Scaremongering about Texas abortion ban isn't helping patients.
"I'm so sorry, but it's just too dangerous for you to stay pregnant any longer. We're going to need to get you delivered."
This is one of my least favorite things to have to say to a pregnant patient, especially when the baby is too young to survive outside the womb. As an OB-GYN, my goal is to end up with a healthy mom and a healthy baby, and it breaks my heart when pregnancy complications make this outcome impossible.
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But when a patient's water breaks prematurely, it's imperative that I watch her closely for infection and separate her from her preborn child at the first hint of it, as it can spread rapidly and prove life-threatening. Failure to act quickly can result in losing both mom and baby.
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Unfortunately, in my 21 years of post-residency practice in Texas, I have had to perform my share of pre-viable deliveries knowing that the baby would not survive if I did, but neither the mom nor baby would survive if I did nothing. The way I treat these tragic situations has remained the same both before and after the enactment of my home state's abortion law.
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It's a decision we as OB-GYNs hate to make, but it is one that we are trained to make. It's also perfectly legal.
Although I would caution against making judgements without reviewing the medical record, some Texas physicians have allegedly expressed confusion over whether our state law allows them to do what I just described.
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A Texas woman named Josseli Barnica passed away from sepsis after her hospital waited 40 hours to deliver her 17-week-old fetus when she went into labor prematurely, ProPublica reported last week. The report claimed her physicians said that it would be a crime to intervene until the fetus had no heartbeat. Yet, the standard of care for a potentially life-threatening condition in pregnancy, regardless of the fetus's heartbeat and not prevented by any abortion law in the country, would have been to deliver her earlier. These maternal-fetal separations, done to save the life of the mother, are different from induced abortions, which intend the death of the fetus. Her physicians' claim that they could not legally intervene is simply not true.
Texas' abortion law defines abortion as "the act of using or prescribing an instrument, a drug, a medicine, or any other substance, device, or means with the intent to cause the death of an unborn child of a woman known to be pregnant". The "intent" piece is key in thinking through cases like Barnica's. When physicians like me deliver a baby prematurely to save the mom's life, our intent isn't to cause the baby's death; it's to prevent the mother's death.
The state law further clarifies this point by allowing physicians to end a pre-viable pregnancy in the case of a medical emergency, defined as "a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy that, as certified by a physician, places the woman in danger of death or a serious risk of substantial impairment of a major bodily function unless an abortion is performed." It also notes that "imminence of the threat to life or impairment of a major bodily function is not required" for the medical emergency clause to apply, meaning a woman does not need to be at death's door before her medical team can intervene.
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My team and I regularly offer lifesaving care to women under the exact situations that the law describes, such as ectopic pregnancies, early pregnancy losses, and other tragic situations that include saving the life of the mother.
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It's important for physicians to be well-informed on the many laws that regulate our practice, including abortion laws. However, whereas we can usually rely on medical professional organizations like the American College of Obstetricians and Gynecologists to offer guidance to doctors who might be confused, these organizations have been less than helpful on the topic of abortion.
A few weeks ago, ACOG published a statement blaming the abortion laws themselves, not the misunderstandings and inaccurate information surrounding them, for the cases we've seen in the news of women not receiving the care that they need. They describe pro-life state laws as "designed to prevent life- and health-saving reproductive health care" and argue that the only way to ensure that women get the timely care they need is to repeal them.
As a physician who provides the kind of lifesaving care that ACOG claims is impossible to offer under my state law, I object to these assertions. In fact, my approach to treating patients with pregnancy complications has not changed since Texas' abortion law went into effect. I suspect that the same is true for the many OB-GYNs in my state who do not perform induced abortions, whether due to personal conviction or their employer's policy.
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Instead of stoking fear about Texas' abortion law, organizations like ACOG should be offering guidance on how to practice well under them.
The medical team at my hospital proves daily that not every woman's story has to end tragically like Barnica's. We as physicians are called to do everything in our power to ensure it doesn't and Texas' abortion law does not prevent us from doing that.
Sudheer Jayaprabhu is a board-certified OB/GYN in Texarkana.
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