When stressors make pregnancy a death sentence

Sarah showed up at the clinic flushed and out of breath. It wasn’t her chronic heart failure or her failing kidneys. Nor was it her weight or high blood pressure. It wasn’t the progressive blindness in her right eye that’s been worsening for the past two years due to diabetes. No, it was her eight-week pregnancy.

“My doctor told me this pregnancy could kill me,” she said.

This is how a local obstetrician-gynecologist, Dr. Brian, came to know Sarah. Already a mother of two, she works two jobs as a line cook to provide for her family. She was referred by another clinic that was uncomfortable handling her case given her numerous comorbidities. These diseases put her at a higher risk of complication from any medical procedure, and the bodily stresses of pregnancy do, in fact, threaten her life. Although she is stable today, her heart is currently putting out only 35% of its maximum capacity. Pregnancy increases stress on the heart in even the healthiest of women. She will not likely carry this pregnancy to term, and by her third trimester — if she can live that long — she will be in serious trouble. An abortion now may save her life.

Texas’ abortion ban threatens many women like Sarah. Although Sarah was proactive in seeing her doctor and seeking an abortion when she first missed her period, she was still eight weeks pregnant by the time she got to Dr. Brian’s office. Were she in Texas, where abortions are now prohibited beyond detection of a fetal heartbeat, she would not be able to receive a life-saving abortion. Although there is a provision for emergency abortions in cases where the mother’s life is on the line, abortions are not allowed preemptively, and there is no clarity as to how imminent the mother’s worsening status must be before this clause can be invoked.

While her physician declared the abortion to be medically necessary, it was not deemed imminently necessary by her insurance, so it cost her $600 out of pocket, even with Medicare. This is commonplace, and comparable to Planned Parenthood costs for so-called “elective” abortions. Sarah was lucky to be in Florida instead of our neighbor across the Gulf. For now. But shortly after Texas succeeded, Florida introduced similar legislation.

Dr. Brian has countless stories like Sarah’s.

Many women do not know they are pregnant by six weeks. Six weeks pregnant means your period is only two weeks late and that’s only if your menstrual cycle is consistent. Many genetic tests to diagnose fetal abnormalities are not available until 10 weeks, and ultrasounds to diagnose fetal malformations are not routinely completed until 18 weeks, meaning that women who later learn their child has a significant condition cannot factor this outcome into their decision.

The Turnaway Study is a ten-year report that took a thousand women who just barely made the deadline for an abortion and compared them to women who just missed the deadline, and as a result bore a child they did not want. The study showed that women who are refused abortions face worse financial, medical and societal outcomes. They suffer an increase in household poverty, are less likely to be able to cover basic costs of living, and have lower credit scores, higher debt and more evictions. They were more likely to remain in violent domestic partnerships and more likely to raise the child alone and below the poverty line. Even preexisting children of these women were more likely to suffer developmentally, and 60% of women who obtain abortions in the U.S. already have at least one child. The women who received an abortion in the study were more likely to have a wanted pregnancy in the future. Other studies have shown that over 95% of women who received an abortion were happy with their decision in the long term. Overall, studies show that abortion rates don’t drop when the procedure is outlawed, they simply become more dangerous. When done right, abortions are far safer than pregnancy.

Any Floridian knows what it’s like to watch a storm brew somewhere far away and patiently wait to see if the threat will turn our way. This feels a lot like waiting for a hurricane. We are watching the path of destruction as it passes through a neighboring region and anxiously anticipating it’s arrival on our shores. But in this case, we can take control of the winds. We need to pressure our Florida Legislature not to put our women through this. As for Texas, the Supreme Court began to hear arguments on a case starting Nov. 1, but did not block enforcement of the ban in the meantime.

When reflecting on Sarah’s case and the implications a Texas-like bill would have if passed in Florida, Dr. Brian said it well: “Are you telling me I have to wait until this woman is on her death bed to perform the abortion? How sick does she need to get? Now her kidneys are failing — is that sick enough? Well now her lungs are filling up with fluid — is she sick enough yet?”

Let’s hope women like Sarah can continue to receive safe abortions. Let’s hope doctors never have to ask these questions.