I'm a midwife and I wish more people knew the way I handle miscarriages and terminations can be the same
- I'm a midwife, writer, and advocate.
- I care for people in all stages of their pregnancy, which includes early loss and elective terminations.
After 50 years of precedent was overturned with the Supreme Court's Roe v. Wade decision, there has been a lot of confusion about what individual states are now going to do when it comes to a person's right to access a safe and legal
As a healthcare provider, it is essential for me to take the time to educate people about what is happening to their bodies with clear, intentional language and discuss their options thoroughly so there is no confusion for anybody — whether that's an individual or a legislator.
Abortion is an umbrella term
Abortion has become a singular concept indicating a termination of pregnancy, especially in the context of Roe v. Wade, but it's really an umbrella term for several conditions that indicate the need to remove products of conception from a person's uterus.
Healthcare providers know that each type of abortion — spontaneous, threatened, incomplete, missed, septic, elective — is possible, even normal, and natural. The clinical management of them is the same, but lots of people don't know that.
For people whose pregnancy was wanted, but ended in a loss, hearing words like "abortion" is often devastating. It can add to the confusion, anger, grief, or guilt someone feels about their early pregnancy loss or
Providers often do not explain this early pregnancy loss in a way that honors it for what it is: a loss. It's often generalized under "abortion services" in the explanation of next steps, in the documentation within the medical record, and even through diagnosis and billing codes.
But it's important that people understand the nuances of these terms and the consistency of these procedures, especially in the context of changes to abortion services in several states.
Early pregnancy loss and termination abortions are managed in the same way
Typically, an early pregnancy loss will pass naturally on its own within four weeks after the fetus' demise, but the risk of bleeding, infection, and other significant
A discussion with a healthcare provider and continuous monitoring of bleeding status and vital signs are necessary if a person elects expectant management. Having access to the resources of active management, also known as abortion services, like taking mifepristone and misoprostol, using manual vacuum aspiration, or having a dilation and curettage at any point during an early pregnancy loss is essential.
As a midwife, I have changed the language I use to reflect the experience a person is going through. I make sure to use the words "pregnancy" and "loss" instead of abortion when someone is experiencing a miscarriage. I ask if they want to name their baby or have any type of ceremony that honors their loss.
We discuss the options of expectant management or active management: The choice is up to the individual to wait until the pregnancy passes naturally on its own — if safe — or, if there is an urgency for completion, move forward with necessary procedures.
In visits for both an early pregnancy loss or an elective ending, I discuss the safety of administering the pills in the comfort and privacy of their personal space, performing the MVA under a local anesthetic in an office setting, or the need for a D&C that is performed under general anesthesia, often in a hospital setting.
How abortion services will change post-Roe
It's important that medical providers meet people where they are with terminology for an early pregnancy loss and elective ending, because the words doctors, midwives, and nurses use may be the difference between ensuring a safe outcome and someone being arrested or fined in a post-Roe world.
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