caring doctor For those who are pregnant, they often have to make time-sensitive decisions when their lives are at stake.But with the U.S. Supreme Court Dobbs decision, which Overturned the nation’s abortion rightstime is no longer on their side.
Many states now have strict restrictions in place that don’t necessarily prohibit doctors from enforcing them any Abortions, but let them wait until a “medical emergency” or “life-threatening” event occurs — the meaning of these terms is not clearly defined. These delays can jeopardize patients who are experiencing an incomplete miscarriage (where the miscarriage begins, but some tissue from the pregnancy remains in the uterus) or an ectopic pregnancy (where a fertilized egg implants somewhere other than the uterus). In many cases, termination of the pregnancy is the safest option.But without the comprehensive protection that once provided roedoctors in these states may not be able to provide appropriate care in a timely manner.
Katrina Green, an emergency physician practicing in Tennessee who has seen many of these pregnant women, said, “It’s very ill. Timing is the key to getting them into the operating room, stat. We don’t have time to call Lawyers and find out: Am I going to jail for my job?”
For example, in an incomplete abortion, if the parent’s body cannot remove the remaining tissue on its own, the standard of care can include a process called dilation and curettage (also known as D&C). This is a type of uterine aspiration – a procedure to remove the remaining tissue from the pregnancy. Here, Green says, timing matters. “What we’ve been trained to do — evidence-based, scientific medicine that’s supposed to happen here — is to do D&C up front,” she said. “The longer the product of conception stays in the womb, the greater the chance of infection.”
If the infection becomes very severe, it can lead to sepsis — when bacteria from an infection enter the bloodstream. This may make D&C or other procedures to remove remaining pregnancy tissue more risky. “Surgeons like to have a stable patient on the operating table,” Green added. “When you have pus, the results are worse.”
Or sometimes, in the process of providing urgent care, doctors find information that makes abortion an option in the state. Diagnosing an incomplete miscarriage depends on a variety of factors, said Stacy De-Lin, a physician and associate director of Planned Parenthood in New York. While many patients experience heavy bleeding, some do not—and doctors can then look at hormone levels or an ultrasound to determine if an incomplete miscarriage occurred or if it was unavoidable. One of the problems, however, is that “there may still be a fetal heartbeat when we diagnose this condition,” Dering said.
Several states, including Georgia, South Carolina and Texas, explicitly prohibit abortion after a fetal heartbeat is detected — sometimes in cases of rape or incest, or when a pregnant woman’s life is at risk. If doctors detect a heartbeat in these states, they usually have to wait until the heartbeat disappears or the pregnant woman’s condition deteriorates enough to be considered life-threatening. “What I’ve seen and heard from colleagues across the country is that patients are being told to go home and wait until they’re bleeding or showing signs of infection, such as a fever, which is really dangerous for pregnant people,” the Illinois-based Amy Addante, an obstetrician and gynecologist, said.