During the Pandemic, More Women Must Miscarry at Home

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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.

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.

“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.”



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