“Asima…this pregnancy appears to be over.”
As an OB/GYN myself, I could read the ultrasound at my nine-week checkup, and I knew what it meant. But I made my doctor say it out loud.
My husband and I already had three beautiful children and had assumed we were “done.” When I found out I was pregnant again, I knew my options and understood the risks. I was 39 years old, several years older than my other pregnancies, and I knew that increased my risk of miscarriage. But as time went on, I let myself get hopeful, even excited, that my kids would have another brother or sister. That was not to be.
I had helped so many of my patients through their pregnancy losses. I thought I knew what to expect, just like I thought I knew what being a parent would be like before I had kids. But no amount of medical training or years of experience prepared me for the pain and emptiness I felt when it happened to me.
After getting the bad news, my doctor and I discussed what to do next. In the aftermath of a miscarriage, it is often necessary to remove pregnancy tissue from the body in a timely manner, either with a procedure or medication. But now these standard medical treatments are suddenly limited in many parts of the country because of abortion bans that followed the Supreme Court’s decision to overturn Roe v. Wade.
My miscarriage happened mere months before that decision. I live in Illinois, but just across the border in Missouri, the care I needed is now heavily regulated under the state’s new abortion restrictions.
As a practicing doctor and an executive at a global fertility health care company, I was well aware that abortion bans would cause widespread harm. However, there are little-known consequences that have not received enough attention.
First, denying access to abortion care means pregnancies like mine may be far more dangerous for millions of Americans. Up to one in four known pregnancies end in miscarriage. There is not always a firm line separating an abortion from a miscarriage. The treatments in either scenario are often effectively the same. In both cases, tissue may need to be removed for the safety of the pregnant person.
Under some state abortion restrictions, doctors can’t offer the full range of treatment options to patients, including those dealing with nonviable pregnancies. The vagueness of new restrictions is also causing health care providers to delay or deny reproductive care that may not actually be illegal for fear that it could still lead to litigation or prosecution. Patients may have to travel out of state to get the care they need, or face waiting periods to verify legally that their treatment is for miscarriage, not elective abortion. Those delays could put patients’ health, future fertility, and even their lives at risk. Miscarried pregnancies that aren’t addressed in a timely manner can result in infection, massive bleeding, permanent damage to the fallopian tubes and uterus, and sometimes even death. The maternal mortality rate in the United States is already higher than in any other developed country and still rising, affecting the poor and people of color at even steeper, more disproportionate rates. New restrictions will likely make it worse.
Another underappreciated consequence is that doctors and medical professionals are now caught between state laws and our fundamental duty to do no harm. We all took an oath when we put on our white coats for the first time. Bans on abortion force us to break that oath. They don’t take into account the medical realities of reproductive care, nor the complexities of the relationships between a patient and their provider. When I counsel my patients, it is my solemn responsibility to present them with all of their options and provide recommendations with their health and safety in mind. But now, depending on where we live, doctors must act on what state politicians have decreed—not on what is best for our patients.
Losing that pregnancy has given me more resolve than ever to share my story and speak out for patients who are now in danger, and for others in the medical field who are no longer able to perform the basic duties of our jobs. I hope more doctors join me in raising the alarm about the full consequences of these new laws—particularly any who also know what it’s like to lose a pregnancy. Those of us who have been on both sides of that devastating conversation know all too well how horrifying it is that people can no longer get the care they need.
New restrictions may tie our hands in the exam room, but we can’t let that stop us from educating the public outside of it. Anyone navigating the American health care system must understand the wide-ranging, potentially fatal consequences of laws that block reproductive care. As medical professionals, we know there’s too much at stake to keep silent.
Asima Ahmad, MD, MPH, is the cofounder and chief medical officer of Carrot Fertility, a leading global fertility care platform for women, plus people of every age, race, income, sex, sexual orientation, gender, marital status, and geography. She is a practicing double board-certified ob/gyn and reproductive endocrinologist with an interest in mechanisms impacting global maternal mortality.
The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.
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