Explaining Jessa Duggar Seewald's spontaneous abortion and dilation and curettage procedure
Jessa Duggar Seewald recently revealed that she experienced a miscarriage over the holidays.
The 19 Kids and Counting alum took fans through her experience in a YouTube video, including telling her four children that she was expecting and grappling with the aftermath of her miscarriage. Seewald said she had been spotting blood and was told at an ultrasound appointment that the baby did not "look good."
Seewald said she and her husband, Ben Seewald, "were just sitting there holding hands and crying, like, 'What do we do from here?'" Seewald then shared that she decided to have a procedure known as a dilation and curettage (D&C) to remove the fetus in order to lower the risk of complications from passing the fetus at home.
Seewald spoke in detail about the procedure, noting that the hardest part for her was when she was alone afterward. "Those 10 to 15 minutes before I was taken back to the room where Ben and my mom were waiting were probably some of the hardest in my life, just laying there feeling so alone," she said.
But Seewald, who is a vocal "pro-life" advocate, received a wave of criticism online after her video was released, with many pointing out that a D&C is a procedure that is also used for surgical abortions. Seewald's home state of Arkansas bans abortions except in situations where the life of the mother is at risk, and there are tight restrictions around procedures like a D&C because of this.
Seewald later followed up in the comments of her YouTube video, defending her decision to have a D&C. "Women have D&Cs for many reasons, not all of which involve killing a living human being," she wrote. "The ultrasound revealed that I had a missed miscarriage. My baby's heart had stopped beating three weeks before I had a D&C." Seewald also shared that she had a previous D&C to treat a retained placenta after her daughter Ivy's birth.
After facing criticism for undergoing the procedure, she then defended her anti-abortion stance. "Each person is created 'in the image of God' (Gen 1:27), and to purposefully destroy a baby in the womb is an affront to the God who created that life," she wrote. "There's a world of difference between someone dying and someone being killed. To equate one to the other — and to a mother grieving the loss of her baby no less — is severely distasteful. There is a world of difference between a mortician and a murderer. Even a child understands the difference between the two."
So, is a D&C an abortion? Here's what you need to know.
What's a D&C?
A D&C is a surgical procedure in which the cervix (the lower, narrow end of the uterus that connects the uterus to the vagina) is opened and a thin instrument is inserted into the uterus, according to the American College of Obstetricians and Gynecologists. The instrument is then used to remove tissue from the inside of the uterus.
A D&C can be done using either a sharp instrument or suction, Dr. Daniel Grossman, director of Advancing New Standards in Reproductive Health, tells Yahoo Life. "This procedure is used with both miscarriage and abortion," he says.
What's the difference between a D&C and an abortion?
This is where things get confusing. A D&C can be used to perform an abortion, but a D&C isn't always an abortion in the sense of how the general public thinks of abortion, Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells Yahoo Life. "This is a general medical procedure which can be done on pregnant and nonpregnant people," she explains. "It's the indication of the procedure that can be confusing."
D&Cs can be performed on people who have a polyp on their uterus or a retained placenta after childbirth or to help control bleeding, Streicher says. In the case of a miscarriage, the D&C is often used to help prevent infection. "Sometimes when a woman miscarries, there is some tissue left inside the uterus — and we need to mechanically clean out the lining and occasionally placental remnants to stop her bleeding," Dr. Mary Jane Minkin, a clinical professor of obstetrics and gynecology and reproductive sciences at Yale School of Medicine, tells Yahoo Life. "If we don't clear it out, it could become infected."
What are the laws in Arkansas surrounding abortion?
Arkansas is labeled by the Guttmacher Institute as one of the states with the "most restrictive" abortion laws in the country. This is what the law says surrounding abortion care in Arkansas, per the Guttmacher Institute:
Abortion is completely banned with very limited exceptions.
Patients must have in-person counseling and another visit to a medical provider at least 72 hours later for the abortion.
State Medicaid coverage of abortion care is banned except in very limited circumstances.
Medication abortion must be provided in person — the state bans the use of telehealth or mailing pills.
Parental consent or notice is required for a minor's abortion.
Only physicians can provide abortions.
Medication abortion is severely restricted.
Did Seewald get an abortion?
It depends on who you talk to. In medical terms, yes, she experienced an abortion. "There is no medical term, 'miscarriage' — the medical term is 'spontaneous abortion,'" Minkin says. However, Seewald would have experienced a "spontaneous abortion" without the D&C — it means the same thing as a miscarriage.
"The only difference between having a D&C for a spontaneous abortion and an elective abortion is that the intact tissue from the pregnancy may still be there," Streicher says.
The public's view of a D&C is "definitely something that is very muddled," Dr. Aishat Olatunde, an ob-gyn in Pennsylvania and a fellow with Physicians for Reproductive Health, tells Yahoo Life. "The reality is, the procedure is just the act of opening the uterus and then using instruments or suction to remove the pregnancy, whether or not it is viable," she says. "We can get caught up in language and certain words and phrases, but the reality of how we're taking care of people doesn't change."
In general, “the procedures and medications used for miscarriage management are the same as the procedures and medications used for early abortion care," Dr. Courtney Kerestes, an ob-gyn in Ohio and a fellow with Physicians for Reproductive Health, tells Yahoo Life. She adds, "Providers who are specifically trained in abortion care are very equipped to take care of patients who need miscarriage care."
Experts say having tight restrictions on medical procedures like D&Cs makes it difficult for people to receive proper reproductive care, whether they have a viable pregnancy or not. "I worry about how providers in states with many abortion restrictions may not be properly trained or have the resources, support and skills to do these procedures, which could lead to unnecessary barriers for patients who need to access this necessary, timely care," Kerestes says. "Even though these procedures for miscarriage care would be legal in states with abortion bans, concerns about legality could also lead to unnecessary delays in patients receiving this care, which underlines how bans on abortion impact everyone and are meant to cause chaos and confusion for providers and patients.”
Olatunde says it's "really unfortunate" that physicians in states with restrictive abortion laws need to navigate restrictions around procedures like a D&C. "It's doing a huge disservice to our patient by not allowing us to provide evidence-based and compassionate care," she says. "Ultimately, physicians are at the mercy of state restrictions and laws, but these restrictions aren't based in facts. We should allow physicians to do their job, whether a patient is being managed for a miscarriage or seeking out an abortion."
Seewald said in her video that she plans to "take a break" from social media for a while to focus on her recovery.
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