I was shocked when I heard the words no pregnant woman wants to hear: "I'm afraid there is no heartbeat," my OB/GYN said in a toneless voice, while waving the ultrasound over my ten-week pregnant belly.
It was devastating to go to the doctor for a routine checkup—the one after we'd heard the heartbeat—only to discover that our planned pregnancy, the one we were so excited about, was no longer.
But it was also confusing and debilitating, especially because we had a decision to make, and fast: We had to decide how I was going to miscarry. Would I let it occur naturally, waiting interminably to bleed out in what is called "expectant management"? Or would I use "medical management"—take a pill to induce the end? Or would I manage it surgically, having a doctor essentially perform an abortion to remove the remains of my pregnancy?
These were all awful options compared to my Plan A, which was to be pregnant. And it was the hardest thing in the world to do a U-turn from thinking about baby names to planning for a miscarriage I really, really didn't want to be having.
But looking back today, I know I was lucky to have all those options. Because in places like Texas and other states where Roe v. Wade is being challenged, miscarriage treatment may also take a turn for the worse.
It hasn't yet: Surgical treatment of a miscarriage—the procedure used in an abortion on a non-viable fetus—is still legal in anti-abortion states like Texas. Still, many worry that this will affect patients undergoing fertility treatment.
"We're nervous," says Dr. Lowell Ku, the head of Dallas IVF. Because the new Texas law is confusing when it comes to surgical treatments for miscarriage. "I think for a doctor who hasn't read the bill, it will be confusing," Dr. Ku told me. "Can you do any [procedure] or any sort of life-saving measure when there's a fetal heart rate? What about when the mother's life is in danger?"
The bill does say that a surgical procedure is permitted when the mother's life is in danger, as in the case of an ectopic pregnancy outside the uterus. But Ku is nervous that doctors may not know that. Moreover, at his fertility practice, he's worried about outsiders looking in.
That's because Texas' law, now under appeal, relies on private citizens to enforce the law by suing providers and others who help Texans access abortions. Sec. 171.208. of the bill, entitled, "Civil Liability for Violation or Aiding or Abetting Violation," states that "Any person, other an officer or employee of a state or local governmental entity in this state, may bring a civil action against any person who: performs or induces an abortion... or knowingly engages in conduct aids or abets employee," including insurance providers.
"Even if I'm following the law, it's a worrisome as a practitioner," Dr. Ku said. "It makes me nervous that I am practicing medicine looking not at the patient, but over my shoulder." Medicine, he said, "should be a decision between patient and doctor."
These aren't abstract concerns: If/When/How: Lawyering for Reproductive Justice, a group that helps people who face criminal charges related to abortion, says that since 2000, there have been at least 21 arrests of people "accused of a crime for ending a pregnancy or helping a loved one do so." And women who had miscarriages and stillborns have been criminally prosecuted under other laws.
Another new anti-abortion law in Texas says that doctors can only give abortion medication to patients at seven weeks, rather than 10 weeks. The medicine, mifepristone and misoprostol, also cannot be mailed anymore. That means patients may not be able to choose "medical management" of their miscarriage, and certainly won't be able to get the pill at home.
The new restrictions can also affect the IVF industry. For example, in the U.S., there are 300,000 IVF cycles done per year. At 10 or 12 weeks of pregnancy, many IVF patients undergo Non-Invasive Prenatal Testing (NIPT) to find out if their fetus may be at risk for disorders such as Down syndrome, Edwards syndrome, and Patau syndrome, as well as conditions caused by missing or extra X and Y chromosomes, some of which are fatal or can cause a baby to die within months.
Under the new Texas law, none of these women will be allowed to terminate due to the presence of a fetal heartbeat.
I never had to make any of these decisions. In my fertility journey I had four miscarriages: One bled out naturally, the others were treated surgically. They were all painful and heartbreaking, especially deciding how to proceed.
But I am certainly glad these options were available to me.
In the near future, they may not be.
Amy Klein is the author of The Trying Game: Get Through Fertility Treatment and Get Pregnant Without Losing Your Mind.
The views in this article are the writer's own.
Uncommon Knowledge
Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
