Tampa couple shares story of pregnancy loss, impacts of miscarriage treatment as SCOTUS weighs mifepristone

TAMPA, Fla. - Oral arguments are set to begin Tuesday in a Supreme Court case over Mifepristone, a drug frequently used in both medication abortions and miscarriage treatment.  

While the groups suing to overturn the Food and Drug Administration’s approval of Mifepristone hope to reduce access to medication abortion, millions of women have already found themselves cut off from a commonly prescribed medication used to manage an early miscarriage. 

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The Supreme Court is expected to issue a ruling by late June, but some women’s care providers have quietly stopped prescribing Mifepristone to women experiencing early pregnancy loss, even in states where the pill remains legal. 

"I think it has to do with the stigma around it," explained Dr. Robyn Schickler, an OB-GYN physician and the chief medical officer of Planned Parenthood of Southwest and Central Florida.  "Some practices and certain hospitals are very adamant about not using it for that reason, so that they don't get labeled as providing abortions."

Many women choose medication intervention, as opposed to a surgical procedure known as a dilation and curettage or D&C so that they can miscarry in the privacy of their own home. 

One Tampa woman, Sarah Krapf, learned she’d miscarried nine weeks into her first pregnancy last year. She says she had little understanding of what to expect when she saw her doctor after she noticed bleeding. 

"They gave me three options," recalled Sarah. "The first was just to sort of ride it out and not have any sort of medical intervention, just to continue to miscarry at home, which, they said could take anywhere from two weeks to several months. We were already so excited to be parents and I didn’t want to wait, so I kind of knew right off the bat that that wasn't something I wanted to pursue.

The other two options were, to take misoprostol, which was a pill, and that would more expeditiously rid my body of the pregnancy. With the third option, a D&C, they explained to me that there would be some chance of scarring that apparently could make it difficult to get pregnant again. There’s a low chance of that, but we didn't want to risk it." 

Sarah says the medication route felt like their best option. 

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"The ability to just be able to take [misoprostol] at the doctor's office, go home, and be in the comfort of your own home and have just what's a really sad experience." 

But a few hours after they went home, Sarah and her husband, Wyatt, say their sad experience took a scary turn.

"As the night progressed, Sarah lost so much blood that she passed out on the bathroom floor and at that point, we knew something was wrong, so I dialed 911," Wyatt said. 

Sarah had started to hemorrhage, a rare, but possible side effect of taking misoprostol. 

"I had lost so much blood with the misoprostol that I needed a blood transfusion," said Sarah. 

To stop the bleeding and ensure her miscarriage was complete, doctors performed a D&C. 

"Which is what we'd been trying to avoid the whole time, to begin with," explained Sarah. 

What she didn’t know at the time was that she’d only been prescribed half of the medications recommended by the American College of Obstetrics and Gynecologists to treat her miscarriage.

"Mifepristone was never mentioned. I didn't know to even ask about what it was," said Sarah.

While misoprostol works on its own, it’s recommended patients first take mifepristone. Several studies show the combined pill regimen increases efficacy (from 80 percent up to 95 percent) and lowers the risk of infection and other adverse health effects. 

"If you're only using the misoprostol, you're going to have a higher risk of it not working. With that, a higher risk of incomplete, and what that puts people at risk for are significant bleeding and infection," explained Dr. Schickler. 

Major adverse reactions associated with mifepristone are low. Less than 1 percent of patients require emergency intervention for excessive bleeding, according to ACOG.

Sarah and Wyatt say they can’t help but wonder if mifepristone would have helped her avoid a trip to the hospital and surgical intervention. 

"It was a very rare situation," said Wyatt. "It turned into a life-threatening situation because of the complications associated with that when something else might have been available."

It isn’t clear why Sarah was only offered misoprostol - her care group did not respond to a request for comment - but Dr. Schickler says the debate over medication abortion, which now accounts for 63 percent of all abortions in the U.S., has cast a shadow over a medication that has been safely used in miscarriage management for decades.

"It's been labeled ‘the abortion pill’ so it's been kept from people with miscarriages who may really need it," said Schickler. 

Sarah and Wyatt hope sharing their story will help inform other families enduring the painful, yet incredibly common experience that is pregnancy loss. 

"I wish that we didn't even have to deal with that aspect of it, that we were just able to mourn the loss of our first child. I think it's important for people to remember that these pills have a purpose. They are multifaceted," said Sarah. 

"This was a very wanted pregnancy. We were devastated by the loss of that pregnancy. I really wish that this was just something that wasn't politicized. It's women's health care, and it should be a discussion between my husband, and myself and my doctor, trusting in them with all their medical expertise to guide us to what is the best solution. Anything that would have been able to help the recovery after losing the baby would have been really nice to have."

Tampa