Abortion laws spark profound changes

NEW YORK >> A sexual assault survivor chooses sterilization so that if she is 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 severe pregnancy complications seems “sick enough.” A lupus patient must stop taking medicine that controls her illness because it also can cause miscarriages.

Abortion restrictions in a number of 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 medical care.

“For physicians and patients alike, this is a frightening and fraught time, with new, unprecedented concerns about data privacy, access to contraception, and even when to begin lifesaving care,” said Dr. Jack Resneck, president of the American Medical Association.

Even in medical emergencies, doctors are sometimes declining immediate treatment. In the past week, an Ohio abortion clinic received calls from two women with ectopic pregnancies — when an embryo grows outside the uterus and can't be saved — who said their doctors wouldn't treat them. Ectopic pregnancies often become lifethreatening emergencies and abortion clinics aren't set up to treat them.

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

Medical dilemmas

Dr. Jessian Muñoz, an

OB-GYN in San Antonio, Texas, who treats high-risk pregnancies, said medical decisions used to be clearcut.

“It was like, the mom's life is in danger, we must evacuate the uterus by whatever means that may be,” he 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 justify an abortion.

With the fall of Roe v. Wade, “The art of medicine is lost and actually has been replaced by fear,” Muñoz said.

Muñoz said he faced an awful predicament with a recent patient who had started to miscarry 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 physically watched her get sicker and sicker and sicker” until the fetal heartbeat stopped the next day, “and then we could intervene,” he said. The patient developed complications, required surgery, lost multiple liters of blood and had to be put on a breathing machine “all because we were essentially 24 hours behind.”

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 dangerous pregnancies. The doctors noted that all of the women had recommended abortions delayed by nine days because fetal heart activity was detected. Of those, nearly 60% developed severe 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 severe complications including brain bleeding, a heart defect, lung disease and intestinal and liver problems.

Chicago diversity executive Sheena Gray survived a harrowing pregnancy-ending experience last year, when doctors discovered she had an embryo in a fallopian tube and an 8-week fetus in her womb. They removed the embryo along with the affected fallopian tube, and told her they needed to abort the other fetus to save her life.

The decision to proceed with treatment was hers — abortion is still legal in Illinois.

Choosing sterility

Julie Ann Nitsch, a sexual assault survivor and community college trustee in Austin, Texas, is among many women in states with restrictive abortion laws who are taking drastic steps.

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

“I ripped my organs out” to avoid that, she said.

Nitsch said she “saw the writing on the wall” after Texas enacted a law last year banning most abortions after six weeks, even in cases of rape or incest. She said she sensed that Roe v. Wade would be overturned, so she had surgery to remove her fallopian tubes in February.