1. Abortion is Healthcare
The following is an excerpt from the statement from the American College of Obstetricians and Gynecologists and the American Medical Association and more than 70 other medical organizations:
“As the U.S. health care system enters a post-Roe era, we, representing dozens of major organizations of health care professionals, oppose all legislative interference in the patient–clinician relationship. Our patients need to be able to access—and our clinicians need to be able to provide—the evidence-based care that is right for them, including abortion, without arbitrary limitations, without threats, and without harm."
2. Texas Abortion Ban Hurts Women
Summarized by my friend, Dr. ML, from a recent article in the American Journal of Obstetrics and Gynecology:
They reviewed the records of 28 patients in Texas who presented at <22 weeks with an indication for delivery (rupture of membranes, vaginal bleeding, severe pre-eclampsia). All the presentations had fetal cardiac movement, so per Texas law, only "expectant" management was allowed. Prior to the passage of the law in Sept 2021, the women would have been counseled on either expectant management or induction (with subsequent comfort care of the newborn if born alive).
Results: 1. Average days between presentation and delivery: 9.2 days. So, 9.2 days of these women staying in the hospital with the knowledge of their child's imminent death. 2. out of 28 pregnancies: 20 died in utero and induction took place. 7 were eventually delivered either spontaneously or via induction and died within 24 hours. 1 remains in the hospital. SO: 1 child "saved" by this. And this child has been in the hospital for MONTHS and will likely be disabled for life if they pull through. 3. 43% of the mothers experienced a severe complication, such as hemorrhage or infection. 4. 32% required surgery or an ICU admission 5. One mother ended up having to have a hysterectomy.
3. Laws by State
In my home state, the South Carolina Supreme Court struck down a ban on abortion after six weeks on January 5, 2023, ruling the restriction enacted by the state violates a state constitutional right to privacy. There was a fast-track effort to pass a near-total abortion ban a few days later, but on February 8th, the SC Supreme Court denied the petition to rehear the case for the ban.
I checked on a few other states that are in the middle of lawsuits and court hearings. There was too much to write up, but I found this interactive map:
Currently, in Texas, a federal judge could rule that the FDA-approved drug, mifepristone, be taken off the market nationwide. This is a safe, proven drug for medical abortions, and usage has been growing for terminating a pregnancy.
If the Texas court imposes a nationwide ban on mifepristone, the highly effective and medically safe method or misoprostol alone is available to end an early pregnancy. Unlike mifepristone, misoprostol is inexpensive and widely available by prescription. U.S.-based providers (including telemedicine providers) will be able to prescribe off-label to patients in states where abortion remains legal. (Ms. Magazine has a detailed article about misoprostol here.)
There are methods of emergency contraception that can also be part of the solution in these times - check out this guest blog by my friend Katie Bennett, CNM.
4. Federal Law on Emergency Treatment Can Preempt State Law
As reported by NPR on July 12, 2022, The Department of Health and Human Services cited requirements on medical facilities in the Emergency Medical Treatment and Labor Act, or EMTALA.
"If a physician believes that a pregnant patient presenting at an emergency department is experiencing an emergency medical condition as defined by EMTALA, and that abortion is the stabilizing treatment necessary to resolve that condition, the physician must provide that treatment," the agency's guidance states. "When a state law prohibits abortion and does not include an exception for the life of the pregnant person — or draws the exception more narrowly than EMTALA's emergency medical condition definition — that state law is preempted."
The department said emergency conditions include "ectopic pregnancy, complications of pregnancy loss, or emergent hypertensive disorders, such as preeclampsia with severe features."
ACOG Conclusion
“Abortion care is safe and essential reproductive health care. Keeping the patient–clinician relationship safe and private is essential not only to quality individualized care, but also to the fabric of our communities and the integrity of our healthcare infrastructure. As leading medical and health care organizations dedicated to patient care and public health, we condemn this and all interference in the patient–clinician relationship.”
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