OGBYN Confirms Miscarriage is Not Abortion, Treatment for Miscarriage is Not Abortion

A recent article in Stateline described the problems of Lulu, a woman suffering from pregnancy loss who “couldn’t access the drug mifepristone – her preferred form of care – to help her body get over the miscarriage,” which Lulu said caused her to bleed for six weeks. The pro-abortion journalist then blamed state laws protecting unborn life and the politicization of abortion drugs for Lulu’s ordeal.[1]

Unfortunately, there are many pro-abortion media sources and medical organizations that spread this misinformation that are more concerned with promoting abortion than protecting women’s health. They also spread the false assumption that state laws protecting unborn life would limit abortion supervision. A straight reading of every state statute restricting the abortion of a living fetus, however, provides clear evidence that abortion treatment is not prohibited by law (because the purpose is to remove a dead fetus).[2] However, widespread confusion and anecdotes of denied care warrant discussion of miscarriage treatment.

The terminology can be confusing, so it’s important to know that “miscarriage” describes a miscarriage, a pregnancy in which the embryo or fetus dies naturally. “Induced abortion,” on the other hand, implies that the pregnancy was intentionally terminated by external action (induced abortion is sometimes referred to simply as “abortion”). In other words, induced abortion occurs when the purpose of the intervention is to produce the death of the unborn child. The methods to manage a miscarriage are often the same as the methods for inducing an abortion, although the moral implications differ significantly.

There are several common options for miscarriage management. The American College of Obstetricians and Gynecologists (ACOG), a renowned professional organization, has provided comprehensive guidelines for the management of many obstetric and gynecologic conditions, including pregnancy loss.[3] “Accepted treatment options for early pregnancy loss include expectant management, medical treatment, or surgical evacuation,” ACOG explains.[4] They also recommend that patients “be counseled about the risks and benefits of each option.” Expectant management, watchful waiting in anticipation of a natural miscarriage without intervention, should “generally … be limited to pregnancy within the first trimester” according to ACOG. This is due to the “lack of safety studies of prospective management in the second trimester and concerns about bleeding.”[5] Surgical uterine evacuation, on the other hand, is recommended for “[w]signs suggestive of bleeding, hemodynamic instability, or signs of infection.”[6] Finally, ACOG’s advice for medication-assisted abortion is as follows:

In patients in whom medical management of early pregnancy is indicated, initial treatment with 800 micrograms of vaginal misoprostol is recommended, with repeated doses as needed. The addition of a dose of mifepristone (200 mg orally) 24 hours before the administration of misoprostol can significantly improve the effectiveness of treatment and should be considered when mifepristone is available.[7]

As a board-certified OB-GYN practicing for over 30 years, when I confirm that a patient’s unborn child has died, I offer her several options. As mentioned before, expectant management is one such option. Before our modern options for medical intervention, women’s bodies usually shed miscarried tissue spontaneously and successfully. Women often choose this natural approach. If a woman doesn’t want to wait, however, medication can speed up the process. Because I practice Hippocratic medicine and do not perform elective abortions, I am not registered to have access to mifepristone (see discussion below).

Misoprostol, on the other hand, is readily available, and I prescribe that drug for women who desire medical intervention. Other women may prefer a minor surgical procedure — suction aspiration — that can be done in an ambulatory surgical facility or in the office for doctors with the appropriate equipment and certification. If a woman chooses a non-surgical option, I remain available for any concerns. In such a case, I schedule a short-term follow-up to verify that the pregnancy tissue has been completely removed and to confirm that my patient wants to continue with the intervention if the tissue remains. If expectant management or medical treatment takes longer than desired or does not fully work, the patient has the option of choosing a surgical procedure at that time.

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Lulu’s complaint that she had to bleed for six weeks after misoprostol did not resonate with her OB-GYN. She could have chosen surgical completion of her miscarriage at any time. As ACOG recommends in their practice bulletin, I also do not recommend expectant management, or medications, for a patient experiencing late pregnancy loss or experiencing heavy bleeding. Such a patient is better served by surgical management to hasten resolution and minimize blood loss.

The FDA’s Risk Evaluation and Mitigation Strategy (REMS) requires a provider to register to prescribe and have access to mifepristone,[8] thus the drug remains unavailable to most OB-GYNS. Only 7-14% of OB-GYNS surveyed indicated that they would perform an elective abortion if requested by their patient, so most did not become registered providers of mifepristone.[9] There are limited data indicating that the addition of mifepristone may improve the efficacy of misoprostol in completing tissue evacuation during miscarriage. A randomized-controlled trial comparing the two options for medical management found that 24% of women receiving misoprostol alone required surgical completion of their miscarriages, compared with 17% of women receiving of mifepristone plus misoprostol.[10] A comprehensive meta-analysis, however, has documented that surgical treatment is the most effective of all available options.[11]

So, if mifepristone is not available to an OB-GYN, his patients will not suffer, because there are many other effective options available for the treatment of miscarriage. Fearmongering about the inability to treat miscarriages after Dobbs v. Jackson Women’s Health The decision, which allowed legislative limits on the elective termination of unborn life, but did not place limits on the treatment of miscarriages, should be recognized for its ideological, pro-abortion rhetoric. The abortion drug mifepristone is not necessary for OB-GYNs to provide quality care to women suffering heartbreaking pregnancy loss.

LifeNews Note: Ingrid Skop, MD, FACOG, is vice president and director of medical affairs for the Charlotte Lozier Institute.

[1] Caitlin Dewey, “State, federal abortion rules prevent many women from accessing essential abortion medicine,” StateslineOctober 20, 2023, https://stateline.org/2023/10/20/many-women-cant-access-miscarriage-drug-because-its-also-used-for-abortions/.

[2] Mary Harned and Ingrid Skop, “Pro-Life Laws Protect Mom and Baby: Pregnant Women’s Lives are Protected in All States,” Charlotte Lozier Institute11 Sept. 2023, https://lozierinstitute.org/pro-life-laws-protect-mom-and-baby-pregnant-womens-lives-are-protected-in-all-states/.

[3] ACOG Committee on Practice Bulletin—Gynecology, “Early Pregnancy,” Practice Bulletin, no. 200 (November 2018): 197–207, https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/11/early-pregnancy-loss.

[4] Ibid., 198.

[5] Ibid., 199.

[6] Ibid., 201.

[7] Ibid., 203.

[8] “Risk Evaluation and Mitigation Strategy (REMS),” REMS Approved in 2016, US Food & Drug Administration, accessed October 31, 2023, https://www.fda.gov/media/164649/download.

[9] Sheila Desai, Rachel K Jones, and Kate Castle, “Estimating abortion provision and abortion referrals among United States obstetrician-gynecologists in private practice,” Contraception 97, no. 4 (April 2018): 297-302, doi: 10.1016/j.contraception.2017.11.004; Debra B. Stulberg, et al., “Abortion Provision to Practicing Obstetrician-Gynecologists,” Obstet Gynecol. 118, no. 3 (September 2011): 609-614, doi: 10.1097/AOG.0b013e31822ad973.

[10] Justin J Chu, et al., “Mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage (MifeMiso): a randomized, double-blind, placebo-controlled trial,” Lancet 396, no. 10253 (September 2020): 770-778, doi: 10.1016/S0140-6736(20)31788-8.

[11] Jay Ghosh, et al., “Methods for miscarriage management: a network meta-analysis,” The Cochrane Database Syst Rev. 6, no. 6 (June 2021): CD012602, doi: 10.1002/14651858.CD012602.pub2.

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