I never thought I’d say this, but I’m lucky I miscarried in Thailand.

While living abroad in Chiang Mai last year, I started to experience vaginal spotting six weeks into my wanted pregnancy, which translates into a diagnosis of threatened miscarriage when it occurs before 20 weeks of gestation.

Two weeks later, on the morning of New Year’s Eve, the threat became more real. I woke up feeling weak and lightheaded, and when I went to the bathroom, I realized with much horror the toilet was full of blood. Panicked, I flushed it.

That’s a common reaction, said Dr. Lora Shahine, a Seattle-based reproductive endocrinologist and OB-GYN.

“In a state of confusion, a person might act reflexively—flushing the toilet,” she said.

After waiting hours in the emergency room of a Koh Tao Island hospital, a sonogram confirmed the baby was stable and had cardiac activity. The physician put me on bed rest for a week. After the ER visit, I was spotting less frequently. I went a week without any bleeding, and I was hopeful the threat of miscarriage had lessened.

But then in early January, a week before I was due to take a flight to the United States, the spotting returned more frequently than before. I went to my OB-GYN in Chiang Mai for a sonogram. I was concerned about the pregnancy and wanted to ensure everything was stable before traveling back home to a country that’s increasingly dangerous for pregnant people.

My worst fear was realized as the doctor told me he couldn’t find a fetal heartbeat. I was more than ten weeks pregnant, but the fetus had stopped growing at around eight weeks. I had a missed miscarriage, meaning a pregnancy loss without the expelling of fetal tissue. The fetus had died soon after the blood loss I experienced a few weeks before.

My doctor told me I could have a medication abortion—which would involve taking mifepristone and misoprostol—for around 15 U.S. dollars (and bring the fetus in for pathology to rule out placenta cancer or molar pregnancy), or have a dilation and curettage (D&C). Abortion within 20 weeks’ gestation has been legal in Thailand since 2022.

Bringing the remains of the fetus to the hospital was unfathomable, so I opted for a D&C the following day, which cost US$777. I didn’t have to endure a parking lot full of protesters harassing folks entering that facility, as I might have in some parts of the U.S. I’m grateful my choice to have a D&C was never questioned or discouraged by medical staff.

Five days later, I flew to the U.S. As I was processing my devastating pregnancy loss, I was overwhelmed with the realization of how fortunate it was to have miscarried in Thailand and not in the States.

American society still considers miscarriage to be taboo, despite it being a natural and common occurrence that ends 10 to 20 percent of pregnancies. We aren’t taught what to do if we miscarry at home—and given my missed miscarriage, I might have passed the fetus during my visit to the U.S. In that case, I could have found myself in legal trouble for absentmindedly flushing the toilet afterward.

“Flushing the toilet may not register as a conscious decision,” Dr. Barbara Sparacino, a psychologist who treated patients in acute psychological crisis for over a decade, said. “Pregnancy loss can trigger acute grief, shock, and dissociation—states in which executive functioning, decision-making, and logical thought are significantly impaired.”

Because the aftermath of a miscarriage and an at-home abortion are medically indistinguishable, some Americans in states with abortion bans are now getting arrested following miscarriages. There’s an ongoing conservative battle to establish fetal “personhood” in many states with anti-abortion legislation.

Earlier this year, 24-year-old Selena Maria Chandler-Scott was arrested in Georgia for having a miscarriage and putting the deceased fetus in the trash. Police charged her with concealing the death of a person and abandoning a dead body. The charges have since been dropped after an autopsy determined the fetus was nonviable.

In 2023, Brittany Watts was arrested in Ohio for a fifth-degree felony charge of “abuse of a corpse” after a miscarriage at home. She had gone to the hospital at 22 weeks because her water broke—a dangerous complication that normally requires in-patient observation for up to a week—but was effectively denied care and went home, according to a lawsuit Watts later filed against the hospital.

“When people worry about being arrested or investigated, they may delay or avoid necessary treatment, which can lead to life-threatening complications like sepsis or hemorrhage,” Shahine said.

Watts returned to the hospital the following day, and was allegedly denied treatment for ten more hours, before leaving again. Two days later, she miscarried in the toilet and was bleeding, so she went back to the hospital. The police determined that she’d “given birth at home to a live baby and caused it to die,” according to the lawsuit. Ultimately, a grand jury declined to indict Watts.

“Expecting someone experiencing miscarriage to research proper disposal practices is deeply unrealistic,” Sparacino said. “Criminalizing this action disregards shock and assigns intent where there often is none.”

South Carolina college student Amari Marsh also miscarried at home in a toilet in 2023 and went to the hospital. Three months after the pregnancy loss, she was charged with murder and homicide by child abuse. She spent 22 days in jail and then was under house arrest for 13 months until a grand jury cleared her.

“Pregnant individuals are living with the added burden of surveillance and fear,” Sparacino said. “Miscarriage is already a profound loss. When someone is investigated, questioned, or arrested afterwards, it can lead to long-term mental health consequences.”

On a 13-hour flight from the U.S. to South Korea in route back to Thailand, I had a medical emergency on board. I was fortunate that an ER doctor, trauma nurse, and travel nurse onboard took care of me. I don’t know if my health crisis was related to the pregnancy loss, but I disclosed my miscarriage and D&C to them just in case.

As I continued to faint repeatedly, the pilot wanted to make an emergency landing in Alaska. I refused. The flight had no WiFi, and I wasn’t up-to-date on abortion legislation in the northernmost U.S. state. Without more information on Alaskan politics, I didn’t feel safe taking the risk of needing emergency medical care there.

I couldn’t risk my miscarriage being criminalized in the United States. And I am lucky that, in Thailand, it was not.