Linda Prine, RHAP’s medical director, moderates the Access List, a clinical listserv with more than 1,000 subscribers all dedicated to providing abortion care within family medicine and primary care settings. This blog regularly features Linda’s postings to the Access List.

Early Pregnancy Loss Awareness

I was shocked by the hurt in her voice when our patient started telling us about the care she received in the previous weeks when she started to have some vaginal bleeding early in her pregnancy. First she called her OB/Gyn, who did not come to the phone to talk to her but whose office staff told her to go to the nearest emergency room. This was a highly desired pregnancy, so it was very scary to her that she needed to go to the ER. She was afraid it meant something bad, not only for her pregnancy, but for her own health. She was at home, in Northern New Jersey, and went to her local community hospital. There she waited more than six hours before she saw a doctor, another three hours until she got an ultrasound, and then another four hours before anyone told her what was happening. Finally the doctor reported, “The pregnancy is not viable, but since your bleeding is light, there is nothing that needs to be done right now, so you can follow up with your gyn.” The doctor was brusque and hurried away, implying that he had “real emergencies” to deal with. They gave her a copy of the ultrasound and discharged her. The words that jumped out at her from the written report read “no fetal heart beat.”

The next morning, she called the OB/Gyn’s office and again was only able to speak to clerical staff. They told her to fax her ultrasound report and they would call her back. Late that afternoon, they called her back to tell her she was scheduled for a D&C in the hospital three days later and to fast after midnight the night before. She had so many questions: “Why had this happened? What was a D&C (dilation & curettage)? Was it the same procedure she’d had years ago when she had an abortion?”  She had not been told to fast that time and had been awake for the procedure. Everyone had been really nice to her at the abortion clinic and had answered all her questions. Now she was being treated like she didn’t matter at all and that her pregnancy “didn’t matter.”

Since she had three days before she was supposed to show up at the hospital, she started to ask around. Through her office-mates she heard about our family practice, which is close by her job. Our staff knows to get someone in right away who is bleeding in early pregnancy. We saw her the afternoon the same day she called. It was a long visit because we did more than just give her all the options for care that we could provide in our office: expectant management, or “letting nature take its course”; misoprostol medication; and/or an in-office Manual and Vacuum Aspiration (MVA) procedure. We also helped her process what she had been through, reassured her that she had not caused her miscarriage, and that she would be able to get pregnant again. It was so sad that she felt demeaned and belittled by the medical system when her situation was so heartbreaking and scary to her.

Miscarriage is so common, it should not be marginalized, and there are rarely times that ER care is needed. Yes, an urgent ultrasound should be done, but that’s not impossible to arrange in most places, and more and more family medicine residency practices have on-site ultrasound. I would really like to see family medicine step up to the plate and own miscarriage care. This woman was so very, very grateful to us for our consideration of her needs – but that should be normal! It shouldn’t feel like special treatment to be respected, to have your worries addressed and to have your grieving acknowledged.

It was sort of nice to hear (although sad that it was coming from such painful feelings) that she’d been treated better when she had an abortion.  And it was good to see how much better she felt after our conversation where we explained everything about her miscarriage and her treatment options.