Baltimore Sun

Abortion laws’ repercussi­ons in other med care

Doctors delaying miscarriag­es, some choosing sterilizat­ion

- By Lindsey Tanner

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 medication that controls her illness because it can also 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. Recently, 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 life-threatenin­g emergencie­s and abortion clinics aren’t set up to treat them.

Medical dilemmas

Dr. Jessian Munoz, an OB-GYN 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 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.

Munoz 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 recent study published 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.

Before it overturned

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

Chicago diversity executive Sheena Gray survived a harrowing pregnancye­nding experience last year, when doctors discovered she had an embryo in a fallopian tube and an eightweek 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. In fact, the state provides greater access to abortion than most others, and has been flooded with patients seeking abortions following the recent Supreme Court decision.

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

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

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.

“It’s sad to think that I can’t have kids, 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 high court’s June 24 decision. Many choose this route because they fear long-acting birth control or other contracept­ives could become targets, he said.

His clinic scheduled a group counseling session to handle the surge, and every one of the 20 patients who showed up to hear about the risks and ramificati­ons of fallopian tube-removal made an appointmen­t to have the surgery.

Some physicians are reluctant to perform the surgery on young women with many reproducti­ve years left, fearing they will change their minds later. Handcock said he heard from one 28-yearold woman who said six OB-GYNs declined to sterilize her.

Handcock said the choice should be up to patients.

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

Targeting medication

Becky Schwarz, of Tysons Corner, Virginia, found herself unexpected­ly thrust into the abortion controvers­y even though she has no plans to become pregnant.

The 27-year-old has lupus, an autoimmune disease that can cause the body to attack tissue surroundin­g 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 saying she’d have to stop taking a medication that relieves her symptoms — at least while the office reviewed its policies for methotrexa­te in light of the Supreme Court ruling. That’s because the drug can cause miscarriag­es and could be used in an attempt to induce an abortion.

“For me to have to be essentiall­y babysat by some policy, rather than being trusted about how I handle my own body ... has made me angry,” she said.

The Arthritis Foundation and American College of Rheumatolo­gy have both issued statements of concern about patients’ access to the drug. Steven Schultz of the Arthritis Foundation said the group is working to determine how widespread the problem is. Patients having trouble getting the medication can contact the group’s helpline, he said.

 ?? JULIE ANN NITSCH ?? Julie Ann Nitsch, a sexual assault survivor, is shown in a Texas hospital before surgery to remove her fallopian tubes in February. Nitsch says she chose sterilizat­ion at age 36 rather than risk getting pregnant by another rapist.
JULIE ANN NITSCH Julie Ann Nitsch, a sexual assault survivor, is shown in a Texas hospital before surgery to remove her fallopian tubes in February. Nitsch says she chose sterilizat­ion at age 36 rather than risk getting pregnant by another rapist.

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