Biting down on a stick

In June of this year, US Representative Marie Gluesenkamp Perez shared that she had recently experienced a miscarriage, and that upon taking the medication necessary to expel the remains of the pregnancy tissue (likely misoprostol), she experienced pain worse than labor. She was not warned of how bad the pain would be, nor was she offered any pain management. In testimony before Congress, she said her four-year-old son had to see her suffering in a way he never should have seen. And in a follow-up interview, Gluesenkamp Perez compared the advice of taking ibuprofen during a miscarriage to “telling women to bite down on a stick.”

Until working on my latest book, I had no idea how painful pregnancy-ending treatment can be. It’s not something you know about until you experience it yourself. But again and again, the women I interviewed compared this pain to labor. Some called it “a light labor,” others said it was “worse than labor.” One of my interlocutors, who had an induced stillbirth, said the pain of contractions after misoprostol was like a “square wave”—an immediate ramp up to full power with no chance to prepare—rather than the gentler “sine wave” of labor.

Misoprostol, given alone or in combination with mifepristone, is an important, necessary treatment to end a pregnancy. These medications are used to terminate pregnancies that are wanted and unwanted and to induce labor. Misoprostol is also a lifesaving intervention for postpartum hemorrhage.

Mifepristone and misoprostol are growing in use as abortion clinics, where surgical abortions can happen, continue to be legislated out of existence. That is despite the fact that surgical abortion is less painful, causes less bleeding and fewer side effects, and requires a shorter recovery time than medical abortion. Surgical abortion is also more effective; a small percentage of people who use medical abortion still require surgical follow up. But with TRAP laws, state-by-state access issues, and poor messaging about pain, most people who need to terminate a pregnancy, or complete a miscarriage or stillbirth, don’t know this.

Like Gluesenkamp Perez, I didn’t know any of this until confronted directly with miscarriage. And this is the story for most people who have any type of pregnancy loss, from miscarriage and stillbirth to ectopic pregnancy, elective abortion, and medical termination for fetal anomaly. These conditions are all treated with the same medicine and cause the same pain, yet patients are typically unaware of how long it will take, how much it will hurt, and how long they will bleed afterwards. Most of the people I spoke to were not warned at all. Nor were they effectively treated for pain. The practice bulletin for the American College of Obstetricians and Gynecologists only advises alternating acetaminophen and ibuprofen.

I had physiologic births at birth centers, attended by midwives, for both of my children. This means I used no pain medication during labor, though we certainly tried a few pain interventions, including electronic stimulation, warm showers, and bouncing on an exercise ball. Which is to say: I understand the ways in which, for some people, in some situations, pain can be productive. My second child got stuck during the push phase, and the pain I experienced made it possible for me to explain to my midwife that something was wrong. She discovered that the baby’s shoulder was stuck behind my pubic bone, did an expert move to dislodge my child, and my baby girl came right out.

But what is productive about pain when you are not in labor to birth a living child? What is useful about square waves of pain? Why subject people suffering through any kind of pregnancy termination to a pain so bad you cannot hide it from the other children under your care? Those who suffer this pain are not attended by a midwife, about to welcome a new baby into their lives. They are often alone, at home, with no other adults and certainly no health providers, having to reckon with the grief of loss alongside this incredible suffering.

The suffering does not end there. From period pain to IUD insertion pain and more, those of us with uteruses are asked to endure, and endure, and endure. While I appreciate that Rep. Gluesenkamp Perez got language added to a House spending bill (that was otherwise terrible) to ask that the NIH study “pain management strategies for miscarriage,” I’m pretty sure we already know what will work. Pain management has been extensively researched and pharmaceutical options abound. The question is, will healthcare providers help their patients anticipate this pain, prescribe the necessary medication, and offer follow-up support? For most of the people I spoke to, what was most distressing was the surprise of the pain, and therefore their inability to prepare for it.

It’s time to take uterine pain seriously and stop treating us with the equivalent of biting on a stick.

Kate Clancy is a Professor of Anthropology at the University of Illinois Urbana Champaign. A scholar both of feminist science and feminist science and technology studies, her work encompasses sexual harassment, environmental stressors, and reproductive health. Clancy was named to the Nature 10 in 2013 and has won several awards for her publicly engaged research. She has testified before Congress, consulted on two House bills, and served on multiple expert consensus committees as well as the NASEM Action Collaborative to Address Sexual Harassment.