By LINDSEY TANNER
A sexual assault survivor chooses sterilization so she won’t be forced to give birth to a rapist’s baby if she’s assaulted again. An obstetrician delays the onset of a miscarriage until a woman with serious pregnancy complications looks “sick enough.” A patient with lupus should stop taking medications that control her disease because they can also cause miscarriages.
Abortion restrictions in a number of states and the Supreme Court’s decision to overturn Roe v. Wade have profound implications for reproductive medicine as well as other areas of medical care.
“For doctors and patients, this is a frightening and difficult time, with unprecedented new concerns about data privacy, access to contraception and even when to start life-saving care,” said Dr. Jack Resneck , president of the American Medical Association.
Even in a medical emergency, doctors sometimes refuse immediate treatment. Last week, an abortion clinic in Ohio received calls from two women with ectopic pregnancies – when an embryo grows outside the uterus and cannot be saved – who said that their doctors would not treat them. Ectopic pregnancies often become life-threatening emergencies and abortion clinics are not equipped to handle them.
This is just one example of the “horrible downstream effects of criminalizing abortion care,” said Dr. Catherine Romanos, who works at the Dayton clinic.
Dr. Jessian Munoz, an OB-GYN in San Antonio, Texas, who treats high-risk pregnancies, said the medical decisions were clear.
“It felt like the mother’s life was in danger, we have to evacuate the womb by any means possible,” 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 warrant an abortion.
With the fall of Roe v. Wade, “the art of medicine is lost and has actually been replaced by fear,” Munoz said.
Munoz said he faced a difficult situation with a recent patient who started having a miscarriage and developed a dangerous infection in the uterus. The fetus still showed signs of a beating heart, 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, had to undergo surgery, lost several liters of blood and had to be put on life support “all because we were basically 24 hours late”.
In a study published this month in the American Journal of Obstetrics and Gynecology, doctors at two Texas hospitals cited the cases of 28 pregnant women younger than 23 weeks who were treated for dangerous pregnancies. Doctors noted that all of the women recommended nine-day delayed abortions because fetal heart activity was detected. Of these, nearly 60% developed serious complications, nearly double the number of complications experienced by patients in other states who underwent immediate therapeutic abortions. Of eight live births among the Texas cases, seven died within hours. The eighth, born at 24 weeks, had serious complications including a brain haemorrhage, heart defect, lung disease, and bowel and liver problems.
Before overturning Roe v. Wade, the Supreme Court has never allowed states to ban abortion before the time when a fetus can survive outside the womb – around 24 weeks.
Chicago diversity officer Sheena Gray survived a harrowing late-pregnancy experience last year, when doctors discovered she had an embryo in a fallopian tube and an eight-week-old fetus in her womb . They removed the embryo along with the affected fallopian tube and told her they had to abort the other fetus to save her life.
The decision to pursue treatment was hers – abortion is still legal in Illinois. In fact, the state offers greater access to abortion than most and has been inundated with patients seeking abortions following the recent Supreme Court ruling.
Gray said she had heard of similar care being denied or delayed in other states and feared the High Court ruling could force other patients to suffer the same fate.
“No one should make those choices for a woman, period,” she said.
Her story has a much happier ending: Gray got pregnant again and gave birth on July 8 to healthy identical twin girls.
Julie Ann Nitsch, a sexual assault survivor and community college administrator in Austin, Texas, is among many women in states with restrictive abortion laws who are taking drastic measures.
Nitsch says she chose sterilization at age 36 rather than risk becoming pregnant by another rapist.
“I ripped out my organs” to avoid this, she says.
Nitsch said she “saw the writing on the wall” after Texas enacted a law last year banning most abortions after six weeks, even in the case of rape or incest. She said she felt Roe v. Wade would be canceled, so she had surgery to remove her fallopian tubes in February.
“It’s sad to think I can’t have kids, but it’s better than having to have kids,” Nitsch said.
Dr. Tyler Handcock, an OB-GYN from Austin, said his clinic has heard from hundreds of patients asking for sterilization since the June 24 Supreme Court ruling. Many choose this path because they fear that long-acting contraceptives or other contraceptives will also become targets, he said.
His clinic scheduled a group counseling session for July 9 to manage the flare-up, and each of the 20 patients who showed up to hear about the risks and ramifications of having their fallopian tubes removed made appointments to undergo the operation.
Some doctors are hesitant to perform the surgery on young women with many years of childbearing left, fearing they might change their minds later. Handcock said he heard from a 28-year-old woman who said six obstetrician-gynecologists refused to sterilize her.
Handcock said the choice should be with the patients.
“I will protect my patients and their rights as best I can,” he said.
Becky Schwarz, of Tysons Corner, Va., has unexpectedly found herself embroiled in abortion controversy, even though she has no plans to get pregnant.
The 27-year-old suffers from lupus, an autoimmune disease that can cause the body to attack the tissues around 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 advice from her doctor saying she should stop taking a drug that relieves her symptoms – at least while the office re-examines its methotrexate policies in light of the Supreme Court ruling. This is because the drug can cause miscarriages and could theoretically be used to attempt to induce an abortion.
“The fact that I basically have to be guarded by a policy, rather than trusting myself with how I handle my own body… made me angry,” she said.
Both 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 group is working to determine the extent of the problem. Patients having difficulty obtaining the drugs can contact the group’s helpline, he said.
Many abortion laws are vague and vary from state to state. This can leave doctors in the lurch.
“We asked some lawmakers, ‘How are health professionals supposed to interpret 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,'” she said.
Associated Press medical writers Carla K. Johnson and Laura Ungar contributed to this report.
The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute Department of Science Education. The AP is solely responsible for all content.