There are now 14 states with near-total abortion bans, where access to full reproductive health care isn’t just impossible, but medical professionals providing that care can’t even talk publicly about what it means for their patients and themselves. Physicians, nurses, nurse practitioners, midwives, physician assistants, social workers, and other health care workers in those states who provide obstetrics care have been gagged by the hospitals and clinics they work for when it comes to abortion and the impact the bans are having on their patients.
The University of California, San Francisco’s Advancing New Standards in Reproductive Health research program stepped into the breach, giving providers the ability to speak out through this anonymous survey and allowing them to detail what’s happening to the standards of care in their states since the Supreme Court struck down abortion rights. The research program released its first report from the survey, which started last September, and the results are as grim as you’d expect for both patients and doctors.
One doctor describes a patient having a miscarriage at around 16 to 18 weeks of pregnancy, who they had to send home to wait after the initial diagnosis. “I meet her 2 days later in the ICU. She was admitted from the ER with severe sepsis … and bacteremia.” She finally is able to deliver the fetus, but not the placenta despite the medical team trying “every medical protocol we can find.”
“The anesthesiologist cries on the phone when discussing the case with me—if the patient needs to be intubated, no one thinks she will make it out of the OR,” the doctor continued. Finally, “I do a D&C” to remove everything as the patient “bleeds from everywhere.” Afterward, the patient, who ended up in the ICU and nearly died, asked, “Could she or I go to jail for this? Or did this count as life-threatening yet?”
The survey authors also note “that patients described as Black or Latina/Latinx/Hispanic, as well as those who primarily speak Spanish, account for about half of all cases in our analysis.” As always, the most disadvantaged people are harmed the most. "Abortion bans that block providers from offering standard medical care have the greatest impact in states like Texas that have some of the poorest indicators of maternal health,” said Dr. Kari White, lead investigator of the Texas Policy Evaluation Project at the University of Texas at Austin. “Pregnant people should be able to rely on their healthcare provider to provide the best possible care, regardless of where they live.”
Some of the providers in the survey talked about the “paralysis” of medical personnel, and not knowing what interventions they can legally provide to help a patient. Here’s the story of a patient who was miscarrying, and the medical team that wouldn’t intervene:
“Anesthesiology colleagues refused to provide an epidural for pain. They believed that providing an epidural could be considered [a crime] under the new law. [...] I will never forget this case because I overheard the primary provider say to a nurse that so much as offering a helping hand to a patient getting onto the gurney while in the throes of a miscarriage could be construed as ‘aiding and abetting an abortion.’ Best not to so much as touch the patient who is miscarrying… A gross violation of common sense and the oath I took when I got into this profession to soothe my patients’ suffering.”
The harm to patients in the long term isn’t known, the report authors point out. The “longer-term effects, which are not yet observable, could include loss of fertility, chronic pain, heart attack and stroke risk related to hypertension, and effects on mental health.”
There are also the effects on the providers and their other patients. Doctors in states without abortion bans who end up treating these critical patients described the tremendous effort required to transfer patients across state lines. “The degree of coordination between Ob/Gyns in different states was heroic,” one said, but added that “this effort took away from other patients that our providers were caring for.”
There’s a lot in the report about the frustration and anger these providers feel when they know what their patients need and have the skills to provide the necessary care, but can’t because of bans imposed by people who have no medical knowledge or expertise. That’s been reported in stories like this one, from Idaho, where rural hospitals are closing their maternity wards because the state “isn’t a safe place to practice medicine anymore.”
The states with abortion bans aren’t safe places to be pregnant anymore, either.
'Idaho isn’t a safe place to practice medicine anymore,' doctors flee strict abortion ban
Surprise! Most medical students surveyed say they won't practice in states with abortion bans
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