Houston — Dr. Amanda Horton, an obstetrician specializing in high-risk pregnancies, was counseling pregnant patients in a small hospital in the Texas countryside last month when a woman was at stake. .. broken.
The fetus could not survive outside the womb, and without the protection of the amniotic membrane, women were vulnerable to potentially life-threatening infections. In Colorado or Illinois, Dr. Horton also practiced, and in states where abortion is generally legal, she would have had the option of ending her pregnancy.
Most abortions are banned in Texas, with the exception of women’s life-threatening cases. However, the patient’s life in this case was not in imminent danger — yet. Her hospital sent her to her home to wait for signs of her infection and labor, Dr. Houghton said.
Worried, there was no other place to turn, so the woman instead traveled hundreds of miles to New Mexico for an abortion.
“She ended up dealing with the problem herself,” Dr. Houghton said. Her patient made a choice “for her life,” she said.
Each of the 13 states where abortion is prohibited Some tax exemptions To save the life of the mother or to address the serious risk of “substantial and irreversible impairment of major physical functions”.
However, making that decision is full of uncertainty and legal risks, some state doctors say, giving significant care to women at high risk of pregnancy complications harming women. He added that he was already forced to change to.
Last week, Texas Attorney General Ken Paxton said the Biden administration over federal guidelines requiring doctors to perform abortions, even in states where abortion is prohibited, if they decide they need to treat dangerous pregnancy complications. I sued.
In the legal debate, hospitals have struggled with where and how to draw the line. Some people join a special committee of doctors and lawyers to determine when pregnancy can be premature. Finished. Others needed multiple doctors to approve such a decision and document in detail why an abortion was needed.
As a result, treatment was delayed and the risk increased, doctors said.
“It’s like taking a lot of people to the top of a skyscraper, pushing it all the way to the edge and catching it before it collapses,” said Dr. Ali Reza A. Shamsilsaz. Obstetrician and fetal surgeon practicing in Houston until last month. “It’s a very dangerous practice. We all know that some of them will die.”
The effect in these cases is on women who only encounter complications during pregnancy and want to have children. Abortion options have been part of the standard care provided by doctors in situations where there is a risk of harm or death to the mother.
This effect is most pronounced in Texas, where a law banning most abortions was passed six weeks after pregnancy last September. This is much earlier than the ban that began to come into effect after the Supreme Court’s decision to overturn the Roe v. Wade case on June 24.
A new study of two Dallas County hospitals found that pregnant women faced serious complications before their fetuses survived after Texas law came into force. They suffered because they were not allowed to end their pregnancy..
Read more about the end of the Roe v. Wade case
More than half of the 28 women who met the study criteria were experienced “Serious” medical problems such as infections and bleeding in the face of State-mandated treatment restrictions, studies have found. One woman needed a hysterectomy.And the incidence of maternal health problems was much higher than that. In other states where patients were offered the option to end their pregnancy, according to a study approved for publication in the American Journal of Obstetrics and Gynecology.
Dr. Judy Lebison, an obstetrician in Houston, mentioned a study in which she was not involved, saying that “mothers’ complication rates have almost doubled.” She added that all but one of her pregnancies ended with the death of the fetus. .. “So why did they let them through it?” She said about the woman.
Last week, the Texas Medical Association sent a letter to state regulators after receiving complaints from doctors that hospitals were preventing women from providing abortion when medically needed for fear of breaking the law. I asked for intervention. The Dallas Morning News reported..
Abortion Ban in Missouri Effective In June exception For emergency medical care that requires an immediate abortion to avoid death or injury.words “Immediate” is a question pierced by state-wide hospital administration as to whether it refers to an imminent danger of death or an urgent threat to women’s health.
Some hospitals, such as Texas, are considering an internal review board to approve abortions that are medically necessary to reduce legal liability. Others require multiple doctors to sign off.
“The law doesn’t require two doctors,” said Dr. David Eisenberg, who specializes in complex family planning at Washington University in St. Louis. “But many institutions find it best to have multiple physicians document the nature of emergency care and the need for abortion treatment.”
Care can vary from town to town and from hospital to hospital, doctors said.
Due to uncertain legal circumstances, even state-wide medical associations are wary of providing instructions on the treatments offered by the “mother’s life” exception.
Dave Dillon, a spokesman for the Missouri Hospital Association, said: Ultimately, he said the meaning of the exception was “probably determined by the proceedings.”
Until then, he said, hospitals need to make decisions based on “whatever the pain threshold is individual to this.” For doctors, it means making a decision knowing that a proceeding or prosecution may come later. In Texas, doctors accused of violating abortion law face fines and unlimited civil proceedings. If the Trigger Act comes into force in the coming weeks, you may be charged with a felony.
“All doctors are complaining, but no one wants to speak out because of the possible consequences. We could be fired,” said Dr. Shamsilsaz, a Houston surgeon.
He described a colleague with twin patients. At week 15, she gave birth to one stillbirth and asked to have another aborted because of the risk of infection. Her proceedings were filed in front of a hospital committee that Dr. Shamsilsaz called the “termination committee,” but her abortion was denied because her fetus still had a heartbeat.
“We sent the patient home against her will,” he said.
The woman felt sick after about two weeks and returned to the hospital. Her pregnancy ended due to concerns about her health, said Dr. Shamsilsaz, but she had to be admitted to the intensive care unit due to sepsis and acute kidney injury-both her life. A threatening condition.
“I have to wait until my mom shows these symptoms,” he said.
All pregnancies carry risks to the health and life of the mother.Researchers have found that there is a risk of complications and death Abortion is higher than abortion..Determining if a woman’s life is at stake at any given time is always a gray area and is changing As medicine advances and social practices change around the acceptance of abortion.
According to Oklahoma University historian Jennifer Holland, abortion was once almost legal, but by 1900, all states were pregnant unless the mother’s life was at stake. Abortion was banned at this stage. Some of these laws, such as the Texas 1925 law, have recently been revived by the overthrow of Law.
The reality of that period was that the decision about abortion was left to the family doctor.
Dr. Holland said there was some “flexibility” in what constitutes a threat to the mother, “especially if you could talk to a caring family doctor.”
After Law was decided in 1973, the state began passing legislation banning abortion after fetal survival, with the exception of “life and health,” said the Guttmacher Institute, which supports the right to abortion. Elizabeth Nash, a state policy analyst, said. In the last decade, the legislature has steadily passed hundreds of abortion restrictions, which has greatly narrowed the word, but it is rarely challenged in court.
Now, with the new abortion restrictions, women and their doctors have noticed that they are crossing uncertain legal territories.
A Texas emergency nurse who requested anonymity to discuss her experience became pregnant last year shortly after the restricted abortion law came into force. It was a happy opportunity, but then her water broke in 19 weeks. She went to the emergency room of the hospital in fear. She already knew that her baby would probably die. But as her nurse, she also knew that her condition was unstable. She wanted to have her fetus aborted, but she was told that all she could do was wait.
“I fought the doctor for a while, but none of them helped me until I was actively ill,” she said. “I was just stunned. I was very confused. Especially as a nurse, no one comes into the ER, so I wait for how sick they are.”
She and her husband flew to Colorado for an abortion. On the day of her surgery, she had a fever of 101 degrees. “I was starting to get sick that day,” she said.
Miscarriage occurs in 15% of all pregnancies and may require procedures to remove the fetus (also used in some abortions). Pre-eclampsia, or pregnancy-induced hypertension, occurs in 5-8% of all pregnancies and can be fatal. There is a 2% chance that the pregnancy is ectopic. That is, the fertilized egg implants outside the womb, making pregnancy infeasible and seriously threatening the mother’s life.
But in the new legal situation, no one knows how serious these conditions must be before justifying abortion under the law.
“That’s all possible,” said Dr. Charles Brown, Texas District Chairman of the American College of Obstetrics and Gynecology. “How much do we need to take before everyone agrees that this woman’s life is at stake?”
After the Oklahoma abortion ban came into effect in May, Dr. Christina Bourne received a call from a patient with an ectopic pregnancy that an obstetrician refused treatment.
Dr. Bourne is the medical director of two abortion clinics just above the border between Oklahoma City and Wichita, Kansas. Still legal.. After consulting with a lawyer at her clinic, she said she had a woman come to Wichita’s clinic. By that time, she had already experienced abdominal pain and bleeding and had to be transferred to the hospital for treatment. The doctor there ended her pregnancy.
“The people we see are much more ill than they used to be,” said Dr. Bourne. “We see the effects of system failures. Pregnancy is where all failed systems come together.”
