When Lawmakers Make Medical Decisions, Patients and Providers Suffer
January 1, 2023 3 minutes read
Research shows that abortion bans in Texas have caused serious harm to pregnant patients with preterm premature rupture of membranes. Their pregnancy care was inadequate without the use of abortion care and resulted in hemorrhaging, serious infection, and one woman undergoing a hysterectomy.1
Investigators found that only one of the fetuses survived, although the infant remains hospitalized. By contrast, the women suffered serious morbidities, and one-third required intensive care admission, dilatation and curettage, or readmission.
The researchers found that 57% of Texas patients who experienced pregnancy problems after the state banned abortions at six weeks had serious maternal morbidity. This compares with 33% of patients with serious maternal morbidity in states where they could undergo immediate pregnancy interruption under similar clinical circumstances.
The findings suggest a future in which doctors in abortion-ban states will have to ask how much of a threat of death is needed before they can give patients the care needed to prevent their death or serious morbidity, the authors concluded.
Another study of physicians’ views on their state’s abortion restrictions also revealed that patient care gravely suffers when lawmakers legislate medical care. Researchers interviewed physicians and held OB/GYN focus groups between 2019 and 2020 — two years before the Dobbs decision. They found as Ohio’s abortion laws became more restrictive, reproductive health clinicians felt their ethical practice guidelines were undermined, says Hillary J. Gyuras, MA, study co-author and a research associate in public health at The Ohio State University. Gyuras’ study is part of the Ohio Policy Evaluation Network, which received a grant to conduct research as part of an effort to expand reproductive health services in Ohio and neighboring states.2
One ethical dilemma is a regulation that restricts abortion provision in public hospital settings. “A lot of physicians who were trained to provide abortion care felt they could not provide it, [even when] the patient’s life was at risk,” Gyuras explains. “They felt they were unable to do it, or their skills had declined over time because they were not able to provide enough abortions to keep those skills.”
Physicians voiced concern about losing skills related to dilation and evacuation (D&E) second-trimester abortions.
“The D&E ban is complicated,” Gyuras says. “Ohio physicians in public hospitals say they don’t feel like they provide enough of these procedures per year to be skilled in providing an abortion in an emergency situation.”
Ohio providers told researchers that Ohio’s 21.6-week limit on abortion care, which was enforced before the Dobbs decision in 2022, prevented them from ending nonviable pregnancies that could soon pose risks to the pregnant patient’s health and life. The limit created ethical dilemmas for physicians who wanted to uphold practice guidelines and follow institutional policies and the law.
Study participants said their employers required hospital legal counsel to approve of abortions when there were threats to maternal life. Their institutions interpreted the law conservatively and would ask them to delay treatment until these high-risk situations turned into a medical emergency.
Some said OB/GYNs had to withhold a therapeutic procedure while watching their patients move closer to death. One clinician described the situation as barbaric and compared it to the Tuskegee syphilis studies in which life-saving antibiotics were withheld from poor Black men in Tuskegee — in the name of research.
“They wanted to provide the care, but felt that legally, their lives were against the wall,” Gyuras says. “They felt their clinical judgment was constrained by the laws and institutions that often interpreted the laws even more conservatively than they are written.”
REFERENCES
- Nambiar A, Patel S, Santiago-Munoz P, et al. Maternal morbidity and fetal outcomes among pregnant women at 22 weeks’ gestation or less with complications in 2 Texas hospitals after legislation on abortion. Am J Obstet Gynecol 2022;227:648-650.e1.
- Field MP, Gyuras H, Bessett D, et al. Ohio abortion regulations and ethical dilemmas for obstetricians-gynecologists. Obstet Gynecol 2022;140:253-261.
Recent suggests a future in which doctors in abortion-ban states will have to ask how much of a threat of death is needed before they can give patients the care needed to prevent their death or serious morbidity.
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