at the pharmacy for treatment of their miscarriage.
RASCOE: So can you explain that a little bit more? Doctors can still prescribe the medication, but some pharmacists are reluctant to actually fill the prescription. Is that what's happening, or are doctors also reticent to make these prescriptions?
THAXTON: Both happen but for the different medications. In the case of mifepristone, because that medication is kept in the clinic and dispensed directly to the patient, some clinic programs have not pursued the steps that are needed to be able to access that medication in their system because of its association with abortion, because of the additional barriers that are created by this REMS strategy.
In the case of misoprostol, what we've seen is the situation where doctors are prescribing this medication for treatment of miscarriage, and patients are taking the prescription to the pharmacy and being told that they can't fill this medication at that pharmacy because of the pharmacy being unable to be certain what it is being used for.
RASCOE: You supervise residents who treat patients who are experiencing miscarriages or ectopic pregnancies. What have you heard from them? Like, are they having trouble prescribing the necessary medications?
THAXTON: Yeah. So through the residency program, that's how I'm hearing these instances of patients that have been turned away from the pharmacies. They're speaking one-on-one with patients who are waiting at the pharmacy for their medication or have already gone home or maybe just waited until their follow-up appointment in clinic, and now are telling our trainees that they were unable to access their medication. And so here they are still with a miscarriage.
RASCOE: That's Dr. Lauren Thaxton of Dell Medical School at the University of Texas at Austin. Thank you so much for joining us.
THAXTON: Thank you so much, Ayesha.
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