It is tough to have a uterus in the post-Dobbs United States. The physicians who treat pregnant women are outraged and horrified, according to their anonymous stories in a new report: Care Post-Roe: Documenting cases of poor-quality care since the Dobbs decision.
Patients experiencing ectopic pregnancy or miscarriage are not receiving the care they would have received before the U.S. Supreme Court overturned Roe v. Wade because healthcare organizations and providers fear aiding and abetting something that might be called an abortion, says Kari White, PhD, MPH, a lead investigator with the Texas Policy Evaluation Project and an associate professor at the University of Texas at Austin Steve Hicks School of Social Work.
“In some submissions [to the research project], the folks indicated that they or their colleagues were brought to tears because of their inability to care for patients in the ways they thought were best,” White says.
For example, one pregnant woman was admitted to the ED with severe sepsis during a miscarriage. Her fetus was delivered at four months of pregnancy. But clinicians could not deliver her placenta, and the anesthesiologist cried on the phone when discussing the case because no one believed the patient would survive intubation. The physician performed a dilation and curettage to save her life. The patient was no longer carrying a fetus, so the state’s abortion ban would not apply.1
The patient feared that she had broken the new state law. “The physician recounted, ‘She asks me: Could she or I go to jail for this? Or did this count as life-threatening yet?’”
In another case, a woman whose membranes had ruptured was denied standard care in her abortion-ban state and had to drive to another state, four hours away. By the time she obtained abortion care, it was five days after the rupture, and the umbilical cord was visible in her vagina.
Fear Among Clinicians
Anecdotal reports, lawsuits, and some research show that since the Supreme Court overturned Roe v. Wade, many women are at risk of illness, injury, and death during pregnancy. With standard abortion care, they would be far safer.1,2
The fear among clinicians has created situations in which some providers will not offer standard pain relief or even touch patients during a miscarriage. In one case described in the study, a physician said anesthesiology colleagues refused to provide an epidural for pain to a woman in too-early labor.
“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,’” the physician recalled.
The abortion bans also are affecting where medical students, residents, OB/GYNs, and other physicians choose to practice.
Abortion bans are leading to increased stress, moral distress, and burnout among physicians.
“They felt a lot of moral distress because they have the clinical skills and professional expertise to provide care for patients in need, and they are not able to do so because of the laws,” White says.
REFERENCES
- Grossman D, Joffe C, Kaller S, et al. Care Post-Roe: Documenting cases of poor-quality care since the Dobbs decision. Advancing New Standards in Reproductive Health/Texas Policy Evaluation Project. May 2023. https://www.ansirh.org/sites/d...
- Goldberg M. You cannot hear these 13 women’s stories and believe the anti-abortion narrative. The New York Times. May 22, 2023. https://www.nytimes.com/2023/0...
It is tough to have a uterus in the post-Dobbs United States. The physicians who treat pregnant women are outraged and horrified, according to their anonymous stories in a new report: Care Post-Roe: Documenting cases of poor-quality care since the Dobbs decision.
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