Louisiana's abortion law leaves some doctors afraid to provide miscarriage care : Shots - Health News When she was pregnant, Kaitlyn Joshua struggled to get medical care — and answers — in post-Roe Louisiana, where abortion is banned.

Bleeding and in pain, she couldn't get 2 Louisiana ERs to answer: Is it a miscarriage?

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Louisiana has one of the most restrictive abortion bans in the country, and it's also one of the most dangerous states to be pregnant and to give birth, especially if you're Black. As part of our Days and Weeks series, which looks at how laws restricting abortion are affecting people's lives, we have the story of one pregnant woman who struggled to get care and answers in post-Roe Louisiana. And just a note - this story includes medical descriptions, including pain and blood loss. Rosemary Westwood with member station WWNO takes it from here.

ROSEMARY WESTWOOD, BYLINE: Kaitlyn Joshua found out she was pregnant in early August. She and her husband Landon live in Baton Rouge. They have a 4-year-old daughter, and they were excited for a second baby.

KAITLYN JOSHUA: We thought we were going to be, like, two and done - like, kind of getting it over with.


K JOSHUA: You know?

WESTWOOD: Kaitlyn was about six weeks along when she tried to make her first OB-GYN appointment for the eight-week mark, similar to when she saw a doctor for her first pregnancy. But she was told she was going to have to wait over a month.

K JOSHUA: They specifically said, like, we now no longer see women until they're at least 12 weeks.

WESTWOOD: Kaitlyn remembers the woman on the phone saying it was because of Louisiana's new abortion ban.

K JOSHUA: And they went into grave detail about this because there are so many women that have miscarriages in that first week - 12-week period. We can't be held liable for that nor do we want to be investigated. And so you have to wait till the 12-week mark to even see if you're going to have a viable pregnancy, and then we see you.

WESTWOOD: As doctors unconnected to the case explained to NPR, some physicians no longer want to be involved in miscarriage care because they fear being investigated and accused of providing an abortion. Under Louisiana's new law, a doctor could get up to 15 years in prison and lose their license for providing an abortion. And here's the miscarriage connection. The same procedures used in abortion are also sometimes used for miscarriage care. Doctors say this is creating a climate of fear.

At a September meeting of the state Health Department, Dr. Joey Biggio, who leads maternal and fetal medicine at Louisiana's largest health system, said some OB-GYN doctors are afraid to provide routine maternity care.


JOEY BIGGIO: Whether it's ectopic pregnancy, miscarriages, ruptured membranes, hemorrhage, many people are not going to provide the care that is needed for patients.

WESTWOOD: Pregnancy can be dangerous, especially for Black women like Kaitlyn. Louisiana has among the highest rates of maternal death in the country, and the rates are far higher for Black women. There are many reasons for this, according to the CDC, including variation in quality health care, underlying chronic conditions, structural racism and implicit bias.

During her early weeks of pregnancy, Kaitlyn had symptoms she never had with her first child - mild cramping and bleeding. But without access to a doctor, there was no one to answer her questions. Then, when she was about 10 or 11 weeks pregnant, she started bleeding even more.

K JOSHUA: Like, clotting and so much tissue and just blood.

WESTWOOD: The pain was terrible. Kaitlyn drove herself to Woman's Hospital. A nurse took her vitals. A doctor did an exam, and she got an ultrasound. Then a nurse gave her the news.

K JOSHUA: The first thing she said was, you may be 10 or 11 weeks, but your baby's just stopped growing. Like, it's measuring at seven, eight weeks when it should be 10 or 11.

WESTWOOD: The nurse told Kaitlyn that it looks like she could be miscarrying, but they couldn't confirm it. Her discharge papers didn't mention the word. She was just told to rest, take warm baths and follow up with her doctor at an appointment that was still over a week away. The nurse did say they'd be praying for her. Kaitlyn herself is Christian and goes to church every Sunday, but she says it felt insulting.

K JOSHUA: Folks need answers, not prayers, and that's exactly what I was looking for in that moment.

WESTWOOD: Woman's Hospital did not comment on Kaitlyn's experience but told NPR later that how it treats miscarriages has not changed because of Louisiana's abortion law and that first trimester bleeding does not necessarily indicate a patient is having a miscarriage.

The next day, Kaitlyn felt even worse. Her husband Landon was worried.

L JOSHUA: I was definitely afraid of what could happen. And my mind goes to the worst sometimes, maybe a situation where she wouldn't be here.

WESTWOOD: By the evening, Kaitlyn was pacing her bathroom floor, bleeding and cramping, when she felt even more tissue come out.

K JOSHUA: It literally felt like I had almost birthed a child, and so I was like, no, I have to go somewhere, like, now. So I asked my mother-in-law to watch my little girl, and I ran out the door.

WESTWOOD: This time she went to a different hospital, Baton Rouge General in Prairieville. There, a security guard put her in a wheelchair. Her jeans were soaked through in blood. While she was getting an ultrasound, the tech told her she'd lost a lot of blood. A few hours later, a doctor arrived with the results. The doctor's first comment was to question whether Kaitlyn had even been pregnant.

K JOSHUA: She came in, and she said, well, it doesn't look like a baby. This looks like it was a cyst. And she was like, are you sure and positive you were pregnant?

WESTWOOD: She says the question made her angry. Then the doctor said that if Kaitlyn was miscarrying, she should do what everyone else had already told her - go home and wait. But Kaitlyn wanted some kind of treatment, either a procedure called dilation and curettage to remove pregnancy tissue and help with the bleeding or medication, which can help clear the uterus more quickly.

K JOSHUA: I know, like, when women are having miscarriages, there are different procedures or different things that, you know, you guys can do to kind of help alleviate not just the pain but, like, make this process go a little faster. And she was like, we're not going to do that.

WESTWOOD: The doctor wouldn't refer Kaitlyn somewhere else or give her discharge papers that actually said she was having a miscarriage, what in medical terminology is called a spontaneous abortion.

K JOSHUA: She stated that they're not going to put anywhere spontaneous abortion because that would then flag an investigation on them, on that staff, on the folks that did our work that night.

WESTWOOD: According to her discharge papers, Kaitlyn was having vaginal bleeding, but in her medical records, which Kaitlyn got later from the hospital, staff did diagnose her with a spontaneous abortion. Sarah Zagorski is a spokeswoman with Louisiana Right to Life, which drafted Louisiana's abortion ban. She says the law does allow doctors to treat miscarriages.

SARAH ZAGORSKI: It looks like the fault is not with the law but with a misinterpretation of the law.

WESTWOOD: Baton Rouge General told NPR later it sympathized with Kaitlyn's pain and anxiety but believed her treatment was appropriate. Over the next week, Kaitlyn continued to bleed heavily, and the pain was striking.

K JOSHUA: You're, like, mourning the loss of, you know, what would have been this new, you know, bright-eyed, sweet baby but then also just so worried.

WESTWOOD: Kaitlyn had another worry, too. And she wondered, given that Black women in the state face greater risks in pregnancy, whether her race had affected her care.

K JOSHUA: I was just wondering if white women get turned away like this.

WESTWOOD: It took weeks of waiting at home, but finally the miscarriage completed. But if she had been given a choice, Kaitlyn would have chosen care that made the experience faster, less painful and less scary, especially in a state like Louisiana, where four Black mothers die for every one white mother.

K JOSHUA: This experience has made me see how Black women die. Like, this is how Black women are dying.

WESTWOOD: The experience also stalled Kaitlyn and Landon's plans for more children.

K JOSHUA: You know, I love my kid, so, like, she constantly makes me want another her. But in this moment - and we've talked about this a lot on and off. Like, in this moment, it's just too dangerous of a task to get pregnant in Louisiana. I don't think it's worth, like, risking your life for a baby right now.

WESTWOOD: Kaitlyn wonders how many other women in Louisiana are now feeling the same.

For NPR News, I'm Rosemary Westwood in Baton Rouge.

CHANG: This story comes from NPR's partnership with WWNO and Kaiser Health News.


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