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September 29, 2011

Miscarriage and Emergency Care

A recent post on RH Reality Check highlights what cuts to medicaid funding may look like, particularly for pregnant patients. Lynn Paltrow and Linda Layne, author of Motherhood Lost: A Feminist Account of Pregnancy Loss in America, discuss the broader implications of medicalizing miscarriage.

In an effort to cut Medicaid costs, Washington State is limiting "non-emergent" emergency room visits. Included in the list of "non-emergent" conditions is miscarriage, sending the message that a potentially life-threatening condition (which many women experience several times) is not an emergency.

Lynn Paltrow: "To add to the discussion -- I wonder what Linda Layne would say? Too often women are left totally unprepared and unsupported when they experience miscarriages. In many cases the only support or advice is to go to an emergency room when that may actually be unnecessary and unhelpful. Clearly limiting access to emergency rooms is not the answer but I urge people to read this discussion of Linda's work.

Linda Layne: "Emergency rooms are horrible places to have a miscarriage. (The first of my 5 miscarriages was in an ER). In the vast majority of cases, miscarriages are non-emergencies. ER staff will assuredly be busy with other cases that are more important in terms of being life-threatening. This is absolutely the wrong environment for women to receive the kind of care and concern they need during a loss.

What is needed is loving, hands-on, experienced care, preferably at home.

The home birth movement provides a valuable example for improving the experience of women who lose their pregnancies through miscarriage or stillbirth. (See my articles: “‘A Women’s Health Model for Pregnancy Loss’: A Call for a New Standard of Care” Feminist Studies 2006 32(3)573-600;
“Designing a Woman-Centered Health Care Approach to Pregnancy Loss: Lessons from Feminist Models of Childbirth” In Reproductive Disruptions: Gender, Technology,. Ed. Marcia Inhorn. 2007 Pp. 79-97. Oxford: Berghahn Books.)

Women need to be told BEFORE a loss occurs how frequent losses are (15-20% of all pregnancies), what it will feel like physically, what to do to be prepared for one (disposable bed liners and paper towels are helpful). I recommend a loss plan, comparable to a birth plan. Where will you be most comfortable? in bed, in the shower? What would help with the pain? Pain killers, massage, cups of tea? Who would you like to be there with you? a trained doula? best friend? What will help most with the emotional hurt? Having those you love with you? Low lights, your favorite music, a plan for commemorating your loss?

Yes, miscarriages can sometimes be dangerous. They almost always involve lots of blood, but there are simple guidelines about under what circumstances women actually need medical attention.

Yes, it is horrible that we don't have a universal health service that would give everyone wonderful care (like I am enjoying this year in the UK). But in the case of miscarriage, less is more. Medicalizing miscarriage is not in women's best interest.

Let us take these proposed cuts as an opportunity to improve the care of the nearly 1 million American women who suffer miscarriage and stillbirth each year, by giving them the social and physical care they need and deserve during these very physically painful and heartbreaking events.

Linda Layne, author of Motherhood Lost: A Feminist Account of Pregnancy Loss in America and co-producer with GMU-tv of eleven episodes of Motherhood Lost: Conversations. (Visiting Fellow, Centre for Family Research, Cambridge University)"

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