It has been just 80 minutes since the US Supreme Court overturned Roe vs. Wade on Friday, when Dr. Nisa Verma’s phone rang with an urgent group message from another obstetrician-gynecologist that made her breathe. There was a woman in Wisconsin who was carrying an embryo with a brainlessness, a deadly genetic defect that lacked parts of the brain and skull. As the abortion was probably illegal in the state, the clinic had canceled its appointment for termination later that day. But forcing her to continue the pregnancy was hard and risky complications. What should I do? wrote the doctor. As colleagues in other parts of the Midwest responded with guides to out-of-state clinics, Verma mentally added the case to the growing list of gray area conditions where new abortion bans fail to capture the complexity of modern medicine and leave it to chance. “There are so many unanswered questions,” said Verma, of OB / GYN in Atlanta, where a six-week wait-and-see abortion ban bill could be enacted soon. “The decision creates confusion and fear because we know what to do medically, but we do not know what we can do under the law.” The Supreme Court ruling that sends the power to regulate abortions back to the states means that there are now 50 states with different approaches, each with its own language and interpretation of where to distinguish between when the procedure is appropriate and when it is a crime. . Graphic: Abortions are now banned in these states. Others will follow. The American College of Obstetricians and Gynecologists has teamed up with many other professional organizations and medical journals in recent days to warn that the decision will affect health care beyond abortions, creating new risks for patients and possibly increasing maternal mortality. Doctors have expressed concern about the consequences of conditions such as miscarriage and in vitro fertilization. The practice of medicine will be reshaped, the group said, or even opposed to “laws that are not based on science or evidence.” Even anti-abortion OB / GYNs recognize medical nuances. Abortion providers from Georgia to California express how they feel about the Supreme Court ruling overturning Roe v. Wade. (Video: Whitney Shefte, Whitney Leaming / The Washington Post, Photo: Eric Lee for The Washington Post / The Washington Post) Christina Francis, a doctor in Indiana and a board member of the American Association of Obstetricians and Gynecologists Pro-Life, said in an interview that “sometimes there are clinical conditions that are unclear” about whether a pregnancy needs to be terminated. But Francis said that in her career working in universal hospitals that prohibit selective abortions, she always felt she could intervene by removing pregnancy tissue when medically necessary, such as in ectopic pregnancies when the fetus is implanted outside the uterus and cannot be implanted. . “There will be an educational process,” said Francis, explaining that many doctors have been trained to prioritize the mother in a pregnancy, but now they have to look at two lives alike – the mother and the fetus. “I have never felt my hands tied to take care of my patients with anything other than excellent health care.” 6 excerpts from the opinion of the Supreme Court concluded by Roe v. Wade Three states – Kentucky, Louisiana and South Dakota – banned the process immediately after the Supreme Court ruling. (The Louisiana law was blocked by a state court three days later, with a hearing set for next month.) Ten have activated laws that have already entered into force or will enter into force in the coming weeks. About a dozen others haveRoe prohibitions or restrictions that could be activated quickly, or conservative legislators who discussed them. In Wisconsin, the 1849 abortion ban is part of state law, and although the attorney general said he would not enforce it, clinics suspended services on Friday. This means that abortion may cease to be an option in the near future in half the country. Verma, an ACOG partner in transitionRoe The working group, organized by groups of doctors in Georgia, said there was concern in their discussions that even standard treatments or procedures such as administering anesthesia or chemotherapy to pregnant patients could put doctors at risk of prosecution for the possibility of fetal injury. . He wondered: “Will surgeons be afraid to intervene when a pregnant patient breaks the appendix because she may inadvertently terminate the pregnancy?” “We see it as a response to disaster,” Verma said. “We are in a state of emergency and this is a disaster.” Even before the upheaval created by its overthrow Roe, obstetrics and gynecology were considered one of the most demanding specialties of medicine due to high pressure decision making and high risk surgeries. The United States suffers from a shortage of thousands of OB / GYNs, and many counties do not have a single provider. The new breeding landscape could further discourage medical students from engaging in the field in the future and leave all practitioners with holes in their knowledge due to the new bans. In a study published in Obstetrics & Gynecology, Kavita Vinekar, an assistant clinical professor at the University of California, Los Angeles, and her co-authors found that about half of the medical specialty would be in states that have or are planning to limit or to prohibit abortion? residents will no longer have access to this education despite the fact that it is a requirement of the medical graduate accreditation board. “In our political climate, there is care for abortions and obstetric care in different tubs,” Vinecar explained. “But clinically, the areas are so interconnected.” One week after the leak of a draft decision on Roe vs. Wade, The Post spoke to two women about health conditions that could make the pregnancy life-threatening. (Video: Sarah Parnass / The Washington Post) In McCall, Idaho, about 100 miles outside of Boise, family doctor Caitlin Gustafson does it all – from nursing care and emergency trauma to childbirth. The abortion ban is scheduled to take effect in about 30 days in her state. Gustafson she said she has read state law more than 100 times but still can’t figure out what is allowed – and what a crime can lead to her going to jail. “Every time I read it I get more confused,” he said. A few weeks ago, a woman’s water broke early in pregnancy, long before the fetus was viable. In these cases, doctors usually advise women that they are at risk of sepsis, a systemic infection, and let them decide how to proceed. Some choose an abortion while others wait – but the longer they wait, the greater the risk of life-threatening complications. Gustafson said he was clear he could give the woman a choice in this case. But what about the next patient in similar circumstances after the ban takes effect? On page 1, Idaho law is larger than most and includes attempts to define certain terms. But Gustafson, who has worked as a doctor for more than 20 years, Phrases such as “the unborn child is given the best chance of survival” do not have clear medical definitions and can be interpreted in different ways. The law makes an exception to the prohibition on rape or incest, but individuals seeking abortion in these circumstances are required to provide a copy of a report from a law enforcement agency to a physician. Gustafson worries that the dam is too high. Few people would be willing to make such a report, he said, and doctors would find it difficult to assess its authenticity. “I personally had to consult a lawyer and that would create a further delay,” he said. In addition, he explained, many pregnancy-related complications – including infection as well as preeclampsia, in which blood pressure can rise sharply – involve a gradual decline in a life-threatening condition. It is not clear how sick a patient must be before the exemption of the state that allows abortion to save the mother’s life begins and the patient is entitled to terminate the pregnancy. Gustafson said the new law would lead to a “complete severance of the doctor-patient relationship” with regard to reproductive health care. He worries that it may take years for lawyers and the courts to resolve these issues: “This is not going to be short-lived. This will continue and will continue. “ Meanwhile, doctors are at a dead end as to the measures they can legally take to protect the lives of their pregnant patients. In Nashville, Edward Hills, a physician at Meharry Medical College, a historically Black College, predicts that physicians should spend more time thinking about “defending ourselves against legal challenges.” “It will slow things down,” Hills said. An almost complete abortion ban is set to take effect in Tennessee in a month, but the state attorney general has filed a motion to enforce the restrictions sooner. Hills worries that in the event of a miscarriage that is clear because there is no longer a heartbeat, doctors may want a second person to confirm the ultrasound after the new law “in case of vigilance” comes into force and charges a doctor who made a miscarriage by mistake. Hills, who completed his medical degree in 1974, the following year Roe vs. Wade legalized the right to abortion across the country, said he had seen some “horrible things” with women trying to manage abortions on their own. The United States already has one of the highest maternal mortality rates in the developed world, disproportionately affecting poor women and women of color. He is concerned not only about the risk of death, but also about their ability to carry babies to …
