Bleeding and in Pain, a Pregnant Woman in Louisiana Couldn’t Get Answers

BATON ROUGE, Louisiana — When Caitlin Joshua found out she was pregnant in mid-August, she and husband Landon Joshua were thrilled to be expecting their second baby soon. They had her four-year-old daughter, who they thought was just the right age to care for her younger siblings.

About six weeks pregnant, Joshua, 30, called a group of doctors in Baton Rouge. She wanted to make her first prenatal appointment at about the 8-week mark, just like she did during her first pregnancy. But Joshua said she was told by the woman who answered the phone that she would have to wait more than a month.

“They specifically said, ‘I’m not going to see women again until at least 12 weeks,'” Joshua recalls. “And I said, ‘Oh Lord. Is this because of my thoughts?’ They said, ‘Yes.'”

Louisiana’s near-total abortion ban, which took effect on August 1, has raised concerns among doctors that miscarriage cures may be investigated. Because the same treatment is used for abortion.

Joshua recalled what the woman said on the phone since the U.S. Supreme Court ruling was overturned. Law vs WadeThe practice was delaying first prenatal appointments with patients.

Joshua recalled her words that many women miscarry in the first 12 weeks of pregnancy and did not want to take responsibility for the investigation. Anyone convicted of having an abortion is subject to severe penalties by law, including 10 to 15 years of her imprisonment, fines of up to $200,000, and loss of her medical license.

Since the Louisiana ban took effect, some doctors have warned that the law’s language is vague, and that fear and confusion over the law can lead to delays in pregnancy care. This is what Joshua and her husband experienced.

During the first few weeks of her pregnancy, Joshua experienced symptoms she couldn’t handle in her first pregnancy. She is mildly spasmodic and spotty. But without medical attention, he felt Joshua had nowhere to go for answers.

“How can we have a viable healthcare system when women, especially women of color, don’t see each other for 12 weeks?” she said.

As a community organizer, Joshua knew that pregnancy can be dangerous, especially for black women like himself. She also knew about Louisiana’s dire maternal health statistics. The state has one of the highest maternal mortality rates in the country, and reports from the state’s health department show that black women are more at risk than white women.

So Joshua made an appointment with one of the gynecologists of color he found a few weeks later. Then, between 10 and her 11th week of pregnancy, she started bleeding profusely, draining blood clots and tissue. She said she was in more pain than when she gave birth.

Her husband was at work, so Joshua went to the emergency room at Baton Rouge Women’s Hospital on her own. There staff performed an ultrasound on her, which showed that her fetus had stopped growing, she recalled. She was 7 or 8 weeks pregnant, not 10 or 11 weeks. Her medical records show that her pregnancy hormone levels were abnormally low.

She was told she had only a faint fetal heartbeat. Joshua knew he had a miscarriage. However, hospital staff never explicitly confirmed that, nor did they explain what treatment options were available in the event of a miscarriage.

Joshua said a nurse told her. But I don’t want to say what it is. Let’s keep watching. You can continue to visit us. Of course we are praying for you. ”

Joshua is a Christian. She spends Sunday mornings at church. But she said the comment felt like an insult. rice field.

The next day her bleeding and pain got worse. Her husband, Landon, feared for her life.

By the evening, Joshua was bleeding and cramping while walking on the bathroom floor. Then she felt more blood and tissue coming out of her body.

“I literally felt like I had a child,” she said. “So I was like, ‘No, I have to go somewhere, right now.'”

Not wanting to go back to the first ER, she called her mother and husband and told them to meet at the nearby Baton Rouge General in Prairieville. There, her guard put her in her wheelchair. Her jeans were soaked with blood. Her staff gave her another ultrasound, and her technician told her she had lost a lot of blood.

A doctor came to talk about the results of the ultrasound. She told Joshua that she looked like she had a cyst, not a pregnancy, and asked if she tested positive that she was pregnant, a question that angered Joshua.

Joshua remembers her doctor telling her that if she really had a miscarriage, she should go home and wait, then follow up with an OB-GYN in a few days.

Joshua asked his doctor for treatment to ease the pain and speed the progression. He has two standard options for managing confirmed miscarriages. In addition to allowing the miscarriage to flow naturally, it is a procedure called dilation and curettage to remove pregnancy tissue. Or a drug that helps clear the uterus faster. Both of the latter treatments are also used for abortion.

“We’re not going to do that,” the doctor told her. “I remember her saying, ‘Not now.'”

Doctors also said they would not refer Joshua elsewhere for miscarriage treatment or give them discharge papers indicating that she was having a miscarriage, known in medical terms as a spontaneous abortion.

“She said she wasn’t going to put ‘spontaneous abortions’ anywhere because that would flag an investigation against them,” Joshua said.

Landon Joshua had the impression that doctors were afraid to confirm his wife’s miscarriage.

“She looked me in the eye and wouldn’t tell me what was going on,” Kaitlyn said.

Frustrated and scared, the Joshua family returned home.

Both Women’s Hospital and Baton Rouge General said in statements to NPR that pregnancy care hasn’t changed since Louisiana’s abortion ban was passed. Baton Rouge General said Kaitlyn Joshua’s care was adequate said. NPR denied that Joshua reached out to the provider who originally asked for her prenatal appointment and changed the timing of her original appointment.

Both ERs Joshua visited deny they changed care because of the Louisiana ban.

In a statement, Dr. R. Cliff Moore, chief medical officer and specialist in maternal-fetal medicine at the women’s hospital Joshua first visited, said bleeding in the first pregnancy is common and not necessarily the patient. He added that diagnosing a miscarriage “requires a complex medical analysis” and could take days or weeks. “Our hearts run out,” he added to those who experienced it.

A second ER, Baton Rouge General, said there was no change in how miscarriages are managed or the options available to patients. In a statement, emergency physician Dr. Kathleen Burns said the hospital “sympathizes with the pain and anxiety” Joshua experienced, but believes her care was “adequate.” Each patient is different, she said, adding, “Sometimes waiting and observing is the right approach, while others require medication or treatment.”

According to Joshua’s discharge papers from Baton Rouge General, she suffered from vaginal bleeding. However, in her chart, which Joshua later obtained from the hospital, the staff wrote, “She appears to be having a miscarriage,” and diagnosed it as “a complete or unspecified spontaneous miscarriage without complications.” The records also show that Joshua’s pregnancy hormone levels, called HCG, were dropping from a previous ER visit that would have been elevated had the pregnancy progressed normally.

After Joshua signed a form allowing him to comment on her care with the hospital, the Baton Rouge general said that because of Joshua’s symptoms, “her discharge paperwork and treatment plan included instructions on how to manage bleeding and We provided instructions on when to follow up with a doctor.”

Other doctors and lawyers in the state are concerned that the abortion ban is affecting health care decision-making. They said even after a state court temporarily suspended Louisiana’s ban last summer, Louisiana Attorney General Jeff Landry threatened the doctor’s license and the doctor could be prosecuted. He points out the fact that he claimed

At a Louisiana Department of Health conference in September, Joey Biggio, M.D., director of maternal and fetal medicine at Ochsner Health, Louisiana’s largest health system, said some OB-GYN doctors don’t have regular care. He said some people are afraid to offer.

“Currently, there is a very high level of concern from the Attorney General’s Office over criminal, civil and professional threats, including ectopic pregnancies and miscarriages, that are preventing many from providing the care they need to their patients. , ruptured membranes, you know, bleeding,” said Vizio. “And we need to figure out how we can provide clear and clear guidance to our providers, otherwise all these unintended consequences will occur.”

policy debate

Senator Katrina Jackson, the author of Louisiana’s anti-abortion bill, is an anti-abortion Democrat. She maintains that the law is clear about miscarriage, and in her emailed statement she said she “does not ban treatment for miscarriage.”

Sarah Zagorski, communications director for Louisiana Rights to Life, who helped draft the ban, said no part of Louisiana law requires doctors to delay prenatal care until 12 weeks of pregnancy. She said the law makes a clear distinction between miscarriage care and abortion.

“It seems that the problem is not the law, but the misunderstanding of the law,” Zagorski said.

Ellie Schilling, an attorney for Rift Louisiana, a reproductive justice organization that challenged Louisiana’s law in state court, said the law allows for the treatment of miscarriages, but it’s written in legal language. That said, it’s not always easy to draw a line because of medicine, but to suit the set of circumstances of each individual patient. And this puts doctors in a very difficult situation.

“They’re trying to interpret a particular language and combine that with a particular patient to do some math. Are we at this threshold yet? Or are we not?” she said. Told.

Doctors also need to consider whether someone else might disagree with their decision later, she added. How might law enforcement and prosecutors interpret it later?”

She argued that the law needed clarification. “It’s putting healthcare providers and patients in a really dangerous situation,” she said. “And it would be irresponsible to abdicate all responsibility for making laws before drafting them in a way that works for doctors in the field.”

patient’s perspective

A week after Joshua’s last visit to the ER, he continued to experience heavy bleeding and piercing pain. While mourning the loss of her newborn baby, she continued to worry about her own health. She feared getting worse and wondered how much she would have to get worse to receive her treatment.

Joshua blames Louisiana’s abortion laws for denying him the treatment he received. “Having to navigate so many different channels to get health care shouldn’t be happening,” she said. Abortion bans should be made clear so that women are not afraid to provide care and support.

It took weeks, but Joshua was able to finish her pregnancy at home. If she had been given the choice, especially as a black woman, the experience would have been faster, less painful, less scary, less risky care. would have chosen

“This experience has taught me how black women die. Likewise, this is how black women die,” she said.

It also prompted Caitlin and Landon Joshua to rethink their plans for more children.

“I love my child so much that she always makes me want another girlfriend. But at the moment, it’s just too risky to get pregnant in Louisiana,” Caitlin said. “I don’t think it’s worth risking your life for a baby right now.”

This story is WWNO When KHNEdited by Carrie Fiebel, Jane Greenhalf, Diane Webber and Carmel Ross. Art direction and design by Meredith Rizzo and Max Posner. Photo by Claire Bunser.

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