Doctors fear prosecution for treating dangerous pregnancy

Dr. Nikki Zite explained the situation to her patient: her pregnancy could kill her.

A 37-year-old nine-week-old patient suffered heart damage during her last pregnancy, and this time her chances of heart failure were between 25% and 50%.

With three children in her arms, the patient decided that this was a risk she could not bear. Zayt had an abortion.

This was in 2018. Today, a Tennessee OB/GYN is not convinced that terminating such a pregnancy would be legal.

Like the other 11 states that have already banned abortion after the Supreme Court overturned Roe vs. Wade last month, Tennessee, makes an exception when a pregnant woman’s life is in danger. But that determination often comes down to judgment.

How much risk is enough to justify an abortion? What if a patient develops a dangerous infection such as sepsis? What if their kidneys show signs of failure? How long should we wait to see if the situation improves?

The laws are vague on these matters. In Tennessee, doctors must prove by “predominance of evidence” that an abortion “necessary to prevent the death of a pregnant woman or to prevent a serious risk of significant and irreversible impairment of essential bodily functions.”

Zayt said her hospital in Knoxville now requires at least two doctors to agree to an abortion.

“I fully intend to follow the law, but my interpretation worries me,” she said. “Even if the entire hospital team agrees, I’m not sure the attorney general would agree.”

She recently took an American Board of Obstetrics and Gynecology exam to update her papers, and although she knew the correct answers about medically necessary abortions, it occurred to her that following those standards might now be illegal in her state.

“Until someone is arrested, we won’t know what these laws mean,” Zayt said. “It’s a difficult way to practice medicine.”

Penalties for doctors can be harsh, with fines of up to $100,000 and jail time of up to 15 years — Texas has a maximum sentence of life imprisonment.

In interviews, doctors said that fear of prosecution prevents them from making their medical judgment.

“A health worker, nurse and anesthetist can go to jail if they make the wrong call,” the doctor said. Rebecca Gee, gynecologist who led the Louisiana Department of Health from 2016 to 2020. “I studied at Harvard and Cornell and spent eight years refining my clinical judgment, and now a lawyer with no medical knowledge decides the fate of a patient.”

“We doctors were not trained to wait until she was almost ready to take her last breath,” she said.

Gee predicted that some people who needed abortions would die because doctors would hesitate to do them, and that the victims would be mostly low-income women of color.

These are the patients who are least likely to be able to travel out of state for emergency care. According to the U.S. Centers for Disease Control and Prevention, black, Hispanic, and Native American women are already two to three times more likely to die from pregnancy-related causes than white women, due to pre-existing health disparities and poorer quality of care. .

“The intentions of these politicians were to prevent selective abortions, but what they have done here goes way beyond that,” Gee said. “I believe that women must die to change these simple laws.”

Dr. Valerie Williams, an ob/gyn based in New Orleans, said this month in an affidavit. that the hospital’s lawyer prevented her from using her preferred method, known as dilation and evacuation, to deliver a non-viable fetus in a patient who broke her water at 16 weeks.

“Going back to that hospital room and telling the patient that she would need to be stimulated and expel this fetus was one of the hardest conversations I have ever had,” Williams wrote.

The patient lost almost a liter of blood and “screamed – not from pain, but from emotional trauma,” the affidavit says. “This was the first time in my 15-year career that I was unable to provide the necessary care to a patient. It’s a parody.”

In perhaps the most famous abortion case after Rowe was capsized, a 10-year-old Ohio rape victim traveled to Indiana in late June. to terminate the pregnancy. Ohio’s ban makes no exceptions for cases of rape or pregnant children, though doctors say giving birth at such a young age poses numerous risks to a patient’s life.

Even clear-cut cases got bogged down in the bureaucracy of the new legal landscape.

Dr. Mae Winchester, a maternal and fetal health specialist in Cleveland, said a patient recently went to the hospital at 19 weeks pregnant with a fever, heart palpitations, and white blood cell counts that doubled in 12 hours. signs of sepsis.

Another five weeks passed before the fetus had a chance to survive outside the womb, and Winchester knew the woman needed an abortion to save her life. But the doctor could not continue until she campaigned for a second opinion and received final approval from the hospital’s lawyer.

Even then, the hospital required Winchester to ask the patient if she wanted to hear a heartbeat. The woman was crying while listening to the ultrasound machine.

The study published Recently, the New England Journal of Medicine found widespread differences in how doctors in Texas have interpreted legal exceptions to a law that went into effect last fall that effectively bans abortions after six weeks.

Some doctors said they thought they could terminate the pregnancy if the patient’s water broke before the fetus was viable. Others felt that they would need to wait until the patient developed a life-threatening infection.

“In many cases, treating physicians, believing, based on their own interpretation of the law or their hospital’s interpretation of the law, that they cannot provide early intervention, send patients home only to see them return with signs of sepsis,” the authors note. wrote.

The only patient who managed to have an abortion in one hospital was a woman whose “severe heart disease progressed to the point that she was admitted to the intensive care unit.”

In another case, a woman who had an early water break said her doctor instructed her to fly to another state and told her that if she went into labor on the plane, she should “keep the placenta inside.” [her body]”.

“You will have to deal with a 19-week-old fetus outside your body until you land,” the doctor said, according to the woman.

After Texas law went into effect, some doctors began using a procedure known as a hysterotomy to end dangerous pregnancies. It involves an incision in the uterine wall and is associated with an increased risk of complications compared to dilation and evacuation, the standard of care for abortions after 15 weeks. But it is unlikely that this will be interpreted as a planned abortion.

Unlike other states, Texas law states that doctors are allowed to terminate an ectopic pregnancy, a dangerous condition in which a fertilized egg is implanted outside the uterus. Pregnancy almost never ends in a viable fetus and can lead to rupture of the fallopian tubes if left untreated.

But some doctors in the state are still hesitant to perform any abortions, instead advising patients to travel out of state. Lori Harper, an Austin maternity and fetal health specialist who helped lead the New England Journal study.

She said she was concerned about patients with pulmonary hypertension, which carries a 50 percent risk of maternal death during pregnancy or within six months of childbirth. Since cardiac events can be sudden, there is no way to simply wait and watch for signs of distress.

“My medical opinion is that this is a high risk,” she said. “I don’t know what the law will say.”

While the laws are open to interpretation, Harper said the alternative — a finite list of high-risk conditions that allow abortion — would be worse because it fails to take into account the nuances that inevitably arise in individual cases.

In at least one respect, the laws are clear: several states expressly exclude mental illness and even the possibility of suicide or other self-harm as a valid reason for terminating a pregnancy.