While not all surgical procedures for miscarriage take place in a hospital setting, roughly 500,000 women a year in the United States find themselves in the emergency room with bleeding related to pregnancy loss. Diminished access to D and Cs could certainly cause that number to rise.
At an appointment in early May, Castilla’s doctor found placental tissue still in her body, a common but potentially dangerous side effect of an incomplete miscarriage. If Castilla’s miscarriage continued, it could damage her fertility.
“This whole time,” she said in early June, “I’ve had dead twins inside of me.” Finally, on June 10, Castilla had a D and C. But the retained tissue led to an infection causing inflammation of her uterine lining, for which she is receiving treatment.
Three months after it began, her miscarriage was finally over.
Finding a way to have the surgery
Not being able to surgically complete a miscarriage is one of many harsh realities women have endured during the pandemic. The causes have less to do with regulation — there are no serious proposed policy changes nor calls for them — than with logistics.
Melissa Riegel, 36, of Greenville, S.C., miscarried in March. Her physician was willing to perform a D and C but could not find a hospital willing to give up an operating room. “My doctor basically told me I should wait for it to happen on its own,” she said. Eventually she had a D and C as an outpatient procedure.
As coronavirus cases rise in dozens of states, many physicians are struggling to do what’s best for their patients as they balance statewide orders with choosing who to treat based on available resources. Experts worry that surgical treatments for miscarriages are last on hospitals’ priorities.
The Coronavirus Outbreak ›
Frequently Asked Questions
Updated July 27, 2020
Should I refinance my mortgage?
- It could be a good idea, because mortgage rates have never been lower. Refinancing requests have pushed mortgage applications to some of the highest levels since 2008, so be prepared to get in line. But defaults are also up, so if you’re thinking about buying a home, be aware that some lenders have tightened their standards.
What is school going to look like in September?
- It is unlikely that many schools will return to a normal schedule this fall, requiring the grind of online learning, makeshift child care and stunted workdays to continue. California’s two largest public school districts — Los Angeles and San Diego — said on July 13, that instruction will be remote-only in the fall, citing concerns that surging coronavirus infections in their areas pose too dire a risk for students and teachers. Together, the two districts enroll some 825,000 students. They are the largest in the country so far to abandon plans for even a partial physical return to classrooms when they reopen in August. For other districts, the solution won’t be an all-or-nothing approach. Many systems, including the nation’s largest, New York City, are devising hybrid plans that involve spending some days in classrooms and other days online. There’s no national policy on this yet, so check with your municipal school system regularly to see what is happening in your community.
Is the coronavirus airborne?
- The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
What are the symptoms of coronavirus?
Does asymptomatic transmission of Covid-19 happen?
- So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
“American surgeons are not used to doing things like that,” said Serena H. Chen, M.D., a reproductive endocrinologist at the Institute for Reproductive Medicine and Science in New Jersey. “That’s not supposed to happen to us. We’re only supposed to read about that happening in the news, in some distant land, not right here at home.”