In some states, doctors are weighing ‘ruinous’ litigation against proper care for women who miscarry

Stell, who was 9.5 weeks pregnant at the time, said she was ‘blindsided’ when her doctor showed her an ultrasound image showing the fetus was no longer alive, then refused to do the standard surgery to remove fetal remains.

“Why is it so complicated to get treatment when it’s obvious to the doctor and me looking at the screen that it’s not a viable pregnancy?” she told CNN.

The answer lies in fear: the same surgical procedure used to remove a dead fetus is also used to remove a live fetus, and doctors in states with strict anti-abortion laws fear prosecution for performing an abortion when they did. miscarriage care.

“Doctors can’t just rely on them being right,” said Dr. Sarah Prager, co-author of an early pregnancy loss practice bulletin for the American College of Obstetricians and Gynecologists. “They could still potentially be sued multiple times and held up for a lot of money.”
Stell miscarried in Texas in September, just weeks after a tough anti-abortion law went into effect. Since then, following the U.S. Supreme Court’s decision last month to overturn Roe v. Wade, more than a dozen other states have sought to enforce abortion bans or highly restrictive policies, according to the Guttmacher Institute, an abortion rights advocacy research group.

These laws will have “a huge chilling effect” on doctors performing miscarriage surgeries, even when doctors “are confident that what they are doing is within the letter of the law,” said Steve Vladeck, a professor at the University of Texas School of Law. and a CNN contributor.

What happened to Stell, he said, “will become the norm in the future” in those states.

A couple’s dream turns into a nightmare

Stell, 42, founder and CEO of beauty company Makeup Geek, suffered a miscarriage shortly after marrying Anuradha De Silva in 2018 in Washington state. She underwent surgery known as D&C – the full name is dilation and curettage – to remove the fetal remains.

“They were caring. They were there for me, asking me with emotion, how was I?” she says.

Stell got pregnant again and in April 2020 gave birth to her daughter, Adelina. About a year later, they moved to Houston to be closer to their extended family. A few months later they discovered she was pregnant again and an ultrasound at 7.5 weeks showed the pregnancy was going well.

But during an ultrasound two weeks later, Stell received the terrible news – and she was on her own due to Covid-19 restrictions.

“She said, ‘There’s no heartbeat. There’s no viable pregnancy,'” Stell recalled.

Stell said the doctor advised her to go home and pass the fetal remains naturally. She thought back to her miscarriage three years prior in Washington and asked the doctor for a D&C, but the doctor refused.

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“She said, ‘Well, because of the new law that’s been passed, you’re going to have to have another ultrasound so I can even do anything for you,'” Stell said.

She said her doctor didn’t advise her where to go for a second ultrasound, so she had to find one on her own.

“I try to grieve, I process, but at the same time I try to find places to fit in,” she said.

She found an imaging center, its walls covered with pictures of smiling babies.

“The tech was like, ‘Oh, where are you? Are you excited?’ and things like that, and I didn’t even know what to say, because it’s like, ‘I’m here because I already know I lost the baby. This isn’t a happy occasion for me. I do this because I have to,” Stell said.

Hearing for the second time that the fetus had died was “heartbreaking”.

“It was hard enough hearing it the first time,” she said.

Stell arranged for the ultrasound results to be sent to her obstetrician. She said that for five days she called the office to see if her doctor would perform the D&C now that the fetal death had been confirmed by a second ultrasound, but she said the doctor still wouldn’t do the operation.

By then, Stell was in so much pain that it became difficult to walk. She said her doctor offered her a prescription for mifepristone and misoprostol, drugs used for miscarriages and abortions, but Stell preferred surgery.

“I don’t want this to happen. I don’t want to be home alone without a doctor,” she said.

In its practice bulletin, the American College of Obstetricians and Gynecologists emphasizes the importance of considering patient preference for all three miscarriage treatment options: natural miscarriage; take the pills; or have a D&C.

About two weeks after her initial ultrasound showing the fetus was no longer alive, Stell found an abortion clinic to do a third ultrasound and perform the D&C. Like the other patients, she had a security escort because of protesters outside the clinic.

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“As I walked into the clinic there were people with signs yelling at me that I was a baby killer,” she said. “Seeing this was another just emotional hit because I wanted this baby, and (to) be told I’m a baby killer when it was something that was out of my control, it was humiliating and it made me angry.”

A few weeks later, she posted a YouTube video to help women who might find themselves in the same situation.

“I’m so angry that I was treated this way because of laws passed by men who have never been pregnant and never will be,” she said in the video.

Medical consequences of delayed miscarriage care

As she sought care, Stell feared she might contract an infection from dead tissue inside her, which doctors say was a reasonable fear.

“All kinds of bad things can happen,” said Dr. Lillian Schapiro, an obstetrician-gynecologist who has practiced for more than 30 years in Atlanta. “She may develop an infection which may render her infertile and never be able to have children again.”

If a dead fetus stays in the womb too long, it can get worse, Schapiro said, causing a condition called disseminated intravascular coagulation.

“The fetal parts decompose and enter the mother [blood] circulation and can actually cause multiple organ failure and death,” she said.

According to the practice bulletin of the American College of Obstetricians and Gynecologiststhe surgery “results in faster and more predictable complete evacuation” of fetal remains compared to letting the miscarriage occur naturally or using mifepristone and misoprostol.

Pit citizens against citizens

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Texas right to life has heard stories like this and says it’s a big “misunderstanding”.
The group claims that doctors were misinformed and that although Texas anti-abortion lawknown as SB 8, does not define the word “abortion”, another texas law says “an act is not an abortion if the act is done with the intent to remove a dead, unborn child whose death was caused by ‘miscarriage’.

Doctors say they understand the law – but that’s not enough to protect them.

Texas and other states allow citizens to sue doctors they suspect of performing an abortion. They have an incentive to bring such lawsuits because they can make money – in Texas, for example, if the citizen wins, the doctor has to pay him at least $10,000.

“Texas law pits citizens against citizens,” said University of Texas legal scholar Vladeck. “Worse still, I think what he is doing is encouraging citizens to spy on each other.”

If the citizen is wrong – if the court concludes, for example, that the doctor performed surgery for a miscarriage and not an abortion – the doctor still has to pay his own legal costs, because texas law specifically prohibits physicians from recovering plaintiffs’ fees.

“Even for vendors who are confident that what they are doing is within the letter of the law, they face the specter of potentially ruinous litigation. They can’t stop it. They can’t avoid it. .-drain it,” Vladeck said.

All it would take to bring the doctor down is a citizen confused about the difference between an abortion and a miscarriage, or someone looking for money, or someone with a vendetta against the doctor or the patient.

“Doctors may be apprehensive about a situation where a woman has a miscarriage and say she has an angry partner and they are trying to accuse the doctors of assisting in an abortion,” said said Dr. Leah Tatum, spokesperson for the Texas chapter of the American College of Obstetricians and Gynecologists.

Tatum says she and her practice partners aren’t shy about performing surgeries for women who have suffered miscarriages, but they work for a large clinic with strong legal backing.

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“In my practice, we have lawyers on hand to help us make those decisions, and we feel pretty well protected, but I’m sad to hear that some doctors feel like their hands are tied, and I think it’s going to get worse,” Tatum said.

Try again in another state?

Although she and her husband dream of having a little brother or sister for Adelina, Stell says she’s not trying to get pregnant right now.

“I know I’m at high risk and there’s a chance I could miscarry again,” she said. “I’m afraid of being infected, of something happening to me, and then my daughter left without her mother.”

That’s why she and her husband are discussing whether to leave Texas.

For one, they moved there just over a year ago, and Adelina has her grandmother, aunts, and uncles in Texas. On the other hand, they want to have more children, and at 42, Stell doesn’t have much time.

As the couple ponder their next move, Stell says she’s speaking up because she knows women in other states might have to go through what she went through.

“I don’t want other women to feel lonely,” she said.

CNN’s Neeraj Patel contributed to this report.

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