ICYMI: A Preview of the Dangerous Future of Abortion Bans -- Texas Senate Bill 8 (NEJM)

[Nevilledog]

Link to tweet

https://www.nejm.org/doi/full/10.1056/NEJMp2207423

*snip*

Clinicians we interviewed recounted a variety of circumstances in which a patient could have received hospital-based abortion care before SB8 but was now denied that care. Patients with a life-limiting fetal diagnosis, such as anencephaly or bilateral renal agenesis, are only being counseled to continue their pregnancy and offered neonatal comfort care options after delivery. All hospitals where our respondents practiced have prohibited multifetal reduction, even though in some cases (e.g., complications of monochorionic twins) failure to perform the procedure could result in the loss of both twins.

Patients with pregnancy complications or preexisting medical conditions that may be exacerbated by pregnancy are being forced to delay an abortion until their conditions become life-threatening and qualify as medical emergencies, or until fetal cardiac activity is no longer detectable. An MFM specialist reported that their hospital no longer offers treatment for ectopic pregnancies implanted in cesarean scars, despite strong recommendations from the Society for Maternal–Fetal Medicine that these life-threatening pregnancies be definitively managed with surgical or medical treatment.4 Some clinicians believe that patients with rupture of membranes before fetal viability are eligible for a medical exemption under SB8, while others believe these patients cannot receive an abortion so long as there is fetal cardiac activity. In multiple cases, the treating clinicians — believing, on the basis of their own or their hospital’s interpretation of the law, that they could not provide early intervention — sent patients home, only to see them return with signs of sepsis. An obstetrician–gynecologist recalled only one patient who was able to obtain an abortion at their hospital under SB8’s maternal health exemption, because her severe cardiac condition had progressed to the point that she was admitted to the intensive care unit. As an MFM specialist summarized, “People have to be on death’s door to qualify for maternal exemptions to SB8.”

Clinicians repeatedly noted that only Texans with financial resources and social support can obtain an abortion outside the state. Moreover, patients who travel for such care can have further complications while on the road or in the air. A patient with rupture of membranes before fetal viability said she was angry and sad to learn she could not get care in Texas because of SB8. She weighed her risks and decided to travel. “I knew how dangerous it was for me to get on a plane and go get an abortion,” she told us, “but I knew that it was still the safer option for me than sitting in Texas and waiting, and I could potentially get sicker.” She reported that her obstetrician advised her, “If you labor on the plane, leave the placenta inside of you. You’re going to have to deal with a 19-week fetus outside of your body until you land.”

The climate of fear created by SB8 has resulted in patients receiving medically inappropriate care. Some physicians with training in dilation and evacuation (D&E), the standard procedure for abortion after 15 weeks of gestation, have been unable to offer this method even for abortions allowed by SB8 because nurses and anesthesiologists, concerned about being seen as “aiding and abetting,” have declined to participate. Some physicians described relying on induction methods to get patients care more quickly; others reported that their colleagues have resorted to using hysterotomy, a surgical incision into the uterus, because it might not be construed as an abortion. Although induction may be appropriate in some circumstances, hysterotomy increases a patient’s immediate risks for complications as compared with D&E or labor induction and has negative implications for all future pregnancies. One obstetrician–gynecologist described this practice as going “back to doing what they used to do before there was a D&E provider in town.”

*snip*

[MiniMe]

1. Who is going to be paying for the care of these infants?

[sakabatou]

2. Most likely, they'll pass the cost to the patient.

[PortTack]

3. Sexually active women with a uterus...please move away from these states

Yes, I’ve heard the excuses. Not everyone can pick up and move. Many can but don’t want to only to find themselves in a much bigger financial and serious medical mess and wish they had.