When my number was called in the hospital waiting room, I was given a bill: $7,662.50 — $4,500 of which was due upfront to cover surgical costs of a dilation and curettage (D&C) I would have two days later. Small amounts went to the hospital pharmacy, the hospital lab, and surgery supplies. Much larger chunks went to operating room services ($2,368), anesthesia ($1,397), medication ($1,066.50), and my brief stay in the recovery room ($1,779). And because I hadn’t yet met my $8,000 deductible, I would be billed for much of the remaining tab later.
After a year-and-a-half of trying to conceive, I’d finally gotten pregnant, only to have my heart shattered in a quiet ultrasound room where the screen was never turned in my direction. My doctor had referred me to hospital intake, where I waited to complete the paperwork that would allow me to pay thousands of dollars to lose the baby I’d dreamed of for years.
As I held the forms, the hospital administrator expressed her astonishment at how good my insurance was. Apparently, I was getting off cheap.
Three more miscarriages after that episode, I had another surgery that — almost miraculously — discovered and resolved a uterine abnormality, allowing me to carry a successful pregnancy. Eleven months after that surgery, my son was born. After tens of thousands of dollars spent on testing, treatment, and loss, I finally birthed a living child. The out-of-pocket cost that day: $45 (on top of the $500 I’d already paid to my OB).
That’s more than $7,000 less than I paid to lose a pregnancy. And that’s without counting the added costs of that miscarriage — lab visit upon lab visit, repeat doctor’s visits, medications, et cetera. Nor does it account for three subsequent miscarriages, the time and money spent on fertility testing, surgeries, and recoveries, or the years’ worth of psychiatric help I sought during this time.
We don’t tend to quantify the emotional toll, but we should.
While the bill for my first miscarriage was significantly higher than that of many women I know, the cost of miscarriage is well above the average American’s financial means. Medical intervention is necessary when a pregnancy becomes nonviable, but the body does not naturally miscarry to prevent life-threatening complications like major infection, potential sepsis, and molar pregnancy. Even if a woman miscarries without medical intervention, she pays extensive fees for doctor’s visits, lab draws, and follow-up ultrasounds.
And follow-up ultrasounds don’t come cheap. Stephanie* from Virginia, was charged double for hers, her doctor citing the added annoyance of performing an ultrasound on a “non-pregnant uterus” as an extra line item. She later developed an infection.
Stephanie was able to fight those extra charges and have them dismissed, but her story is illustrative: The U.S. medical system extracts a physical, financial, and emotional toll on miscarrying women.
We don’t tend to quantify the emotional toll, but we should.
One in six women experienced post-traumatic stress after miscarriage or an ectopic pregnancy in a study of 737 women conducted at Imperial College London over a year-long period, and published in the American Journal of Obstetrics and Gynecology.
This jibes with my experience as the author of a miscarriage support journal and frequent contributor to online miscarriage communities: PTSD is a very real emotional hurdle after a miscarriage.
When a miscarrying mother receives a daunting medical bill related to her loss, she is often transported directly back to the physical and emotional experience of miscarriage. This facet of PTSD is called a “trigger” — a specific sound, noise, sight, smell, or other “stimulus” that can send a person back to the physical space of trauma, reigniting the emotions they experienced during the traumatic event. “[When] the medical bills started to arrive,” author Ayana Lage wrote in a recent essay for The Washington Post, “I felt like I was losing my son all over again.”
I had the same experience. Every medical bill took me back to the office from which it was sent, the silent waiting room, the ultrasound room where I experienced the death of my dream — the death of my child.
The lack of affordable care genuinely could’ve killed me.
Stephanie, who took the less expensive route of a medically managed miscarriage using Cytotec (misoprostol), a drug that induces loss when the body does not do it on its own, says her surprise $1,000 hospital bill was “shocking. It still is almost five years later.”
Cytotec is the least expensive way to induce a miscarriage that the body does not manage naturally. But many women who take misoprostol still end up footing hospital bills, either at an emergency room for hemorrhage or in a surgery center for a D&C. These are supposedly rare occurrences, yet I know hundreds of women who have had them.
There’s also an emotional toll associated with taking these drugs. There are regular reports of pharmacists refusing to fill misoprostol prescriptions, often calling it an “abortion pill” and citing personal beliefs as reason for their refusal. Examples that have made the news in the past occurred at a Meijer pharmacy in Michigan, an Arizona Walgreens, and a Georgia Walmart. And while laws differ in various states, the emotional toll of this refusal on an already grieving family is immense. I know multiple women who have feared taking in their misoprostol prescriptions, despite ending up with caring and empathetic pharmacists.
Further, the experience of miscarrying with misoprostol can be excruciatingly painful, resemble full labor, and cause psychological damage. Margo* from Maryland says it was “the most painful experience, both physically and emotionally” that she has undergone. She elected to pay for surgery for her second and third miscarriages just to avoid the emotional trauma of taking misoprostol again.
Surgery in a hospital costs thousands of dollars. So-called “abortion clinics” are an alternative and last resort for many women to safely manage miscarriage at a reasonable cost.
I know many women who have gone to Planned Parenthood to more affordably treat miscarriage. Dozens have told me of the emotional trauma they endured walking across picket lines to get help losing a wanted pregnancy that was already nonviable. But with abortion debates raging and funding to such organizations being cut, even these options are becoming harder to come by, especially for women living in rural areas. The number of specialized abortion clinics nationwide dropped from 452 in 1996 to 253 in 2017, according to a September 2019 report from the Guttmacher Institute. The declines are especially prevalent in the rural South.
Elizabeth*, from South Dakota, desperately needed intervention when her body didn’t recognize that it had lost a pregnancy. She didn’t have insurance at the time, and her doctor, who she says knew she “couldn’t afford a D&C,” refused to perform one, instead suggesting that she go to a less expensive “abortion clinic.” But “there was only one provider,” Elizabeth told me, and she couldn’t get in. So she ended up waiting nine weeks to finally miscarry.
That is, she spent two months living through the trauma of knowing she was carrying a nonviable pregnancy, all the while suffering from a high fever and chills — both clear signs of infection. According to the Guttmacher Institute report, there was just one provider in her state in 2017.
“The lack of affordable care genuinely could’ve killed me,” she says. Because Elizabeth didn’t have access to affordable health care, she paid an extreme physical and emotional cost, which brought a financial burden later.
It’s time we normalize and support miscarriage medical care and give women a way forward from bodily trauma.
Living in the southern urban center of Atlanta and having access to various hospitals and clinics through my insurance provider, I was able to cover the cost of my medical care, and I was lucky enough to have a health spending account (HSA) to pay the bills. But the chills down my spine, the weight in my chest, the shortness of breath, and the vision that blurred as I looked at the $7,662.50 bill that I was given in the hospital that day, nearly four years ago — these weren’t totted up. Even now, the psychological trauma remains.
Emily* from Florida has that experience monthly. Every time the new bill is due on her financing. She was able to cover the cost of her first miscarriage, but the second was unaffordable. She and her husband had to finance their second miscarriage, despite insurance coverage.
Miscarrying mothers deserve better from our health care system than to consistently re-experience psychological trauma due to massive medical expense. And they certainly deserve better than to risk death because medical care isn’t available.
It’s time we stop letting a faulty medical system break women like me, like Stephanie, like Emily, like Margo, like Elizabeth. It’s time we normalize and support miscarriage medical care and give women a way forward from bodily trauma that can be unbearable even on its own. Miscarriage is traumatic enough. Isn’t the first rule of medicine “first do no harm”?
*The women interviewed for this article asked to be identified by their first names only.
Farren, J., Jalmbrant, M., Falconieri, N., Mitchell-Jones, N., Bobdiwala, S., AL-Memar, M., Tapp, S., Van Calster, B., Wynants, L., Timmerman, D., Bourne, T. (2019) Post-traumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multi-center, prospective, cohort study. American Journal of Obstetrics and Gynecology, DOI: 10.1016/j.ajog.2019.10.102
Jones, R., Witwer, E., Jerman, J. (2019) Abortion incidence and service availability in the United States, 2017. Guttmacher Institute, https://www.guttmacher.org/sites/default/files/report_pdf/abortion-incidence-service-availability-us-2017.pdf