New Treatment For Miscarriages Is Complicated By Abortion Debate

A medication commonly used to provide abortions can also help ease the recovery process for women experiencing miscarriage. Doctors find it difficult to navigate heavy regulations around the pill.

RACHEL MARTIN, HOST:

We're going to focus now on a very personal trauma that so many women go through, even though it's not often publicly discussed. We're talking about miscarriage. When a woman learns her pregnancy is no longer viable, she often faces a decision about what to do next. There is now a new treatment method available to help patients get through the process a little faster. But as NPR's Sarah McCammon reports, access to that medication is being complicated by the larger debate around abortion.

SARAH MCCAMMON, BYLINE: Kirstin Herbst and her fiance are ready for a family. They started trying for a baby recently, and Herbst says things happened fast.

KIRSTIN HERBST: It was pretty quick into it. We were pretty lucky that way. So nothing wrong with getting pregnant, thankfully.

MCCAMMON: Herbst is 30 and lives in Toronto, Canada, where she works as an illustrator. She says she wasn't too worried when she went to her doctor early in the pregnancy to check on her progress.

HERBST: I was thinking it was any other normal appointment, to be honest. People had come out just before us, and they were. Coming out with pictures.

MCCAMMON: But something didn't look right on her ultrasound. The fetus was measuring too small, and Herbst's doctor said she'd had a miscarriage. Herbst was given a few choices - wait for her body to expel the pregnancy naturally, which could take days or weeks, have surgery or take a medication called misoprostol to help her body complete the miscarriage more quickly. Herbst chose the medication.

HERBST: There's definitely a comfort level in having the ability to get this whole process finished or do most of it at home, I guess, compared to going out into a very public space, a lot of things you don't know and doctors doing all sorts of things to you, as opposed to you understanding the process and doing it yourself.

MCCAMMON: Herbst had to take a few rounds of misoprostol before all was said and done. So several months later, when she was diagnosed with her second miscarriage, her doctor offered her another drug, mifepristone, along with the misoprostol. Herbst says that miscarriage was similar, but she got through it faster. That's true for many women, according to a study published in The New England Journal of Medicine. Dr. Courtney Schreiber is an OB-GYN and lead author of the article, which recommends using a combination of mifepristone and misoprostol to treat patients who discover in their first trimester that a pregnancy is not viable.

COURTNEY SCHREIBER: There is such a sense of a need to improve care for women who have a miscarriage. And the fact that this new regimen can help with the rapid completion of the miscarriage, allow women to return back to their lives more quickly, has been received with tremendous enthusiasm.

MCCAMMON: The American College of Obstetricians and Gynecologists is among groups recommending the new protocol and urging the Food and Drug Administration to ease restrictions on mifepristone in the U.S. Mifepristone is better-known as the abortion pill. It's been heavily regulated since it was approved for medication abortions in 2000. It can't be stocked at commercial pharmacies in the U.S., and clinics that carry it have to apply for a special designation. And that makes mifepristone harder to access for women who need it for miscarriages. Allison Wray is 30 and lives in Vancouver, Wash. When she miscarried in November, she was first prescribed misoprostol alone.

ALLISON WRAY: And unfortunately, I got nothing. I got no side effects, but no, like - nothing really happened at all.

MCCAMMON: Wray took another dose and waited. Still nothing. She really wanted to avoid surgery. Her doctor suggested mifepristone, which the office had just begun stocking that week. That finally worked, much to Wray's relief.

WRAY: Just knowing that it's kind of done and that we can move on and move forward, and my body can heal and get back to normal so that we can start trying again.

MCCAMMON: Some abortion rights opponents argue the restrictions on mifepristone are appropriate. The drug causes a woman to have what's essentially a very heavy period, and there is a small risk of excessive bleeding. Dr. Christina Francis of the American Association of Pro-Life Obstetricians and Gynecologists says her main concern is patient safety. She also believes that loosening regulations on mifepristone could mean more abortions.

CHRISTINA FRANCIS: That's not why I'm questioning this article as far as changing my practice. But I do think, as a side issue, more women are probably going to be able to obtain medical abortions.

MCCAMMON: The FDA and many medical groups say mifepristone is safe and effective, though the FDA said in a statement to NPR that the regulations are necessary to ensure patient safety. But for many physicians, those regulations are a barrier to prescribing the drug to women experiencing miscarriages. Dr. Kristyn Brandi is an OB-GYN at Rutgers New Jersey Medical School.

KRISTYN BRANDI: Women have a lot of reactions. Sometimes they're tearful. Sometimes they're in shock. And so I want to help them get through this process as best as I can. And part of that is often trying to help them go through the process as fast as possible.

MCCAMMON: Because of the red tape, Brandi says she can't prescribe the drug right now.

BRANDI: And it's been really frustrating to know that there's a medication out there that I can give to my patients that I don't physically have to give to them.

MCCAMMON: Kirsten Herbst in Toronto says she's thankful to live in Canada, where easier access to the drug made her second miscarriage go a little more smoothly.

HERBST: It's such a terrible, terrible experience in every way, that to make it harder is just cruel.

MCCAMMON: Herbst says her two pregnancy losses have been extremely difficult.

HERBST: But I've grown a lot in the fact that I understand grief, and I can understand other people's grief a lot better now.

MCCAMMON: Despite the grief of her miscarriages, Herbst says she and her fiance are still hoping for a baby soon. Sarah McCammon, NPR News, Toronto.

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MARTIN: This piece was produced with the help of Dr. Mara Gordon, this year's NPR health and media fellow from Georgetown University Hospital.

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