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It had barely been 80 minutes since the U.S. Supreme Court overturned it Roe against Wade on Friday, when Dr. Nisha Verma’s phone rang with an urgent group message from another obstetrician-gynecologist that made her catch her breath.
There was a woman in Wisconsin who was carrying a fetus with anencephaly, a fatal birth defect in which parts of the brain and skull are missing. With abortion probably illegal in the state, the clinic had canceled her appointment for a termination later that day. But forcing her to continue the pregnancy was cruel and carried the risk of complications. What should I do? wrote the doctor.
As colleagues in other parts of the Midwest responded with clues to out-of-state clinics, Verma mentally added the case to her growing list of gray area situations where new bans on the abortion fails to capture the complexity of modern medicine and leave doctors in a position. the fence.
“There are so many unanswered questions,” said Verma, an obstetrician / gynecologist in Atlanta, where a six-week abortion ban law that is pending could soon be activated. “The decision is creating confusion and fear because we know what to do medically but we don’t know what we can do according to the law.”
The decision of the high court to return to states the power to regulate abortion means that there are now 50 states with different approaches, each with its own unique language and interpretation of where to draw the line between when the procedure is appropriate and when it is a crime. .
Graph: Abortion is now banned in these states. The others will follow.
The American College of Obstetricians and Gynecologists has joined numerous other professional organizations and medical journals in recent days to warn that the ruling will affect health care beyond abortion, creating new risks for patients and increasing potentially maternal mortality. Doctors have expressed concern about the impact in situations such as miscarriage and in vitro fertilization. The practice of medicine will be reshaped, the group said, or even contradicted “by laws not based on science or based on evidence.”
Even obstetricians and gynecologists who are anti-abortion recognize the medical nuances.
Providers of abortion from Georgia to California express how they feel about the Supreme Court’s decision to quash Roe v. Wade. (Video: Whitney Shefte, Whitney Leaming / The Washington Post, Photo: Eric Lee for The Washington Post / The Washington Post)
Christina Francis, a doctor in Indiana and a board member of the American Association of Pro-Life Obstetricians and Gynecologists, said in an interview that “sometimes there are clinical situations that are unclear” about whether to terminate a pregnancy. . But Francis said that in his career working in Catholic hospitals banning elective abortion, he always felt he could intervene by removing the tissue from the pregnancy when it was medically necessary, as in ectopic pregnancies when the embryo is implanted. out of the womb and cannot survive.
“There will be an educational process,” Francis said, explaining that many doctors have been trained to prioritize the mother in a pregnancy, but now they will have to consider two lives: that of the mother and that of the fetus alike. “I’ve never felt like my hands were tied to taking care of my patients with excellent health care.”
6 conclusions of the Supreme Court opinion that ended Roe v. Wade
Three states, Kentucky, Louisiana and South Dakota, banned the proceedings immediately following the Supreme Court decision. (Louisiana law was blocked by a state court three days later, with a hearing set for next month.) Ten have enacting laws that have already gone into effect or will go into effect in the coming weeks. About a dozen more haveRoe prohibitions or restrictions that could be activated quickly, or conservative-leaning legislatures that have been debating them. In Wisconsin, the 1849 abortion ban is part of state law, and while the Democratic attorney general has said he would not enforce it, clinics suspended services Friday. This means that abortion may cease to be an option in the near future in half the country.
Verma, an ACOG fellow who is in a post-Roe A working group organized by groups of doctors in Georgia said there had been alarm in their discussions that even routine treatments or procedures such as administering anesthesia or chemotherapy to pregnant patients could put doctors at risk of being processed due to the possibility of injury to the fetus. He asked, “Will surgeons be afraid to intervene when a pregnant patient breaks the appendix because she could end the pregnancy unintentionally?”
“We’re treating this as a response to a disaster,” Verma said. “We’re in an emergency and that’s a disaster.”
Even before the agitation created by the overturning of Roe, obstetrics and gynecology was considered one of the most challenging specialties in medicine due to high pressure decision making and high risk surgeries. The United States suffers from a shortage of thousands of obstetricians / gynecologists, and many counties do not have a single provider.
The new reproductive landscape could further discourage medical students from following the field in the future and leave all learners with holes in their knowledge due to the new bans. In a study published in Obstetrics and Gynecology, Kavita Vinekar, an assistant clinical professor at the University of California at Los Angeles, and her co-authors found that about half of medical residency would be in states that have or are expected to restrict or ban . abortion; residents would no longer have access to this training even though it is a requirement of the graduate medical accreditation board.
“In our political climate, there is abortion care and obstetric care in different cubes,” Vinekar explained. “But clinically, all areas are very interconnected.”
One week after the leak of a draft decision on Roe v. Wade, The Post spoke with two women about health conditions that could endanger the life of the pregnancy. (Video: Sarah Parnass / The Washington Post)
In the city of McCall, Idaho, about 100 miles outside of Boise, family doctor Caitlin Gustafson does it all, from care for the elderly and emergency trauma to the birth of babies.
The ban on abortion is expected to take effect in about 30 days in its state. Gustafson she said she has read state law more than 100 times, but she still can’t understand what is allowed and what a crime could take her to jail.
“Every time I read it I feel more confused,” he said.
A few weeks ago, a woman’s water broke at the beginning of her pregnancy, long before the fetus was viable. In these situations, doctors often advise women who are at risk for sepsis, a systemic infection, and let them decide how to proceed. Some choose an abortion, while others wait for it, but the longer they wait, the longer the risk of life-threatening complications. Gustafson said he was clear he could give the woman a choice in this case. But what about the next patient in similar circumstances after the ban goes into effect?
With a page and a half, Idaho law is longer than most and includes attempts to define some terms. But Gustafson, who has worked as a doctor for more than 20 years, such phrases as “provided the best opportunity to survive the newborn” have no clear medical definitions and can be interpreted in different ways. The law makes an exception to the prohibition of rape or incest, but people seeking abortion in these circumstances must provide a copy of a report from a law enforcement agency to a physician.
Gustafson worries that the barrier is too high. Few people would be willing to make a report like that, he said, and doctors would they have difficulty assessing its authenticity.
“I personally should consult a lawyer, and that would generate more delay,” he said.
In addition, he explained, many pregnancy-related complications, including infection and preeclampsia, in which blood pressure can rise hastily, involve a gradual decline toward a life-threatening state. It is unclear to what extent a patient must be ill before the state exception that allows abortion to save the mother’s life is initiated and the patient has the right to terminate the pregnancy.
Gustafson said the new law would lead to “a complete disruption of the doctor-patient relationship” with regard to reproductive health care.
He is concerned that lawyers and courts will take years to resolve these issues: “This will not be short-lived. This will continue and will continue.”
Meanwhile, doctors are left in limbo as to what measures they can legally take to protect the lives of their pregnant patients.
In Nashville, Edward Hills, a doctor at Meharry Medical College, a historically black college, predicts that doctors will have to spend more time thinking about “defending ourselves from legal challenges.”
“It will slow things down,” Hills said.
The near-total abortion ban will take effect in Tennessee in a month, but the state’s attorney general has filed a motion to enact the restrictions sooner.
Hills is concerned that in the case of a clear miscarriage because there are no more heartbeats, doctors still want a second person to confirm the ultrasound after the new law goes into effect “in case a miscarriage occurs. vigilante “and accuses a medical provider of performing an abortion incorrectly.
Hills, who finished his medical residency in 1974, the following year Roe against Wade legalized the right to abortion nationwide, said he had seen some “horrible things” with women trying to handle abortion alone. The United States already has one of the highest maternal mortality rates in the developed world, disproportionately affecting poor women and women of color. He cares not only about his risk of death, but also about his ability to bring babies to the …