Former reality star Jessa Duggar Seewald, known from the TLC show 19 Kids and Counting, revealed on her YouTube channel that she had a miscarriage. The nearly 20-minute video posted on Feb 24., titled “Heartbreak Over the Holidays,” follows Seewald getting an ultrasound after she had spotting, or light bleeding, at 11 weeks of pregnancy.
“As soon as she started taking a look at the baby, I could tell that there was some concern in her voice,” Seewald says in the video, sharing the ultrasound. She said a healthcare provider told her during an appointment that "the sac looks good, the baby does not.”
For people who have a nonviable fetus in the first trimester (the first 12 weeks of pregnancy), there are usually two choices: a wait-and-see approach, in which the body might shed the tissue via heavier-than-normal bleeding, or a D&C, a dilation and curettage, a common procedure used to remove it from the uterus. Failure to remove the embryo or fetus can lead to sepsis, which can be life-threatening.
Due to her history of hemorrhaging, Seewald added that passing the pregnancy at home didn’t seem like a good option. As a result, she was checked into a hospital and underwent a D&C.
However, after the overturn of Roe v. Wade in June 2022, abortion laws and restrictions are now implemented by state, resulting in trigger laws or complete bans. As a result of anti-abortion legislation, access to some procedures, including D&Cs, is limited across the US.
There have been multiple cases where people needed a D&C to treat a miscarriage but were unable to obtain one as soon as they needed due to the overturn of Roe v. Wade, including a woman in Louisiana and another in Texas. Waiting too long to remove what’s called the “products of conception” can increase the risk of life-threatening complications.
Ultimately, the D&C procedure is the same for miscarriage, abortion, or many other types of necessary treatments; in fact, the medical term for a miscarriage is a spontaneous or missed abortion.
The Duggar family, including Jessa, have shared their anti-abortion views through campaigns to enact abortion restrictions. Jessa herself compared abortion to the Holocaust in an Instagram caption, which said, “Millions of innocents denied the most basic and fundamental of all rights--their right to life. One human destroying the life of another deemed 'less than human.'”
An estimated 26% of pregnancies end in miscarriage, and the D&C procedure is crucial to care for many kinds of pregnancy termination, including elective abortion. Here's what you need to know about the D&C procedure, and how abortion restrictions can affect people looking for treatment.
The procedure is difficult to obtain in many states
When it comes to elective abortions, the type of treatment depends on the stage of pregnancy.
Up to 10 weeks, the abortion pill — a combination of two medications — can be used to end pregnancies without surgery. About half of all abortions are performed in this way. The same combination of pills can also be used to treat a miscarriage.
“People may prefer a procedure or medication to help manage their miscarriage for many different reasons, and no one should have their options for the care they need and want limited legislative interference,” Dr. Nisha Verma, an OB-GYN based in Georgia and a fellow at the American College of Obstetricians and Gynecologists, told BuzzFeed News.
Whether the person getting the procedure is pregnant or not, a D&C removes tissue from the uterine cavity through the cervix. The procedure can reduce bleeding in people who have abnormal bleeding after menopause or as a result of fibroids, polyps, uterine cancer, or hormonal issues. It can also be used to control bleeding after giving birth.
However, some states now make it difficult, if not impossible, to get a D&C.
“We know that legal restrictions on abortion are and will continue to affect a wide spectrum of patient care, including miscarriage management, ectopic pregnancy care, cancer care, and so on,” Verma said. “For example, a patient may present in the process of having a miscarriage with heavy bleeding and pain. However, doctors may be hesitant to intervene in states with strict laws banning abortion care.”
Surgery is preferred in people who are at risk of hemorrhaging (like Duggar), abnormal or unstable blood pressure, or infection. Additionally, the procedure is a method of treatment for people with other conditions, such as cardiovascular disease, severe anemia, and bleeding disorders.
“There are some situations, like when a patient is experiencing very heavy bleeding, when a procedure is the safest option to manage the miscarriage,” Verma told BuzzFeed News.
Although fetal tissue can pass on its own through “expected management,” waiting for treatment can result in heavy bleeding, clots, and pain, which might require further treatment. Waiting might not be an option for some people with conditions and may lead to an infection in the uterus, or septic abortion. Sepsis can trigger a life-threatening emergency, which may be caused by remaining tissue in the uterus causing an infection.
Having the option to choose is important
Seewald is from Arkansas, a state where abortion is illegal and no longer allows abortion services. It’s unknown whether she traveled out of state to get the procedure to treat the miscarriage, or if she qualified for an exemption to save her life.
Whether or not she qualified, Gil Weiss, an OB-GYN at the Association for Women’s Health Care and assistant professor of clinical medicine in obstetrics and gynecology at Northwestern Memorial Hospital, told BuzzFeed News, “Restrictions and limitations on D&C may cause unnecessary delays, which in turn may cause patients to seek unsafe alternatives treatments that can endanger their physical and mental well-being,” Weiss said.
In a study done at the University of Colorado, Boulder, researchers estimated that if abortion were fully banned in the US, the number of maternal deaths would rise by 24%. For Black women, maternal deaths would rise by 39%. “If D&C is unavailable, history has shown that alternative procedures without medical guidance will become more common resulting in more injuries and deaths to women,” Weiss said.
Seewald benefited from the procedure, and it’s important for other people to have the same option.
“These laws are meant to create fear and confusion and make it much harder for clinicians to care for the person in front of them,” Verma said. “When we’re thinking about people’s healthcare, their pregnancies, and their lives, every person is different, and no law can take each unique situation into account.”