An obstetrician delays inducing a miscarriage until a woman with severe pregnancy complications appears “sick enough.” A patient with lupus must stop taking medications that control the autoimmune disease because it can also cause miscarriages. These are just some of the profound effects on reproductive medicine, as well as other areas of care, in some US states now that there are restrictions on abortion after the Supreme Court’s decision to overturning Roe v. Wade. “For doctors and patients, this is a scary and difficult time, with new, unprecedented concerns about data privacy, access to contraception and even when to start lifesaving care,” said Dr. Jack Resneck, president of the American Medical Association. Even in medical emergencies, doctors sometimes refuse immediate treatment. Last week, an Ohio abortion clinic received calls from two women with ectopic pregnancies who said their doctors wouldn’t treat them. In an ectopic pregnancy, a fertilized egg implants and grows outside the main cavity of the uterus, which could endanger both the pregnant woman and the fetus. In these types of pregnancies, the fetus has a very rare chance of survival. They also often become life-threatening emergencies and no abortion clinics have been set up to treat them. The Ohio incidents are part of “the horrific downstream effects of the criminalization of abortion care,” said Dr. Catherine Romanos, who works at the Dayton Clinic.
Medical dilemmas
Dr. Jessian Munoz, an obstetrician-gynecologist (OB-GYN) in San Antonio, Texas, who treats high-risk pregnancies, said the medical decisions were clear. “He was like, ‘Mommy’s life is in danger.’ We have to evacuate the uterus by whatever means that may be,” he scripted. “Whether it’s surgery or medicine—that’s the cure.” Now, he said, doctors whose patients develop pregnancy complications struggle to determine whether someone is “sick enough” to warrant an abortion. With the fall of Roe v. Wade, “the art of medicine has been lost and has actually been replaced by fear,” Munoz said. Protesters walk to city hall in Odessa during a march in support of reproductive rights in Texas on July 9. (Eli Hartman/Odessa American/The Associated Press) Munoz said he faced a dire predicament with a recent patient who had begun to miscarry and had a dangerous uterine infection. The fetus still had signs of a heartbeat, so an immediate abortion — the usual standard of care — would have been illegal under Texas law. “We watched her physically get sicker, sicker and sicker” until the fetus’s heartbeat stopped the next day, “and then we could intervene.” The patient developed complications, required surgery, lost several liters of blood and had to be put on a ventilator “all because we were essentially 24 hours behind schedule,” he said. In a study published this month in the American Journal of Obstetrics and Gynecology, doctors at two Texas hospitals reported cases of 28 women who were less than 23 weeks pregnant and were treated for high-risk pregnancies. The doctors noted that all the women had recommended abortions nine days late because fetal heart activity was detected. Of those, nearly 60 percent developed serious complications—almost double the number of complications experienced by patients in other states that performed immediate therapeutic abortions. Of the eight live births among the Texas cases, seven died within hours. The eighth, born at 24 weeks, had serious complications, including brain bleeding, a heart defect, lung disease and intestinal and liver problems. Before overturning Roe v. Wade, the Supreme Court had never allowed states to ban abortion before the point when a fetus could survive outside the womb — about 24 weeks. Chicago diversity executive Sheena Gray survived a painful miscarriage last year. Doctors discovered she had an embryo in a fallopian tube and an eight-week-old fetus in her uterus. They removed the fetus along with the affected fallopian tube and told her that they had to abort the other fetus to save her life. The decision to go ahead with treatment was hers — abortion is still legal in Illinois. In fact, the state provides more access to abortion than most other states and has been flooded with patients seeking abortions since the Supreme Court ruling. Gray said she has heard of similar care being denied or delayed in other states and fears the high court’s decision will force other patients to face the same fate. “No one should have to make those choices for a woman, period,” she said. Gray’s story has a much happier ending: she gave birth on July 8 to healthy twin girls.
Sterility option
Julie Ann Nitsch, a sexual assault survivor and community college custodian in Austin, Texas, is among many women in states with restrictive abortion laws who are taking drastic measures. Nitsch said she chose to be sterilized at 36 rather than risk getting pregnant in another rape. “I tore up my organs” to avoid it, he said. Nitsch said she “saw the writing on the wall” after Texas passed a law last year banning most abortions after six weeks, even in cases of rape or incest. He said he felt that Roe v. Wade is going to be undone, so she had surgery to remove her fallopian tubes in February. “It’s sad to think that I can’t have children, but it’s better than being forced to have children.” WATCHES | Biden signs executive order to secure certain reproductive rights:
Biden is trying to protect reproductive rights with an executive order
US President Joe Biden signed an executive order to secure certain reproductive rights across the country. It does not legalize abortion, but it does improve access to emergency contraception, legal services and pills that can cause an abortion in the early stages of pregnancy. Dr. Tyler Hadcock, an Austin gynecologist, said his clinic has heard from hundreds of patients seeking sterilization since the Supreme Court’s June 24 ruling. Many choose that route because they fear long-acting birth control or other contraceptives could also become targets, he said. His clinic scheduled a group counseling session on July 9, and every one of the 20 patients who showed up to hear about the risks and consequences of tubal removal made an appointment to have the surgery. Some doctors are reluctant to perform a sterilization procedure on young women of childbearing age for fear that they will change their minds later. Handcock said he heard from a 28-year-old woman who said six OB-GYNs refused to sterilize her. But the choice should be up to patients, he said. “I will protect my patients and their rights as best I can.”
Targeting medication
Becky Schwarz of Tysons Corner, Va., found herself unexpectedly embroiled in the abortion controversy, even though she doesn’t plan to get pregnant. The 27-year-old has lupus, which can cause the body to attack the tissues surrounding joints and organs, leading to inflammation and often debilitating symptoms. For Schwarz, these include bone and joint pain and difficulty standing for long periods of time. She recently received a notice from her doctor saying she would have to stop taking a drug that relieves her symptoms — at least while the office reviews its methotrexate policies in light of the Supreme Court ruling. This is because the drug can cause miscarriages and could theoretically be used in an attempt to induce an abortion. WATCHES | There is a renewed focus on abortion pills after Roe v. Wade:
Renewed focus on abortion pills after US Supreme Court ruling
Kate Kelly, with the advocacy group Shout Your Abortion, says many groups in the US are working to educate people about the availability of abortion drugs after Roe v. Wade. “To basically have to be taken care of by some policy, instead of being trusted with how I handle my body … has made me angry,” Schwarz said. The Arthritis Foundation and the American College of Rheumatology have issued statements of concern about patient access to the drug. Steven Schultz of the Arthritis Foundation said the team is working to determine how widespread the problem is. Patients who have trouble getting the drug can contact the group’s helpline, he said.
Confused laws
Many abortion laws are vague and vary by state. This can leave doctors in a quandary. “We asked some lawmakers, ‘How are medical providers supposed to interpret the laws?’ said Dr. Dana Stone, who is based in Oklahoma, a state that recently banned nearly all abortions. “They say, ‘They’ll figure it out.’
