One morning in 2012, eight weeks into her pregnancy, Shannon Withycombe woke up bleeding: She was having a miscarriage. In the emergency room, however, no doctor or nurse uttered that word. Instead, she had to wait to read her discharge papers, which read “incomplete abortion.”
Dr. Withycombe, a medical historian at the University of New Mexico, knew the term from her research on 19th-century medical journals; it was doctorspeak for a miscarriage that had not fully exited the uterus. But it was jarring to see it on her own 21st-century medical notes.
“I’ll admit, I was surprised,” she said. “Like most of us, I had been socialized to think that miscarriage and abortion were very different animals.”
Physiologically, miscarriage and medication abortion are near-identical experiences. Both start with a decrease in the hormones that maintain pregnancy, followed by vaginal bleeding, and then the uterus squeezes like a fist to push out the tissues of pregnancy. Both are managed with the same tools and medications, which is why laws that restrict abortion care also affect women who miscarry.
In the 21st-century United States, of course, the distinction matters. Dr. Withycombe’s odd-sounding diagnosis is a relic of a time when the word “abortion” had none of the legal, moral or political connotations that it does today — a time before doctors had medicalized miscarriage and legislators had moralized abortion.
In medical circles during the 1800s, “abortion” was the preferred term for any form of early pregnancy loss, used interchangeably with the more colloquial “miscarriage.” It was often accompanied by a modifier like “spontaneous” (meaning it happened of its own accord), “missed” (tissues were retained in the uterus) or “habitual” (several miscarriages occurred consecutively).
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