A new Louisiana law coming online in October reclassifies lifesaving drugs Misoprostol and Mifepristone as Schedule IV “controlled dangerous substances.” The drugs, which are used to treat postpartum hemorrhaging, will now be pulled from emergency response carts and require a prescription. Nurses, medical associations and the FDA do not describe the drugs as dangerous. In fact, the American Medical Association describes them as “incredibly safe” and “effective,” but conservative politicians argue they pose a threat to unborn fetuses as potential abortifacients. The law is the latest move by anti-abortion advocates trying to restrict access to abortion medications in states with abortion bans. So far, Louisiana is the only state that has reclassified the medicine as a schedule IV drug.
The new law imposes criminal prison penalties for some people in possession of Misoprostol or Mifepristone without a valid prescription, prompting more than 250 OB-GYNs and other physicians across Louisiana to sign a letter to the bill's sponsor, state Sen. Thomas Pressly, warning the restriction could threaten women's health by delaying lifesaving care. Pressly claims he penned the law because his sister’s husband attempted to slip his sister an abortifacient against her will.
The incoming law, which demands “controlled dangerous substances” be stored in a secure location, has prompted some hospitals to preemptively pull misoprostol from their obstetric hemorrhage carts and kits. Doctor will soon have to write a prescription and the patient will have to wait for the prescription to be filled in the middle of a hemorrhage. One source told reporters this process can take up to 45 minutes in a rural hospital because doctors sometimes must call a remote pharmacy and leave a voicemail, reducing the application of vital medicine to nail-biting, life-altering phone tag.
Working without the benefit of these lifesaving medications is already a reality for Louisiana midwives, however.
“We only have access to Methergine,” says Rebecca Honeycutt, a midwife who works in Louisiana’s northern territory. “I’m originally from Arizona, and (Misoprostol) is common there. I was a little shocked that this drug is not acceptable in Louisiana.”
For Honeycutt the first line of defense against deadly bleeding is Pitocin, otherwise known as oxytocin, which is also used to induce labor. Then comes Methergine, which Honeycutt describes as “pretty effective.” However, in Arizona, when Methergine fails, Cytotec (misoprostol) is frequently the fallback against postpartum hemorrhage.
“You have to get more aggressive when the least aggressive things are not working.
A problem with Methergine, according to studies, is its increased side effects, including pain or tightness in the chest, neck, back and arms, or pain, tingling, and numbness in the hands or feet, as well as seizures and sometimes stroke.
The biggest fear for Honeycutt, however, is the removal of yet another crucial tool from an essential healthcare toolbox.
“It’s concerning for someone like me working in a rural area. I go through the steps: I use the Pitocin, do a certain amount of doses, and use the Methergine. But if the uterus still doesn’t contract, the only option I have is very invasive,” said Honeycutt. “I administer bimanual compression. That’s when I stick my hand inside the woman’s vagina and my other hand on top of her uterus and I clamp the uterus until (emergency medical services) arrive and transport her (to a hospital).”
“Some of my patients are an hour away from a hospital,” she added. The procedure itself, she said, can be “very painful.”
Additionally, blood does not come cheap, especially for those who are uninsured. A 2023 analysis found the average cost for hospitals to purchase one unit of red blood cells was about $200. Hospitals then turned around and charged consumers a median price of $634 per unit. The median price for a blood transfusion procedure was a whopping $2,388, depending on the type of hospital and the patient’s insurance.
A birthing woman bleeds literally and figuratively—that is, financially. Misoprostol and Milfepristone stop more than one kind of hemorrhage.
Critics also question Louisiana lawmakers’ anti-abortion ploy for its futility. Despite the impending clampdown, Misoprostol is still available through mail order. Since the U.S. Supreme Court overturned Roe v. Wade in 2022, several states have enacted abortion shield laws that protect telehealth transactions when providers inside safe states prescribe abortion pills to patients in anti-abortion states.
This means a registered doctor or nurse in Louisiana must now go through the process of getting clearance for Misoprostol and Milfepristone, while Sen. Pressly’s brother-in-law can easily lay hands on the same drug from out of state and allegedly slip it to another victim.
The Harris presidential campaign is eager to use the law as a cudgel to beat Trump in the voting booth in November, blaming the former president for appointing judges who enabled the situation in Louisiana.
“Let’s be clear: Donald Trump is the reason Louisiana women who are suffering from miscarriages or bleeding out after birth can no longer receive the critical care they would have received before Trump overturned Roe,” Harris-Walz spokeswoman Sarafina Chitika said in a statement to the Illuminator. “Because of Trump, doctors are scrambling to find solutions to save their patients and are left at the whims of politicians who think they know better.”
Harris predicts Trump will continue his anti-abortion crusade to the detriment of women’s health if he wins in November.
Honeycutt said she empathized with doctors and nurses preparing to lose “an extra layer of security” during childbirth and advised medical workers to be more vigilant about politics.
“Be aware of what’s going on at the legislative level,” she told BGX. “Be an active participate and vote.”
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