A patient comes into my emergency department bleeding and scared. She suspects she is pregnant but she has not yet been able to see an OB-GYN or get an ultrasound. I am the one who tells her that she’s both pregnant and experiencing an early pregnancy loss, or a miscarriage. As an ER physician, I have had countless versions of this conversation.
The patient tells me she wants medication to complete the miscarriage at home, so she can be with the people she trusts and process the loss in private rather than undergo a procedure or wait for the pregnancy to pass on its own. The medical standard in her case would be to prescribe mifepristone followed by misoprostol, a safe, highly effective treatment that gives her that very option.
This is the best way I know how to care for my patient. And it is now under threat.
If my hospital does not stock mifepristone, which is fairly common, I can send the prescription to a certified retail pharmacy. Before she leaves the ER, I walk her through exactly how to take the medications and what to expect. This is the best way I know how to care for my patient. And it is now under threat.
On Wednesday, the 5th U.S Circuit Court of Appeals will hear arguments in a lawsuit seeking to bar me and my colleagues from sending my patient home with the most effective medicine for her care. Since the fall of Roe v. Wade, mifepristone has become the target of countless efforts across the U.S. to restrict how it can be prescribed, dispensed and distributed.
Yes, restricting mifepristone will make abortion care dramatically harder to access in the U.S, especially for those living in states with abortion bans. But that is nowhere near where the consequences stop.
And as an ER doctor, I worry about much more than losing one medication. I worry about our patients’ health and safety when doctors cannot provide the care they know is appropriate.
There is no medical doubt that mifepristone is an incredibly safe medication, with less than 1% of patients experiencing serious or adverse complications — regardless of the reason they took it. It’s equally safe for abortion or miscarriage treatment. The medicine does not change because one patient chose to end a pregnancy while another wished hers to continue.
Historically, patients were required to receive mifepristone under a clinician’s supervision in person at a doctor’s office, hospital or clinic. But in January 2023, the FDA permanently changed this in-person requirement, allowing patients to receive the medication by mail or from certified pharmacies.
For those of us in the ER, this change was significant. I now can send a script to a certified retail pharmacy that carries mifepristone, much like I would send a patient home with a prescription for antibiotics, pain medication or any number of other drugs after an ER visit.
If that retail pharmacy option disappears, emergency doctors like me will have far fewer ways to treat patients experiencing pregnancy loss. Some patients may need to be referred or transferred elsewhere, undergo a procedure they might not otherwise need or return for additional care — all because the medication their doctor recommends has become has become the target of a misguided political agenda.
A recent study published in The Journal of the American Medical Association examined tens of thousands of first-trimester miscarriages before and after Dobbs. In states with abortion bans, patients became more likely to be told to wait for their miscarriage to happen on its own and less likely to receive medication. Among patients who received medication, researchers found a 13.8% increase in the use of misoprostol alone, rather than mifepristone plus misoprostol.
That is what abortion bans have brought into exam rooms: hesitation where there should be urgency.
Misoprostol alone remains an evidence-based option for managing miscarriage. The problem is not that it is unsafe. It is that mifepristone plus misoprostol is more effective, and abortion restrictions are narrowing the best treatment choices available to patients.
I see the complications from the lack of miscarriage management options firsthand. People whose doctors or hospitals were afraid to act because of an abortion ban. People who drove hours looking for care. By the time some reach us, a treatable pregnancy complication has become an emergency that could affect their future health and fertility. That is what abortion bans have brought into exam rooms: hesitation where there should be urgency.
Treating a miscarriage is not a partisan act. But when political decisions interfere with our ability to provide standard care, physicians have an obligation to speak up. That starts in our own hospitals. Emergency physicians should know whether mifepristone is available where they practice, understand how to prescribe it under current rules and push their health systems to provide evidence-based miscarriage care.
And policymakers need to understand what they are choosing when they restrict this medication. They are not regulating abortion from some safe distance. They are reaching directly into emergency departments, narrowing the choices we can offer our patients and making an already painful loss harder to endure.
Let doctors be doctors. And let us give our patients the care we know how to provide.
The post I treat pregnancy emergencies in the ER. Restricting mifepristone ties my hands. appeared first on MS NOW.
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