The Road To Gilead Goes Through Women's Medicine, Con't

One of the immediate effects of the death of Roe v. Wade and Casey v. Planned Parenthood, plus the onslaught of red state abortion bans is that modern OB/GYN medical care for women in those states -- here in Kentucky included -- has now effectively collapsed for millions of women in just a few weeks.

 

A sexual assault survivor chooses sterilization so that if she is ever attacked again, she won’t be forced to give birth to a rapist’s baby. An obstetrician delays inducing a miscarriage until a woman with severe pregnancy complications seems “sick enough.” A lupus patient must stop taking medication that controls her illness because it can also cause miscarriages.

Abortion restrictions in a number of states and the Supreme Court’s decision to overturn Roe v. Wade are having profound repercussions in reproductive medicine as well as in other areas of medical care.

“For physicians and patients alike, this is a frightening and fraught time, with new, unprecedented concerns about data privacy, access to contraception, and even when to begin lifesaving care,’’ said Dr. Jack Resneck, president of the American Medical Association.

Even in medical emergencies, doctors are sometimes declining immediate treatment. In the past week, an Ohio abortion clinic received calls from two women with ectopic pregnancies — when an embryo grows outside the uterus and can’t be saved — who said their doctors wouldn’t treat them. Ectopic pregnancies often become life-threatening emergencies and abortion clinics aren’t set up to treat them.

It's just one example of "the horrible downstream effects of criminalizing abortion care,'' said Dr. Catherine Romanos, who works at the Dayton clinic.

MEDICAL DILEMMAS

Dr. Jessian Munoz, an OB-GYN in San Antonio, Texas, who treats high-risk pregnancies, said medical decisions used to be clear cut.

“It was like, the mom’s life is in danger, we must evacuate the uterus by whatever means that may be,” he said. "Whether it’s surgical or medical — that’s the treatment.’’

Now, he said, doctors whose patients develop pregnancy complications are struggling to determine whether a woman is “sick enough" to justify an abortion.

With the fall of Roe v. Wade, “the art of medicine is lost and actually has been replaced by fear,’’ Munoz said.

Munoz said he faced an awful predicament with a recent patient who had started to miscarry and developed a dangerous womb 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 physically watched her get sicker and sicker and sicker” until the fetal heartbeat stopped the next day, “and then we could intervene,’’ he said. The patient developed complications, required surgery, lost multiple liters of blood and had to be put on a breathing machine “all because we were essentially 24 hours behind.’’

In a study published this month in the American Journal of Obstetrics and Gynecology, doctors at two Texas hospitals cited the cases of 28 women less than 23 weeks pregnant who were treated for dangerous pregnancies. The doctors noted that all of the women had recommended abortions delayed by nine days because fetal heart activity was detected. Of those, nearly 60% developed severe complications — nearly double the number of complications experienced by patients in other states who had immediate therapeutic abortions. Of eight live births among the Texas cases, seven died within hours. The eighth, born at 24 weeks, had severe complications including brain bleeding, a heart defect, lung disease and intestinal and liver problems.

Before it overturned Roe v. Wade, the Supreme Court never allowed states to ban abortion before the point when a fetus can survive outside the womb — roughly 24 weeks.

Chicago diversity executive Sheena Gray survived a harrowing pregnancy-ending experience last year, when doctors discovered she had an embryo in a fallopian tube and an eight-week fetus in her womb. They removed the embryo along with the affected fallopian tube, and told her they needed to abort the other fetus to save her life.

The decision to proceed with treatment was hers — abortion is still legal in Illinois. In fact, the state provides greater access to abortion than most others, and has been flooded with patients seeking abortions following the recent Supreme Court decision.

Gray said she’s heard about similar care being denied or delayed in other states, and fears the high court ruling will force other patients to face the same fate.

“No one should make these choices for a woman, period,” she said.

 

But the Roberts Court and GOP state legislatures have already made that choice for millions.  It will absolutely lead to a skyrocketing of maternal mortality, already a crisis in the US for Black and Latino women, is expected to rise exponentially.

For Black women in the US, the number is 55 per 100,000, a staggering number that matches countries like Maldives or Cape Verde. You're literally more likely to survive childbirth in Mongolia than being a Black woman in this country.

But almost overnight, that has become far, far worse. How bad will these numbers get, with women dying from ectopic pregnancies and more? Who knows?

What I do know is Republicans could not care less.