Lauren Whitehurst
My first pregnancy didn’t work out. It’s funny that in years of writing about parenting, I have never written about this. It was upsetting. I bought a shallow granite bowl to, what?—honor? commemorate?—this ghost not-a-child, and it’s been in our garden ever since, sometimes filled with mulch or heart-shaped rocks, occasionally standing water and decomposing leaves.
The pregnancy was unexpected. I wasn’t sure my husband and I were ready. Nervous uncertainties fluxed and flexed, for sure, but we wanted the pregnancy to succeed.
Around 12 weeks, our doctors ordered an ultrasound to determine gestational age: My menstrual tracking and belly measurements didn’t match up. I’m sure I was chatty as the ultrasound tech ran the gelled wand over my abdomen, but she didn’t say much. She definitely wouldn’t answer any questions, and then she left the room abruptly and returned only to say I needed to call my doctor. My husband and I drove to the clinic immediately and learned in short order that there was no fetal cardiac activity.
We were so sad. I remember someone telling me, in sympathy, that it wasn’t really a baby; it was just a fetus. This was not comforting, but it was true. Given its roughly 9-weeks’ size, it wasn’t even that: It was embryonic. My case was closed with the designation “blighted ovum,” which means it maybe never even achieved embryo status. And yet, of course, it was much more than medical terminology in our emotional imagination.
Because my body wasn’t passing the miscarriage and I’d been pregnant for 12 weeks, I was referred for a D&C, or dilation and curettage, a procedure that dilates the cervix and removes uterine tissue with a very thin, spoony, straw-like instrument. D&C is among the most common gynecological procedures, and roughly a third of American women have one for a variety of reasons. These include miscarriages like mine, diagnostic testing, and pregnancy termination. The association of the procedure with abortion is one reason few people talk about D&Cs.
It’s also the reason my appointment required me to buzz into a locked antechamber protected by bullet-proof glass before I was allowed through the next set of locked metal doors into to a waiting room. The room itself was a cozy iteration of any family practice waiting room, which it was. A carpet underlay a not-too-conversational seating arrangement, magazines and lamps sat on low tables, colorful pictures hung on the walls. A tween-ish girl and who I assumed was her father waited there, too. Whether they were there for a sports physical, a vaccine, the pill, or an abortion was something I couldn’t know—and wouldn’t have wondered about if not for the entry gauntlet—and absolutely had no business guessing or trying not to guess. I remember being glad that girl wasn’t alone, regardless of why she was there: The door situation alone was scary.
When I sat down with the check-in paperwork, I realized it required I consent to a D&C as if I was choosing to end a pregnancy that could’ve been carried to healthy term. There was only this one form, I was told when I asked if there was a different one for miscarriages. I desperately wanted another option besides having to check the line saying that, yes, I did want to voluntarily end this pregnancy.
What I wanted was a healthy pregnancy; what I needed was a compassionate, competent resolution to a miscarriage my body wasn’t releasing. The moment felt mismatched because it carried messages beyond my actual experience in that place and time. Reproductive health care, like all health care, must respond to patients at all stages of their lives with the best practices available for whatever care they need—without any judgement but the professional kind. Behind the bulletproof antechamber and high-security check-in procedures was simply a doctor caring for her patients, as she cared for me. As it should be.
Miscarriages are common, occurring in anywhere from 10-20 percent of confirmed pregnancies to an estimated 50 percent, when accounting for people who miscarry before knowing they’re pregnant. Like mine, most happen before 13 weeks. On one hand, they’re simply par for reproduction. From the perspective that life begins at conception, they’re an enormous loss of human life—tens of millions worldwide every year—much of which could be prevented with better access to health care for infections, sexually transmitted disease, and prenatal support.
Miscarriages are frequently hushed because of shame, stigma, or, perversely, the idea that non-viability means we shouldn’t make them a big deal. I had my D&C, kept it on the low down, and returned to work in short order. Some women pass miscarried uterine tissue for weeks. They can be painful on many levels—especially when they might be criminalized or pose complications.
That line is harsher now, with the overturning of Roe v. Wade—and prior to that, with the Texas law inviting literally anyone to file civil suit against another person suspected of “aiding or abetting” an abortion. From what vantage can you judge whether someone is getting care for an abortion or a miscarriage?
Already, some pharmacies in abortion-ban states refuse to fill prescriptions of misoprostol and mifepristone for miscarriage treatment. These drugs are used to induce abortion. They’re also what the American College of Obstetricians and Gynecologists recommends for medically treating early pregnancy loss (aka, miscarriage). Doctors afraid of lawsuits are leery of performing D&Cs.
In the wake of the Dobbs decision, news articles are addressing how abortion restrictions can inhibit miscarriage care. “The challenge is that the treatment for an abortion and the treatment for a miscarriage are exactly the same,” says Dr. Sarah Prager, a University of Washington professor of obstetrics and gynecology, in one such piece by NPR.
This is an important crux—not only for miscarriage and abortion, but for women’s health care more broadly. Criminalizing one slice of reproductive care has negative repercussions for the full range of health care women and girls might need to access throughout their lives. The euphemism for this, “returning it to the states,” does not ameliorate these repercussions, it just further segregates them by wealth, race, and geography.
No matter where one stands on the complicated issue of abortion, it doesn’t make sense to isolate and excise one segment of health care that’s integrally related to the best-practices care of conditions all along a reproductive spectrum. In the US, where the maternal mortality rate is roughly twice that of other so-called developed countries, sound, time-sensitive, reproductive care needs all its resources at the ready. There are actually a lot of lives at stake here.
This is one reason that life-or-death framing of abortion debates feels hollow. I agree more with New York Times columnist Ezra Klein, who says, “I think these questions are actually of life versus life, a commitment to life versus a commitment to life.” health care choices are rarely as simple as an on-off switch.
Some argue that abortion is not complicated: On one side, bodily autonomy and sex equality trump fetal value to the point of birth. On the other, abortion is tantamount to murder and no exceptions justify killing. For most of us, however, it is a nuanced, morally fraught issue.
Earlier this year on his podcast, Klein interviewed University of Oxford law professor Kate Greasley. Both support reproductive choice—and also, very articulately, dive into the complications of that stance and others. They discuss philosophical facets of personhood, individual rights, and precedent. It’s worth a listen no matter where you stand, and it certainly addresses the issue’s quandaries better than I can.
The quandaries themselves are important: deep questions on everything from ensoulment to ethical binaries, racial equity to the writings of Benjamin Franklin, rape to IVF to stem-cell research.
Not everyone is going to parse these difficult, often inconclusive arguments. Thinking about them philosophically, and definitely personally, makes our heads hurt. Maybe this is why some whose individual lives have been positively shaped by an abortion don’t necessarily support others’ access to such care: Their experiences were personal; national, state, or even religious policy is not. In its remove, the latter too easily turns blunt.
But the fact of complexity should give us pause—a very humane pause—because for all the legitimate debate fronts—religious, historical, philosophical, legal, regulatory, etc.—the personal front is the one in danger of being eclipsed.
Political debates and philosophical podcasts deal with stock claims, hypotheticals, thought experiments; but each pregnancy is very real. And sometimes complicated. Sometimes sad and sometimes tragic. Often hopeful and miraculous. Often not. I can’t begin to describe all the experiences of pregnancy, but I know it is physical embodiment of weighing life—and sometimes life versus life—regardless of outcome. And I know, unequivocally, that it is always personal and always in need of safe, accessible, responsive options for care.
