OPEN UP, DOCTOR, IT'S THE MISCARRIAGE POLICE
America's exciting new landscape of post-Roe abortion bans is already resulting in hospitals and pharmacies withholding care to women experiencing miscarriages because providers worry they'll run afoul of the new laws, according to media reports all over the country. The New York Times (gift link) reports on several such cases, including a woman in the Dallas-Fort Worth area who had a miscarriage last year in her first trimester and received excellent, compassionate care that included removal of the tissue from her uterus. But after Texas passed its bounty-hunter ban on abortions last fall, she had a very different experience:
[In] January, Amanda, who asked to be identified by her first name to protect her privacy, experienced another first-trimester miscarriage. She said she went to the same hospital, Baylor Scott & White Medical Center, doubled over in pain and screaming as she passed a large blood clot.
But when she requested the same surgical evacuation procedure, called dilation and curettage, or D&C, she said the hospital told her no. [...]
Amanda said the hospital didn’t mention the abortion law, but sent her home with instructions to return only if she was bleeding so excessively that her blood filled a diaper more than once an hour.
Tests at the hospital showed the fetus no longer had any cardiac activity, which had also been the case when Amanda had had an ultrasound the week prior. But sorry, nobody wants to get sued — although of course no one said that openly. Her case notes, the Times says, noted that "This appears to be miscarriage in process," and recorded that Amanda was experiencing considerable pain and distress, but she was sent home and told she should make a follow-up appointment in a week.
Once home, Amanda said, she sat on the toilet digging “fingernail marks in my wall” from the pain. She then moved to the bathtub, where her husband held her hand as they both cried. “The bathtub water is just dark red,” Amanda recalled. “For 48 hours, it was like a constant heavy bleed and big clots.”
Then again, the Bible says "In sorrow thou shalt bring forth children," so this is probably just a return to how God wants things, at least for those who passed these laws.
The Texas Tribune reports that the situation in Texas hospitals is so confusing that the Texas Medical Association has asked regulators at the Texas Medical Board to take action to make sure pregnant patients experiencing complications get the care they need. In a letter to the board, the TMA said last week that
they have received complaints that hospital administrators and their legal teams are stopping doctors from providing medically appropriate care to patients with some pregnancy complications. They ask the board to “swiftly act to prevent any wrongful intrusion into the practice of medicine.”
The letter didn't specify the hospitals where these incidents occurred, but they're horrifying.
In Central Texas, a physician was allegedly instructed to not treat an ectopic pregnancy until a rupture occurred, which puts patient health at serious risk, the letter says.
“Delayed or prevented care in this scenario creates a substantial risk for the patient’s future reproductive ability and poses serious risk to the patient’s immediate physical wellbeing,” the letter says.
The TMA letter also accused two other hospitals of telling doctors to turn away pregnant patients and send them home to “expel the fetus” if their water broke too soon, which can put them at risk of infection.
You can also add into the mix the understandable concern providers and hospitals have about the cost of not acting: if delaying care to meet the perceived limits of the law harms a patient, then that's going to result in a malpractice lawsuit. Attorneys may soon become standard parts of all ER and OB-GYN medical teams.
And let's not forget that Texas Attorney General Ken Paxton is suing the federal government for reminding hospitals that under federal law, they do indeed have to provide lifesaving emergency care to pregnant people. Paxton claimed the Biden administration was trying to "use federal law to transform every emergency room in the country into a walk-in abortion clinic." Yes, that's literally from the lawsuit.
Gosh, why on earth could all these doctors and hospitals be having such needless worries about providing lifesaving treatment?
In the Times, John Seago, the president of the anti-abortion group "Texas Right to Life," said with big crocodile tears that abortion bans were most certainly not meant to impede care for miscarriage or other complications of pregnancy, you silly doctors who need to go to prison and lose your licenses if you kill a precious baby. Seago told the Times that
he considers any obstacles miscarriage patients encounter to be “very serious situations.” He blamed such problems on “a breakdown in communication of the law, not the law itself,” adding “I have seen reports of doctors being confused, but that is a failure of our medical associations” to provide clear guidance.
For supposedly being smart people, doctors sure are dumb bunnies, huh? It's all very simple, except when it isn't, which is why in Texas the medical association is asking the state to please offer some damn clarity on when exactly the state plans to treat doctors as lifesaving heroes, and when it'll accuse them of running "walk-in abortion clinics" in the ER.
Both the Times and the Texas Tribune report that pharmacies — sometimes following directives from corporate HQ — have become reluctant in some cases to fill prescriptions used to treat miscarriage, such as mifepristone and misoprostol, which are frequently used to expel miscarried tissues. Problem is, the same meds are used to induce abortions early in pregnancy, and some pharmacies have refused to fill the prescriptions, even when a doctor specifies that it's for treating a miscarriage.
Women are going to die because of these laws and because healthcare providers fear prosecution. Consider two of the cases mentioned in that Texas Medical Association letter, in which doctors were told to send patients home if their water broke early in pregnancy — just tell them to wait until they "expel the fetus" naturally. The Times explains that in cases of "inevitable miscarriage" like that, the fetus still has cardiac activity, but with little or no amniotic fluid in the womb, the pregnancy simply wont be viable.
A study from two Dallas hospitals reported on 28 patients whose water broke or who had other serious complications before 22 weeks’ gestation, and who, because of Texas laws, didn’t receive medical intervention until there was an “immediate threat” to their lives or fetal cardiac activity stopped. On average, the patients waited nine days, and 57 percent ended up with serious infections, bleeding or other medical problems, the report said. Another article, in the New England Journal of Medicine, said similar patients returned with signs of sepsis after doctors or hospitals decided Texas’s abortion law prevented them from intervening earlier.
That nice Mr. Seago (he has a doctorate in bioethics from Loyola but is not an MD), the exasperated Texas Forced Birth fellow who was so sad doctors don't understand that of course they can always provide routine miscarriage treatment, turned on a dime and became Bad Abortion Cop. You see, routine treatment for a patient whose water breaks long before viability is MURDER, because the fetus has that heartbeat. So even if infection sets in and the patient is in pain, that's just too bad.
In such cases, Dr. Seago of Texas Right to Life said abortion bans might require delaying intervention. What he characterized as a doctor saying “‘I want to cause the death of the child today because I believe that they’re going to pass away eventually,’” is prohibited, he said. He acknowledged that such delays could cause medical complications for women but said “severe” complications could legally be treated immediately.
It's all so easy! You simply have to wait until the patient is about to die, and then the narrow "life of the mother" exception kicks in, and perhaps you can provide treatment before the patient dies. Also don't call it an abortion then, please.
Yes, this is where we remind you again that delaying care during a miscarriage killed Savita Halappanavar at a hospital in Ireland in 2014: She was miscarrying a 17-week-old fetus, doctors agreed it couldn't survive, but it still had a heartbeat, so no treatment until the heart stopped. Halappanavar died of sepsis, and surely that could never happen today with guardians of Life like Ken Paxton and John Seago protecting fetuses.
Given politicians' and prosecutors' (ah, but we repeat ourselves) fearmongering and threats, two scenarios seem inevitable. It's only a matter of time until somewhere in a red state, a really zealous prosecutor decides to pursue charges against a doctor, or perhaps a pharmacist, for providing what until last month had been normal emergency care. Wouldn't being the first DA in the country to punish some baby killers be a great qualification to be elected state attorney general?
Somewhere else, a woman will die in agony because she's denied lifesaving care while miscarrying, because what doctor or hospital wants to be the first prosecuted by an overzealous DA?
If you don't mind, we won't be placing any bets on which happens first.
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Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.