My miscarriage looked like an abortion. Today, I would be a suspect.

Women will bleed to death on their bathroom floors if they are afraid to get medical care

Louisa Cannell for the Washington Post
Louisa Cannell for the Washington Post

What does a miscarriage look like? What does an abortion look like? What secrets are known only to a woman and her toilet? Apologies to the squeamish, but let me tell you a tale of a miscarriage — of how similar it can look to an abortion. And how dangerous both can be when a woman doesn’t have safe access to medical care.

I sat in my sunny bathroom above a toilet full of urine and stared at the object in my right hand in denial. This couldn’t be happening. This was going to ruin my life. Or at least the near-term plans I’d made for it.

You’d be forgiven if you think I’m describing the day I found out I had an unwanted pregnancy. I’m not. In that same spot, about two months earlier, I’d been overjoyed when I’d peed on a stick and gotten a positive pregnancy test. Which is why, on this afternoon, what I held filled me with horror.

There was blood on the toilet paper.

I called my husband in a panic. I called my doctor in an even bigger panic. She reassured me that it was probably nothing. I’d had an ultrasound just two days earlier, and everything looked perfect. My husband and I had been giddy at the sight of the dancing little fetus on the screen. And we were comforted by the conventional wisdom that a good ultrasound after 10 weeks is almost as good as holding a baby, since the risk of losing a pregnancy drops to the low single digits once you’ve passed this milestone.

But as the day went on, events worsened. By bedtime, I was cramping and passing clots. We called the doctor again. The after-hours nurse told us the best we could do was go to the ER.

By the time we arrived, I knew in my heart that my pregnancy was ending. As we walked through the sliding doors, I pulled my baseball cap low over my eyes to hide my tears from the roomful of strangers and stepped up to the triage counter. I leaned forward and said in a flat, husky whisper, barely holding back the sobs, “I think I’m having a miscarriage.”

Unfortunately for everyone that night, at that same moment a pedestrian who had been hit by a truck arrived in the ER, and we were sent to the orange plastic chairs to wait. Realizing that the woman sure sounded as if she was going to live, I angrily blurted to my husband that I hated her for cutting the line. (Please consider: I didn’t really mean it, and I wasn’t at my best.) By the time they called my name, it felt as if a taloned beast had taken a firm hold of my womb and was pulling it floorward. And just as I stood up, I felt a sudden gush and watched in terror as blood soaked my jeans from my hips to my knees.

I remember the next half-hour in a nightmarish series of clips. The nurse hustling me into the room and closing the door as I screamed and strangers gawked. My husband helping her yank my blood-soaked jeans off my legs as they lay me back on the exam table. The doctor bustling in and saying that she couldn’t diagnose a miscarriage until they found a fetus outside my body. The nurse and doctor poking around the clots of gore that surrounded me on the bed until I heard the nurse say quietly, “I found it.” The doctor holding up a little pink blob the size of half my pinkie and dropping it in a plastic specimen cup.

For most women, what comes next is that you clean yourself up, get dressed and go home to sort out your grief. But my miscarriage wasn’t typical. When we got to the clean-yourself-up-and-get-dressed part, I discovered that I was so drenched in blood that the hospital rags they gave me were utterly useless. As soon as I wiped the blood away, more took its place. And it just kept coming. We called the nurse back in. She took one look at the bed, left the room and returned rapidly with the doctor. I was experiencing an incomplete miscarriage, bleeding uncontrollably.

The doctor ordered an emergency dilation and curettage, or D&C, a clean-out procedure that’s essentially the same as an abortion. On the way to the OR, I continued to bleed so heavily that the pre-op nurses couldn’t even discern my external anatomy. The surgeon discovered that a significant amount of tissue had failed to detach from my uterine wall, hence the bleeding. She removed it, the bleeding stopped, and I was allowed to proceed to the go-home-and-grieve step.

In a frustrating epilogue, doctors were never able to determine why my miscarriage happened. Against medical probability, my healthy pregnancy simply tanked. Sometimes, even in our era of modern medicine, these things just happen with no proof of what went wrong.

This story has become a long-buried, sad chapter in my life. I went on to have three healthy babies. But since the Supreme Court decision overturning Roe v. Wade was leaked, making real the possibility of fetal-assault laws being applied to women who present at emergency rooms with miscarriage symptoms, I’ve been troubled by a chilling thought: If I had that same miscarriage today in the wrong part of the United States — or if I were poor or a woman of color — would I be under suspicion of ending my own pregnancy?

Like many Texas women, I had a safe, legal abortion. What happened to our state?

The fact is that no one can tell a medical abortion (one that is accomplished with prescription medication) from many types of miscarriage. Both generally present with escalating bleeding, cramping and the eventual passing of the products of conception. Currently, there is no empirical way to say whether an expelled pregnancy was medically induced or unfortunate happenstance. All doctors have to go on is the patient’s medical history and the story she tells them herself.

All she has is her word.

As of this moment, at least a half-dozen states either ban self-managed abortion or do not exempt pregnant women from prosecution under fetal harm laws. These laws, enacted with the intention of providing justice for women who lose wanted pregnancies because they are victims of violence, could be perverted to instead make women themselves the criminals.

What would the facts of my miscarriage look like to a not-so-unbiased stranger? Would the triage nurse see my baseball cap-hidden eyes as a sign of despair or deviousness? My hoarse whisper as someone straining to retain her composure or defiant gruffness? Would the staff see my complaints about the traffic-accident victim as exactly the type of selfish coldness that a person indifferent to the health of her pregnancy would display? How about the perfect ultrasound just days earlier? Or the fact that the first time a medical professional saw me, I was already covered in blood? Or the subsequent medical reports that found no clear reason for my pregnancy loss?

My doctor would back me up, surely, I thought. But then I remembered I had left this maternity practice because they could never keep their patients straight. Nobody ever knew me or why I was there. They were so overworked that the official cause of my first miscarriage (this was my second) was still listed as unknown because someone forgot to update my chart. So to a detached observer, it would sure seem as if I’d had two pregnancies suddenly end under similar circumstances. If they looked at my employment history, they’d also see that I’d received a promotion that year. And if they talked to people at a reunion I’d attended shortly before I became pregnant, they’d say that I loudly, drunkenly and repeatedly declared that having kids right now would be a disaster for me.

Would all of this be enough to raise suspicion?

I can’t begin to describe what the days following a miscarriage are like to a couple who desperately wanted that baby. It is abject grieving. It is a roaring hellscape of pain and lost dreams. Imagine having to prove to the law that you didn’t do this to yourself while your ears are still ringing from the explosion. At a time when a woman needs the most compassion, treating her as a suspect would be inhuman.

I am worried for American women when I consider the complications I had from my miscarriage. In rare circumstances, a woman undergoing a medical abortion could experience the same complications. I needed immediate medical help, and so would she. But would she be too afraid of getting in trouble to go to the hospital?

This is how women bleed to death on their bathroom floors.

Today, I am as stunned as most of the world that America has taken this giant step backward. Women should not be put in the position of defending things that their bodies do naturally or fear getting that care because their reproductive decisions began outside current restrictions. Some things should remain between a woman, her doctor and her toilet.