Just after arriving in Texas in December, I noticed I was bleeding — a clear sign of a pregnancy at risk. My obstetrician couldn’t offer me medical guidance while I was out of state, and I had a decision to make: Seek care in Texas or return home to Massachusetts. Ultimately, I chose to stay in Texas, a decision I later came to regret.
I was in my 9th week of pregnancy when my husband, toddler, and I flew to Houston to visit my in-laws. When an obstetrician in Texas found no indication of a heartbeat and diagnosed a miscarriage, my husband and I were devastated. We had wanted that baby and had already started dreaming of a dark haired, dark-eyed little boy.
The obstetrician walked us through my options for women who miscarry. There are three ways to expel the fetus — medication, wait for it to happen naturally (expectant management), or surgery (dilation and curettage). I chose the medication.
A few days later, when I filled my prescription and returned to my in-laws’ house, I found 4 pills — 800 micrograms of misoprostol. Concerned that something was amiss, I called my obstetrics team who confirmed that in Massachusetts, following the guidelines from the American College of Obstetrics and Gynecology, I would have been given a dosage of mifepristone first and then, 24 hours later, the misoprostol. Here in Texas, I was missing a key component.
Texan politicians have limited mifepristone in an effort to limit medical abortion and, as a consequence, I was not given access to this medically-advised pharmaceutical combination. The combination of mifepristone plus misoprostol offers women an over 95 percent chance of expelling the fetus within approximately one day of finishing the medication. With misoprostol alone, however, the probability drops to 80 percent. The status of mifepristone is now in jeopardy with a pair of contradictory rulings issued Friday by federal judges.
I took the medication and waited for the expected cramps. My bleeding intensified, but not like I had been told it would. I didn’t see what I thought would be the bulk of the fetus. After 24 hours, I called the hospital in Houston, and the staff told me to keep waiting. I called my own obstetrics team, who told me they would have prescribed me additional misoprostol if I were in Massachusetts, per medical guidelines, but that they could not do so while I was in Texas.
I flew back to Massachusetts later that week, still not sure if I had passed the fetus. As I tried to get ready to go back to work, my hormones continued to fluctuate. Yet another week later, as I entered my third week of bleeding, I experienced excruciating cramps. I guessed that I was not in the 80 percent for whom misoprostol alone helped pass the fetus.
Under guidance from my obstetrics team, I went to the Emergency Department, with blood seeping through my clothes. After a 6-hour wait, I was told there were still “artifacts of conception” inside me. Because the miscarriage had been taking so long, I was scheduled for a D&C for the next day. Now I was on to the third of the three methods for treating a miscarriage. I went under general anesthesia to empty the rest of my uterus. Recovery took time, and four and a half weeks after the spotting began, it finally stopped.
While the bleeding and pain had stopped, the effects of my drawn out miscarriage lingered. For over a month I had a constant physical reminder of my lost baby. Every time I went to the bathroom, I watched that life seep out of me. What had been so easy — just a plane flight — meant me going from having access to the full spectrum of reproductive care to having limited options.
If I had been given mifepristone in Texas, would the miscarriage have resolved sooner? Would I not have experienced so many highly emotional, deeply uncomfortable days where I wasn’t able to be fully present for my family or my job and had to worry about my own health? Could I have avoided $3,361.83 in costs from the ER visit and surgery?
I am deeply sad I lost that baby — a baby that my husband and I so badly wanted. In emotionally charged moments, you shouldn’t have to question whether politicians are limiting your doctor’s ability to deliver scientifically-backed care. I am enraged that my health was compromised.
On Friday, Judge Matthew Kacsmaryk in Texas ruled that the FDA must pull mifepristone, a drug which has been safely prescribed for decades. The Justice Department has appealed the ruling.
Having lived in Massachusetts nearly my whole life, I never questioned whether my doctor was giving me medical advice or options filtered through a political screen. When the Dobbs decision was handed down last June, I cried, worrying what it meant for other women — particularly young women — but assumed it would not impact me here in Massachusetts as an almost 40-year-old woman with a great education and a job in health care.
For so many women, their health care isn’t limited by an inopportune timed trip to visit their in-laws but by the actions of politicians in their home state. Until I was caught in the crosshairs of the assault on women’s health and abortion, I didn’t realize how my rights could evaporate when I crossed state lines. Many women don’t have the option of avoiding these unjust restrictions on women’s health care. A threat to one woman’s rights is a threat to all women’s rights, and we all deserve better.
Alexis Bernstein works in value-based care and digital health. She is a resident of Needham.