We don't hear too much about it in the news but there is a growing crisis of OB-GYNs. Fewer medical students are choosing to become OB-GYNS. Additionally, OB-GYNS who have been practicing for years are deciding to drop the specialty or drop higher-risk patients. Most of this shift is due to skyrocketing malpractice insurance premiums. OB-GYNs pay higher malpractice insurance premiums than many other doctors. According to USA Today, an OB-GYN can expect to be sued two or three times during their career.
Many OB-GYNs are frustrated and some simply can't afford the specialty anymore. In some places in the United States, a woman might have to drive hundreds of miles just to see an OB-GYN. I live in a densely populated area and I general have never had trouble finding a doctor. However, with my three late miscarriages, I had to have D&E procedures (more complicated than D&C procedures). I was told there were only two doctors in the state who did the procedure.
So what does a lack of OB-GYNs mean for miscarriage in general? First, it may be harder to find a doctor in the first place, especially if you have had a miscarriage or recurrent miscarriages. It's not illegal for doctors to pick and chose which patients they will and will not see. More and more, that's exactly what they’re doing.
While many early miscarriages cannot be prevented, there are miscarriages that may be avoidable with good prenatal care. Some instances of this are if the mother has a blood clotting issue or a chronic disease like diabetes. With fewer OB-GYNS practicing, good prenatal care, which we take for granted in this country, may become more difficult to get.
Finally, if you do have a miscarriage, you may require procedures such as the D&E (or D&C). Even if your miscarriage proceeds naturally, you may need subsequent diagnostic testing to make sure everything completed as it should, If you have a miscarriage you may also need more medical support with a subsequent pregnancy.
While I have heard stories of insensitive and even negligent OB-GYNS most of them are capable. We have learned a great deal about pregnancy and pregnancy loss in the last hundred years or so but there is still much we do not understand. This is especially true of miscarriages. If we fully understood them, we'd be better at preventing them. Unfortunately, we also live in an overly litigious society and we like to have a place to place blame.
The news is not all bad however. There are places in the country where malpractice insurance is lower and OB-GYNS are doing better than their overwhelmed colleagues. Additionally, midwives are experiencing a resurgance in popularity. While they do not attend as much school as doctors, they do receive extensive training.