In a doctor’s suspicion after a miscarriage, a glimpse of expanding medical mistrust

The idea that she might be pregnant hadn’t crossed Janneke Parrish’s mind. She used contraceptives and trusted them. Now, sitting on the examining table with the doctor telling her there were pregnancy hormones in her system, she panicked. She’d had nightmares about this. They emerged whenever she was stressed out, any and all worries transformed into her biggest worry, of becoming a mom against her will. Some parasite would be eating her from the inside, and she’d have no way to get it out. She’d be entrusted with some delicate being, and no matter how careful she was, it would shatter.

The doctor was saying something, asking something, but she couldn’t put words together. He must’ve led her toward a transvaginal ultrasound but her mind was elsewhere, on this thing inside of her. She fixated on it, tried to will it out. That was crazy, that wasn’t something she could control. She tried to focus on what she could. Would she drive to New Mexico? That was seven hours. Would she fly to California?

She would fly to California. She had friends in Los Angeles, she could crash on their couch. There had to be abortion clinics in Los Angeles. She was in the process of moving, she didn’t have time for this trip, but she didn’t have much choice. She lived in Austin. Texas Senate Bill 8 had come into effect in September, allowing anyone to sue you if you helped with or provided an abortion after six weeks’ gestation, when a flutter of electrical activity is detectable in what could become the fetal heart. The U.S. Supreme Court had declined to block the law. She’d done the math, her mind whirring, figured she was just past six weeks. She would go to California.

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It felt good to have a plan, at least. She could feel the ultrasound wand moving back and forth, beaming a grayscale image of her organs onto the screen. Back and forth, back and forth. The technician sounded confused.

She’d had a miscarriage, the doctor said, once she was dressed. That was why she’d been in pain, why there was no fetus visible on the ultrasound. He was sorry for her loss. She felt a surge of relief, and teared up. The doctor mistook that for devastation. Gently, he began asking questions, his voice soothing.

Had she been trying to get pregnant? No. Did her partner know? No. Had she been pregnant before? Yes. How many kids did she have? None. Miscarriage? No, she said, an abortion, when she was 19 — and suddenly, something in the doctor changed. The questions kept coming, but they were clipped now, formal. They no longer sounded like they were meant to console. Had she taken misoprostol, a drug used in medication abortions? Did she use illicit drugs? What about alcohol? What kind of physical activity had she been doing recently?

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It felt like an interrogation, as if she were being accused of doing something wrong, of causing the loss of a pregnancy she hadn’t even known about when she arrived at urgent care. She wanted to go home. She wished she hadn’t come to see the doctor at all.

It was a glimpse of a new era of medical mistrust. At least, it was new to her. There are plenty for whom the doctor’s office has long been contested terrain, where you need to watch what you say and keep your guard up, where Black people in pain are dismissed as drug-seeking, where women are told their symptoms are all in their head, where seeking help might get you into more trouble. Now, with Roe v. Wade overturned, that phenomenon is expanding. To Sarah Prager, professor of obstetrics and gynecology at the University of Washington, all doctors, not just reproductive specialists, should be up in arms about how abortion bans fracture the doctor-patient relationship. “If clinical spaces become unsafe for patients, that is just a really bad precedent,” she said. “Our ability to take care of patients relies on trust, and that will be impossible moving forward.”

To restrict abortions is to prevent evidence-based care, she went on — but it also affects other medical encounters, too. “These sorts of restrictions are really going to put a damper on people seeking care, even in very normal, very legal situations.”

Irregular periods are common. Many people don’t realize they’re pregnant until six weeks in or later. Some aren’t aware of a pregnancy until they seek care for what turns out to be a miscarriage, or for something else. And miscarriages are common, too. They typically occur in 11% to 16% of known pregnancies, and in an estimated 30% of pregnancies overall.

In other words, Parrish was sitting on that examining table because of an utterly commonplace medical issue — and feeling like she was being cross-examined for it. The physician might’ve been misguidedly acting in self-defense. No state currently requires that a doctor report a patient’s self-induced pregnancy loss to authorities. But there’s a lot of fear and confusion among physicians. “It’s really unfortunate that a lot of states are putting clinicians in a place where they feel like, in order to protect themselves, they need to be an extension of the state,” said Nisha Verma, a specialist in complex family planning and a fellow at the American College of Obstetricians-Gynecologists.

Parrish wasn’t naïve about the ways institutions could turn against you. She was 31. She said she’d been fired by Apple in 2021. She believed it was in retaliation for her pay-equity activism; the company didn’t comment when journalists had reached out at the time.

But she hadn’t thought twice about saying she’d had an abortion. Her mother is a nurse practitioner who’d moved from the Netherlands to the United States. The family talked about diagnoses at the dinner table. “I’ve always been told you can trust your doctor. This is what doctors are here for: They take the Hippocratic oath, and they are here to help people,” she said. “And what you say to a doctor is confidential.”

In that moment, hearing the sudden change in tone, she wondered if that was really true. People had been prosecuted for miscarriages before, even imprisoned. She wondered — wildly, implausibly, and yet — if this doctor was going to call the police. Because she told him about a medical procedure she’d had 12 years ago.

“There is not a moment that’s gone by when I’ve regretted it. It was absolutely the right decision.”

Janneke Parrish

She was 19 and unemployed and trying to get into college. She was living in Raleigh, N.C., in the cheapest apartment she could find. There wasn’t enough room for both a bed and a couch. The carpet was a generic beige, with edges that looked like they’d been chewed on. Every so often, the electricity would flicker out and back on, she didn’t know why. Maybe the building was old.

She was only just scraping by. When she found out she was pregnant, she was flooded with dread. There was no way she could care for a child. She could hardly keep body and soul together herself. It felt suffocating to picture being responsible for someone else.

She didn’t have internet at home, so she searched for abortion providers at the public library. It cost around $500, an exorbitant amount for her at the time. She never imagined that by the standards of Texas in 2022 — drive seven hours? fly to California? — that would seem wonderfully accessible.

She spent a few weeks scraping the money together. On the day of her appointment, she waded through the anti-abortion protesters outside the clinic. A staff member spotted her and rushed out to guide her. The waiting room was crowded. She had a counseling session; she explained she’d been on birth control pills but they’d failed. She was shown an ultrasound of her uterus, 10 weeks pregnant. She chose to be sedated for the procedure, and woke up in a room with four other patients. Someone had left a juice box and crackers by her bedside. She felt groggy, sore, and hugely relieved.

“There is not a moment that’s gone by when I’ve regretted it,” she said. “It was absolutely the right decision.”

She got into college, North Carolina State, where she studied philosophy and religious studies. She did a master’s at the University of Glasgow, in Scotland, focusing on international politics and human rights. In 2015, she moved to Austin to look for work, and got a job creating digital maps of various parts of the world.

The pain began as a soreness in her flank and pelvis. Then it got worse, first a throbbing, then a flashing. When it woke her up at night, she decided to go to the doctor. It was April 2022. She’d donated a kidney to a friend 10 months earlier. What if something was wrong with her remaining kidney? That was her biggest worry. There was also the possibility that she’d injured herself. She played tennis, she cycled, she sat at a home desk much of the day for her job as a product manager. Any of those things, she figured, could be at the root of her pain.

Now, sitting on the examining table, the paper crinkling beneath her, she was scared. In retrospect, she felt naïve for trusting the doctor, for wanting him to know her full medical history. It might seem piddling — a prickle of fear, a few minutes of uncomfortable questions, a change of mood in the examining room — but the threat she felt was real.

That worries doctors. Some obstetrician-gynecologists are starting to counsel patients that they don’t need to be honest with providers about whether they experienced an abortion or a miscarriage because there’s no way to clinically tell the difference after the fact. If someone’s trying to get pregnant, it could be important to make the distinction: a history of miscarriages, rather than abortions, could provide clues for a clinician helping with fertility issues. But in other situations, if differentiating the two could put a patient at risk, it might not be worth it.

When she heard the shift in tone, Parrish’s tone shifted, too. She made her responses as terse as possible, as firm as possible. She wanted to leave. Her kidney was fine, she now knew the source of her pain, she’d gotten the answer she needed, and she wanted to go home. Eventually, the doctor seemed satisfied that she hadn’t caused her own miscarriage. She paid $65 for the visit and drove home. Within a few weeks, she’d left town. First, she stayed with friends in North Carolina. Then she moved to Amsterdam, as planned.

Only once she’d left Texas did she feel comfortable speaking out. She wrote about that doctor’s visit on Twitter. Her chain of tweets went viral. There were sympathetic responses. There were aggressive responses. Experts began referencing her story in media interviews. That makes it sound unusual. In fact, what was remarkable about her story was that it was so unremarkable, a gynecological issue experienced by countless others, but stigmatized and seldom talked about. She figured that if miscarriages are so common, then the threat she felt from the doctor would be, too.

Source: STAT