US abortion: How new bans muddle up medical emergencies

By Chelsea Bailey & Kayla Epstein

BBC News, Washington

Chrissy TeigenImage source, Getty Images

Image caption,

Chrissy Teigen revealed she had an abortion in 2020 after a pregnancy complication

Moments after unveiling a bill that would ban all abortions in the United States at 15-weeks, US Senator Lindsey Graham was interrupted by a mother with a devastating story.

“I did everything right and at 16 weeks we found out that our son would likely not live,” Ashbey Beasley told a crowded room. “When he was born, for eight days he bled from every orifice of his body,” she said.

But, she said, at least she got to choose how to handle her difficult pregnancy, while Mr Graham’s law would take away that choice.

“What do you say to someone like me?”

Mr Graham is not the only lawmaker who has been asked tough questions about his abortion stance, and how it might affect women with complicated or dangerous pregnancies.

Since the Supreme Court struck down Roe v Wade this summer, states across the US have pushed through abortion bans or severely restricted the procedure. But as such laws have gone into effect, unintended consequences have followed.

Doctors and patients say that confusing standards and the vague language of these laws have had a chilling effect on the medical field in anti-abortion states, leaving tragedies in their wake – and more in the making.

‘We can’t help you, good luck’

Abortions for medical reasons are rare, constituting less than 4% of all such procedures in the US in 2004, according to the Guttmacher Institute.

But for certain pregnancy complications, they are an accepted and not uncommon procedure to save lives.

The model Chrissy Teigen, for example, said on Friday an abortion was used to save her life when she was 20 weeks along with a pregnancy that was unviable.

But today, in states with strict abortion limits, that option is becoming increasingly complicated.

For the last year, Amanda Horton, a Texas doctor who specialises in high-risk pregnancies, has struggled to care for patients with pregnancy complications.

At times, Dr Horton must inform families that their babies have been diagnosed with a fatal foetal anomaly. These conditions are rare and likely to lead to the death of a foetus in utero, or shortly after birth.

But under a strict abortion ban in Texas, her hands are tied.

“We can say, ‘If you’re interested in pregnancy termination, that’s always an option. But it’s not an option for you in Texas. And that’s really where the counselling begins and ends,” she said.

“These are people who love their unborn baby, and who, through no fault of their own, have been challenged in ways that they never expected,” she said. But because her state bans all abortions except in life-threatening circumstances, “now, the answer is, ‘We can’t help you, good luck.'”

Defining emergency

Texas has one of the country’s most restrictive abortion bans. But like all such bans passed this year, the state allows an exception when a pregnancy is a threat to the mother’s life.

Indeed, all states that ban abortion include similar exceptions when the life of a mother is threatened.

About a dozen states’ laws include language allowing abortions in cases of a “medical emergency”, and three specifically include an exception for foetal anomalies. West Virginia, which just passed an abortion ban this week, outlaws the procedure “except in a medical emergency or a non-medically viable foetus”.

Mr Graham’s proposal for a national law would come with broadly worded exemptions for a woman whose “life is endangered”.

Image source, Getty Images

Image caption,

US Senator Lindsey Graham proposed a bill that would ban all US abortions at 15-weeks

However, critics say that in practice these laws give little guidance on broad terms like “life-threatening”, or what constitutes a medical emergency that would permit an abortion.

That leaves ample room for debate over when a doctor should act, and in some cases, has even altered options that would have been considered a standard of care.

In July, a Texas woman identified only as Amanda, told the New York Times that she spent 48 hours in agony, sitting in a bathtub while the water turned “dark red” as she waited for her body to expel the pregnancy after suffering a miscarriage.

Previously, when she had a miscarriage, doctors had performed a dilation and curettage (also known as a “D & C”) procedure, in which tissue is removed from the uterus. But at the time of her second miscarriage, Texas had implemented a ban allowing private citizens to sue anyone who helps perform an abortion after six weeks of pregnancy.

Amanda was not given the procedure.

“It was so different from my first experience where they were so nice and so comforting, to now just feeling alone and terrified,” she said.

Such cases have highlighted the gap between written policies over abortion limits and the medical reality, and it has doctors worried.

“It’s very dangerous when legislators who have no experience in the area of medicine are legislating about how we can practise medicine, and prohibiting us from providing the standard of care,” said Daniel Grossman, an obstetrician at the University of California in San Francisco.

‘Reasonable medical judgment’

Many of the bans are modelled after draft legislation proposed by the National Right to Life (NRL), the nation’s oldest anti-abortion organisation. Their model legislation allows for abortions when the mother’s life is threatened.

“Our model law language says, ‘reasonable medical judgement’ of the attending physician, which is the usual case in all medical situations, not just abortions,” NRL told BBC News in a statement.

“We’re not aware of any pro-life legislation, including our model law, that would prevent appropriate medical treatment in any of these cases.”

Image source, Getty Images

Image caption,

Doctors say medicine has a lot of grey areas and it’s impossible to list every condition to meet a law’s medical emergency exception

But for people facing difficult pregnancies, these laws, in practice, can get in the way of medical care.

In Louisiana, the story of Nancy Davis made national headlines after she said doctors would not terminate her non-viable pregnancy. At a press conference, Ms Davis told reporters her baby had acrania, a condition that causes a foetus to develop without a skull and is incompatible with life.

“Basically, they said I had to carry my baby, to bury my baby,” she said, adding doctors “seemed confused about the law and afraid of what would happen to them if they performed a ‘criminal abortion’ according to the law.”

“I want you to imagine what it’s been like to continue this pregnancy for another six weeks after this diagnosis,” she said. “This is not fair to me, and it should not happen to any other woman.”

In South Carolina, a Republican state senator, Neal Collins, went viral for confessing he regretted voting for a six-week abortion ban, after a local OB-GYN told him the story of a 19-year-old who faced a harrowing miscarriage but was denied care.

“That whole week, I did not sleep,” Mr Collins said in a speech before the state’s judiciary committee. He said he followed up and, two weeks later, the ER was able to “extract” the foetus, but only after it had died.

Medicine by exemption

Days after expressing his regret, Mr Collins voted in favour of a near-total abortion ban that includes a list of some dozen situations that qualify as exceptions.

And last month, after Ms Davis miscarried, Louisiana’s health department issued a list of conditions that would render a pregnancy “medically futile” and qualify for an exception to the state’s near-total abortion ban.

But Dr Grossman says it’s impossible to make a list of the conditions that meet the “medical emergency” exception.

“It doesn’t work that way. In medicine there’s a lot of grey areas and uncertainty,” he said. “If there’s a 20% risk of death in the next month if they continue the pregnancy, that’s a tremendously high risk. It would be the standard of care to offer that patient termination.”

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