Abortion laws cause profound changes in other medical care

A sexual assault survivor chooses sterilization so that if she’s 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 serious pregnancy complications appears “sick enough.” A lupus patient should stop taking her medication that controls her disease because it can also cause miscarriages.

Restrictions on abortion in various 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 health care.

“For clinicians and patients alike, this is a scary and tense 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 medical emergencies, doctors sometimes refuse immediate treatment. Last week, an Ohio abortion clinic received calls from two women with ectopic pregnancies, when an embryo grows outside the uterus and cannot be saved, who said their doctors would not treat them. Ectopic pregnancies often become life-threatening emergencies and abortion clinics are not equipped to treat them.

It’s just one example of “the horrible aftereffects of criminalizing abortion care,” said Dr. Catherine Romanos, who works at the Dayton clinic.

MEDICAL DILEMMAS

Dr. Jessian Munoz, an obstetrician and gynecologist 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 have to evacuate the uterus by any means,” she 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With the fall of Roe v. Wade, “the art of medicine is lost and has actually been replaced by fear,” Muñoz said.

Munoz said he faced a dire situation with a recent patient who had started miscarrying 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 saw her physically getting sicker and sicker” until the fetal heartbeat stopped the next day, “and then we were able to intervene,” he said. 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 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 women less than 23 weeks pregnant who were treated for unsafe pregnancies. Doctors noted that all of the women had been advised to delay abortion for nine days because fetal heart activity was detected. Of those, nearly 60% developed serious 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 serious complications including bleeding in the brain, a heart defect, lung disease, and intestinal and liver problems.

Before overturning Roe v. Wade, the Supreme Court never allowed states to ban abortion before the point a fetus can survive outside the womb, about 24 weeks.

Chicago diversity executive Sheena Gray survived a harrowing abortion 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 that they needed to abort the other fetus to save her life.

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

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

“No one should be making these decisions for a woman, period,” he said.

Her story has a much happier ending: Gray became pregnant again and gave birth to healthy identical twin girls on July 8.

CHOOSE STERILITY

Julie Ann Nitsch, a sexual assault survivor and administrator at a community college in Austin, Texas, is among many women in states with restrictive abortion laws who are clamping down.

Nitsch says she chose sterilization at age 36 rather than risk becoming pregnant by another rapist.

“I ripped out my organs” to prevent that, he said.

Nitsch said she “saw the writing on the wall” after Texas enacted a law last year that bans most abortions after six weeks, even in cases of rape or incest. She said that she felt that Roe v. Wade would be overturned, so she underwent 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,” Nitsch said.

Dr. Tyler Handcock, an Austin OB/GYN, said his clinic has heard from hundreds of patients seeking sterilization since the June 24 Supreme Court decision. Many choose this route because they fear long-acting or other contraceptives may also become targets, he said.

His clinic scheduled a group counseling session for July 9 to handle the surge, and each of the 20 patients who showed up to hear about the risks and ramifications of having their fallopian tubes removed made an appointment to undergo Surgery.

Some doctors are reluctant to perform the surgery on young women who have many reproductive years left, fearing that they will change their minds later. Handcock said she heard from a 28-year-old woman who said six OB/GYNs refused to sterilize her.

Handcock said the choice should be up to the patients.

“I will protect my patients and their rights however I can,” he said.

TARGETED MEDICATION

Becky Schwarz, of Tysons Corner, Virginia, has found herself unexpectedly embroiled in the abortion controversy even though she has no plans to get pregnant.

The 27-year-old has lupus, an autoimmune disease that can cause the body to attack the tissue around the 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 that she should stop taking a medication that relieved her symptoms, at least while the office reviews its policies for methotrexate 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.

“For me, having to be essentially taken care of by some policy, rather than being trusted with how I handle my own body…has 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 how widespread the problem is. Patients who have problems obtaining medication can contact the group’s helpline.he said.

CONFUSED LAWS

Many abortion laws are vague and vary by state.. That can leave doctors in a dilemma.

“We’ve asked some legislators, ‘How are medical providers supposed to interpret the law?’” said Dr. Dana Stone, who lives in Oklahoma, a state that recently banned nearly all abortions.

“They say, ‘They’ll figure it out,’” he said.

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Associated Press medical writers Carla K. Johnson and Laura Ungar contributed to this report.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The Associated Press is solely responsible for all content.

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