In late October 2012, a 31-year-old woman visited a hospital in Galway, Ireland, for the second time that day, complaining of terrible pain. The medical staff informed her she was miscarrying her pregnancy at 17 weeks. Their plan was to attend for her body to expel the fetus naturally.
The next day, the still-hospitalized woman asked about getting an abortion but was told that under Irish law she couldn’t terminate the pregnancy until a fetal heartbeat could not be detected in her womb. She and her husband continued to attend until her teeth began chattering — she was cold. A couple of hours later, she began vomiting. Over six hours then passed before the lady was diagnosed with sepsis and permitted a medicine abortion, but the medication was never delivered because she went into “spontaneous delivery,” in response to a subsequent investigation.
She was moved to an operating room. Then a high-dependency unit. Then an intensive care unit. Several days later, she went into cardiac arrest and died.
The death of Savita Halappanavar helped mobilize the movement against Ireland’s strict anti-abortion rules, which voters discarded in 2018. Now that the U.S. Supreme Court has decided against nationwide abortion access, reproductive rights advocates worry about Americans whose pregnancies may similarly put their lives in danger.
Like Ireland used to, several U.S. states with strict anti-abortion laws have carved out exceptions to preserve the lifetime of the mother, but these “mainly serve to make a draconian policy seem barely less cruel,” in response to the Guttmacher Institute, a research institute that advocates for reproductive rights. One OB-GYN wrote a Latest York Times opinion article calling such exceptions “medically illiterate.”
They may be present in states like Missouri, Kentucky, South Dakota, Louisiana and Texas, amongst others, although some have been affected by ongoing litigation and a few won’t go into effect for just a few more days.
In practice, medical decisions involve weighing risk and potential outcomes, including death. If a pregnant patient receives a cancer diagnosis, for instance, the patient may need to finish the pregnancy in an effort to start treatment on the earliest possible point, which could have an enormous effect on their lifespan. There are many other situations by which a pregnant patient might not be in imminent danger but is developing a dangerous condition.
At what point is the lifetime of the mother endangered enough to perform an abortion? What level of risk is appropriate or unacceptable? Is mental health an element? Who gets to determine?
Dr. Lisa Harris, a researcher and professor of obstetrics and gynecology on the University of Michigan, told HuffPost one example she uses for instance the risks is pulmonary hypertension, where “the guts and lungs really just can’t proceed to work properly and meet the demands of pregnancy,” potentially resulting in heart failure.
“We are likely to cite a 30 to 50% likelihood of dying for individuals who proceed the pregnancy,” Harris said.
“They could actually be OK within the early parts of the pregnancy. But there’s really profound changes that occur in the way in which the guts and lungs work and the way in which that the fluids within the body work after delivery,” she went on. “In order that they may have the option to truly deliver a baby, but in those moments right after birth, there’s so many shifts within the fluid and all of the blood flow that was going to a placenta and a baby that now’s in the lady’s own body and that may produce heart failure and an inability to oxygenate the body.”
“It’s not 100%. Some women will survive,” Harris said, adding: “Is that a high enough percent likelihood of dying that a girl could request an abortion?”
Declaring that America already has a high maternal mortality rate, Dr. Iffath Hoskins, president of the American College of Obstetricians and Gynecologists (ACOG), said in a news conference last week that abortion bans with narrow exceptions will only increase that statistic. By how much is difficult to say; if the U.S. enacted a complete abortion ban, the country’s maternal mortality rate would increase by 21%, in response to researcher Amanda Stevenson.
A pregnant person could also be barely more prone to die based on where that person lives, as some areas are higher equipped to handle pregnancy than others. The patient’s race also aspects in: Black women die in pregnancy and childbirth at much higher rates than white women.
Compounding matters, the exceptions to strict anti-abortion laws are likely to be written in vague terms; lawmakers have refused to define key phrases reminiscent of “medical emergency” or “substantial risk of death” in some states, leaving it as much as a physician’s “good faith” judgment on when a patient crosses the road into needing an abortion.
Abortion, in any case, is usually an especially secure path.
Medical and legal experts worry doctors usually are not prepared for the upcoming confusion wrought by laws various widely among the many states. Confusion can mean delay, and delay can mean death or significant injury.
“It’s an actual patchwork on the market, and that patchwork itself is a danger to people as they seek essential reproductive health care. If a physician can’t tell what the law is on the time they’re trying to supply the care, it has a very chilling effect on the medical care provided,” ACOG lawyer Megan Meegan said last week.
For doctors ― largely a risk-averse group ― the implications of creating the flawed decision range from disciplinary measures by their employer to losing their license, facing lawsuits and even criminal penalties, which usually are not covered by malpractice insurance.
Doctors may have different skilled opinions, leaving open the chance for state prosecutors to argue that an abortion was not warranted because not all consulting physicians agreed the patient’s life was sufficiently in danger.
“It’s an actual patchwork on the market, and that patchwork itself is a danger to people as they seek essential reproductive health care. If a physician can’t tell what the law is on the time they’re trying to supply the care, it has a very chilling effect on the medical care provided”
– Megan Meegan, lawyer for the American College of Obstetricians and Gynecologists
“It’s just one other feature of medication. Doctors at all times disagree, right?” Harris said.
In some places, like Missouri, the onus of justifying an abortion is on the medical providers themselves, shifting the burden of proof from state prosecutors to the shoulders of already overburdened health care employees.
Because of this of those harsh recent restrictions, for some who’re pregnant, whether or not they will get an abortion will likely be decided by hospital attorneys.
It already happens. Dr. Lori Freedman, a reproductive science professor on the University of California, San Francisco, told HuffPost that many hospitals have restrictions on abortion in place which can be “more narrow than the law.”
“After which they’ve certain authorities they need to run their case by,” reminiscent of a hospital lawyer and a hospital chairperson, she said.
Dr. Jen Gunter, who wrote the Times editorial, recalled the absurd situation she found herself in while treating a girl in her first trimester who was susceptible to kidney failure. Saving the lady’s kidneys “would prevent a cascade of medical events that might end her life prematurely in the long run,” Gunter wrote. Under Kansas law, nevertheless, she was uncertain whether the lady’s life was endangered enough for an abortion to be legal, so she called the hospital’s attorneys, who also didn’t know. The attorneys set her up on a call with the legislator who created the state’s abortion policy and who quickly told her to go ahead with whatever plan of action she thought was best.
The situation could have easily gone in another way, Gunter said.
ACOG’s CEO, Dr. Maureen G. Phipps, voiced concern about such scenarios last week, saying that such narrow exceptions “allow state legislators to inform physicians what care they will and might’t provide to their patients.”
Abortion restrictions usually are not recent for religiously affiliated hospitals ― arguably to the detriment of quality health look after pregnant patients. Religious facilities commonly have ethics committees guided by theology that determine whether an abortion could also be warranted to avoid wasting the patient’s life, Freedman said.
But with more states adopting extreme bans inside their borders, patients have fewer options. If a Catholic hospital refused to terminate a pregnancy since the patient’s life was not sufficiently endangered, the patient who could previously transfer to a special hospital to finish their pregnancy not has that alternative when every facility within the state can only provide an abortion under the identical narrow circumstances.
Plus, Harris told HuffPost that she has heard “countless stories” about religiously affiliated hospitals which have strict rules against ending pregnancies unless it’s an emergency. People susceptible to infection because of ruptured membranes could have to attend until the infection arises.
“So despite the fact that it will be predictable that over time someone’s end result could be worse, health care teams wait for the person to worsen slightly than treat them early,” she said.
“There must be space for girls’s values and preferences,” Harris argued,
“and to be part of those decisions together with their family members.”
