28 November 2022
It has been five months since the U.S. Supreme Court overturned Roe v. Wade. The ruling ended a 50-year-old legal right to abortion nationwide. Instead, individual states now decide on whether to permit, limit or ban the medical procedure to end a pregnancy.
Some doctors in states with restrictive abortion laws say they have sent more patients go somewhere else than ever before. Some women are facing harmful, possibly deadly, delays. Doctors say they are forced to balance medical judgment with possible punishments, including prison time.
Weeks after the overturn of Roe, Dr. Grace Ferguson treated a woman whose water had broken halfway through pregnancy. The baby would never survive, and the patient's chance of developing a possibly life-threatening infection grew with every hour.
The woman had already spent two days at a hospital in West Virginia before she saw Ferguson in the neighboring state of Pennsylvania. She was not able to get an abortion in West Virginia because the state bans the procedure except in the case of a medical emergency. The patient's life was not in danger at that exact time, so doctors did not operate.
At the hospital in Pennsylvania, where abortion is legal, Ferguson was able to induce labor to end the pregnancy.
How close to death must the patient be?
Although even the strictest laws permit abortion to save a mother's life, a serious question remains: How close to death must the patient be? "You don't automatically go from living to dead," Ferguson said. "You slowly get sicker and sicker."
It is impossible to say when that line is crossed, said Dr. Alison Haddock. She is on the board of the American College of Emergency Physicians.
"There's just no moment where I'm standing in front of a critically ill patient where I know: OK, before their health was just in danger. But now, their life is in danger," she said.
Experts say it is hard to know the number of abortion denials when serious complications happen. Employers often tell their health care workers not to speak about such cases. Even still, The Associated Press reached several doctors and patients who shared stories of such denials.
Many doctors and researchers agree that evidence shows it is a widespread problem. In Texas, for example, a doctors' association sent a letter to the state's medical board saying some hospitals refused to treat patients with major complications because of the state's abortion ban.
Dr. Cara Heuser is a maternal-fetal specialist in Utah. She recalled one patient who was denied an abortion in the neighboring state of Idaho despite developing a serious heart condition halfway through pregnancy. The woman had to be sent to Utah for the procedure.
Dr. Lauren Miller is a maternal-fetal specialist in Idaho's capital of Boise. She said she often sees patients whose water breaks at 15 through 19 weeks of pregnancy. All that doctors can do is help them make the difficult decision: "Do they stay here for their care and just wait until something bad happens, or do we facilitate them finding care out of state?"
The stories are similar when pregnancy is complicated by cancer. About 1 in 1,000 pregnant women find out they have cancer each year.
Dr. Karen Knudsen is chief executive officer of the American Cancer Society. She said some cancer doctors have questions about treating pregnant cancer patients, especially when therapies may cause miscarriage.
Some abortion opponents say doctors may be unnecessarily denying abortions in life-threatening situations out of fear.
It comes down to intent
Dr. Patti Giebink is a former abortion doctor who described changing her opinion about the procedure in her book Unexpected Choice: An Abortion Doctor's Journey to Pro-Life. She said it comes down to intent. If you intend to save the mother and not end the life of the fetus, she said, "you're doing good medicine."
"We're sort of in a period of time where all these questions come up," she said. "The legislatures are going to be working to solve some of these problems."
Dr. Paul LaRose is a member of the American Association of Pro-Life Obstetricians and Gynecologists. He said he thinks the issue is overstated.
"Most pro-life physicians would take care of the mother and do what's necessary without purposely taking the life of the unborn baby," LaRose said.
But some women say restrictive abortion laws have put them in danger.
Mylissa Farmer is from Joplin, Missouri. In August, her water broke 17 and a half weeks into her pregnancy. She went to the emergency room. Tests showed she had lost all her amniotic fluid. The fetus she and her boyfriend had named Maeve was not expected to survive.
Despite risks of infection and blood loss, she could not get an abortion. The fetus still had a heartbeat. Doctors told her Missouri law superseded their judgment, medical records show.
She tried for days to get an out-of-state abortion, but many hospitals said they could not take her. In the end, an abortion helpline connected Farmer with a medical center in Granite City, Illinois. She drove more than four hours from home — while in labor — and had the procedure.
News organizations reported on Farmer's story. She appeared in a political advertisement. Later, the Missouri health department started an investigation into whether the Joplin hospital had violated federal law. The state has shared its early findings with the federal government.
Farmer said the experience was deeply traumatic. She decided to take a permanent step to make sure nothing like this happens to her again.
She got her tubes tied. The procedure prevents her from getting pregnant in the future.
The Associated Press reported this story. Ashley Thompson adapted it for VOA Learning English.
Words in This Story
induce - v. to cause (someone or something) to do something
automatically - adv. happening or done without deliberate thought or effort
moment - n. a particular time : a precise point in time
complication - n. something that makes something harder to understand, explain, or deal with
maternal - adj. of or relating to a woman who is having a baby
facilitate - v. to help (something) run more smoothly and effectively
miscarriage - n. a condition in which a pregnancy ends too early and does not result in the birth of a live baby
amniotic fluid - n. the fluid surrounding a fetus
traumatic - adj. causing someone to become very upset in a way that can lead to serious mental and emotional problems