AILSA CHANG, HOST:
Even though voters in some states expressed support for abortion rights last week, in many places, abortion bans are still the law of the land. NPR's looking at the impact of these laws in a series called Days and Weeks. And today NPR's Selena Simmons-Duffin reports on one woman's experience at an ER in Ohio. And we should mention this story describes a miscarriage, which involves a lot of bleeding. And without treatment, blood loss can be deadly.
SELENA SIMMONS-DUFFIN, BYLINE: Christina Zielke knew early on in her pregnancy that she might be having a miscarriage. At her initial appointment in Washington, D.C., at around eight weeks, there was no heartbeat.
CHRISTINA ZIELKE: So I went in for my hormone testing, got those results back, went back a couple of days later. And that confirmed it. My levels were going down - the laboratory sign of a miscarriage.
SIMMONS-DUFFIN: A doctor called to lay out her options. She could take medication to make the pregnancy tissue leave her uterus faster or have a dilation and curettage procedure, a D and C, to remove the pregnancy tissue or wait for it to come out on its own. The doctor suggested she wait, but she wasn't told how long that might take. When a few weeks passed and she didn't have any bleeding, she was confused.
ZIELKE: So, as most millennials do, turn to the internet. And some women noted, it could take weeks to a month, you know? And so I counted myself as one of those women - it was just taking longer for my body - and tried to kind of put it out of my mind.
SIMMONS-DUFFIN: Soon after that, she and her husband drove from Washington, D.C., to northeast Ohio for her brother's wedding party.
ZIELKE: It was actually on the drive to Ohio. I had some really heavy bleeding. It was to the point, like, we had to, like, stop and clean out the car and, like, change all the clothes.
SIMMONS-DUFFIN: She assumed her body had finally passed the pregnancy tissue. But two days later, just before dawn, she started to bleed again a lot. She crawled into an empty bathtub at her dad and stepmom's house so it wouldn't make a mess.
ZIELKE: I was passing, like, blood clots, like, the size of golf balls. And at that point I woke up my husband, and I was like, please bring a phone. We need to call.
SIMMONS-DUFFIN: A nurse on an advice line told them to go to the emergency room. They arrived at University Hospitals TriPoint Medical Center in Painesville, Ohio, at around 6 a.m. Medical staff there did an ultrasound. Again, there was no heartbeat. She says she was told she hadn't lost enough blood yet for it to be of concern. One nurse mentioned in passing that a D and C procedure is sometimes needed to get heavy bleeding to stop. But she says she wasn't given any treatment, not even IV fluids or pain medicine. Meanwhile, she kept bleeding heavily.
ZIELKE: So about 2 1/2 hours into this slew of tests, finally, a nurse comes in and tells me that I'm being discharged. They said they needed to prove there was no fetal development, and I was told that I could come back in two days for a repeat hormone test to confirm I was miscarrying.
SIMMONS-DUFFIN: She objected, saying she already had those two hormone tests confirming her miscarriage weeks earlier in D.C. She tried to show them her medical records on her phone and offered her doctor's contact information. But she says she got no response. Zielke's husband Greg Holeyman says to him, hospital staff seemed hesitant.
GREG HOLEYMAN: We kind of knew it was like, OK, it's Ohio. This is a delicate subject.
SIMMONS-DUFFIN: Ohio's abortion law is now on hold. But when they were at the hospital on September 2, the state had a six-week abortion ban in effect. People who violate that law face felony charges, prison time, fines, the loss of their medical license.
HOLEYMAN: I wish someone had come and said, hey; this is the state law; this is what we're afraid of, and was a little more frank. But it was sort of like this could still be viable is what they were saying. You know, like, you think this is what - the information you got in D.C. But we can't confirm it, so we need to confirm it.
SIMMONS-DUFFIN: Zielke says she didn't want to leave the ER, but she didn't know how to protest. On her discharge papers, she says she wrote, I disagree. And at around 10 p.m., she and her husband drove 20 minutes back to her dad's house.
ZIELKE: I didn't make it back through the door again until there was blood running down into my shoes.
SIMMONS-DUFFIN: When a miscarriage doesn't resolve on its own, hemorrhage is one of the main risks, says Dr. Kamila Dixon. She's an OB-GYN and professor at the Ohio State University who was not involved in Zielke's care.
KAMILA DIXON: If the miscarriage had started and there was still pregnancy tissue inside of the uterus, that can incite heavy bleeding.
SIMMONS-DUFFIN: The other big risk during a miscarriage is an infection which can get into the bloodstream and be life-threatening. The way to stop bleeding or treat an infection from an incomplete miscarriage is to remove the pregnancy tissue with a D and C procedure, Dixon says.
DIXON: Basically it's a procedure where we put instruments inside of the uterus to remove the pregnancy tissue.
SIMMONS-DUFFIN: It's exactly the same procedure that's used for abortions. So when someone seeks care during a miscarriage, a doctor who suspects a patient is actually seeking an abortion might deny or delay that treatment, fearing prosecution.
KATIE WATSON: I think we're in a moment of tremendous fear, and we're working with hospitals and doctors who are not fans of liability.
SIMMONS-DUFFIN: Katie Watson, a bioethicist at Northwestern University, says that has led to situations...
WATSON: With physicians or staff saying, only if I think I'm 1,000% safe will I do necessary, potentially life-saving medical care.
SIMMONS-DUFFIN: Back at the house, Christina Zielke was still bleeding. She climbed back into the empty bathtub.
ZIELKE: About another hour of bleeding passes. And I say, I don't think this is right. I don't think we should have come home.
SIMMONS-DUFFIN: By this point, she'd been bleeding heavily for seven hours. They called an advice line again, and a nurse said they needed to go back to the hospital right away.
ZIELKE: And so I tell my husband, all right. I just need a minute or two to, like, wash off, get myself clean enough to get out of this tub. And that's when I started to feel the world slip away. I looked at him, and I said, I don't think I'm OK.
SIMMONS-DUFFIN: She'd lost so much blood so quickly. Her blood pressure had plummeted. Her eyes rolled back. Her body went limp.
HOLEYMAN: She stopped breathing. She stopped moving. She's not responding. And for, like, 30 seconds, I thought she was, like, a goner.
SIMMONS-DUFFIN: Her husband yelled to call 911. Then her eyes opened again, and he told her that an ambulance was coming.
HOLEYMAN: They'll be here soon. Just keep breathing. Stay calm.
SIMMONS-DUFFIN: When the paramedics arrived, they had to use a sheet to pull her out of the bathtub and onto a stretcher. Just hours after being discharged, she was back in the very same ER. This time she was admitted to the OB-GYN department of the hospital and had the D and C. She had the option to stay overnight but chose to go home that evening.
ZIELKE: It wasn't a place I felt safe or wanted to stay in.
SIMMONS-DUFFIN: University Hospitals declined NPR's request for an interview, citing patient privacy. They sent a written statement saying, quote, "University Hospitals complies with Ohio laws. Our position is always that health care decisions are best made between the patient and her physician." Zielke filed a complaint with the hospital. She also got bills for two separate ER visits totaling more than $10,000. She still doesn't understand why they didn't treat her the first time.
ZIELKE: Knowing Ohio's laws and knowing I was close to 12 weeks and them needing to have that two-part confirmation - I think it could have cost me my life that day.
SIMMONS-DUFFIN: That thought still haunts her. Selena Simmons-Duffin, NPR News.
CHANG: If you have a story to share about new abortion laws in your state and how they're affecting you, get in touch at npr.org/abortionlaws.
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