UCSF study shows health complications due to post-Roe abortion laws

A new report has identified dozens of examples in which medical providers say pregnant patients received care in the past year that deviated from care they would have received before the Supreme Court overturned Roe v. Wade — a sign, researchers said, of a pattern of serious health complications triggered by abortion bans.

While no nationwide data has yet emerged to show the extent of these complications, the report, being released Tuesday by researchers at the University of California San Francisco and shared with The Washington Post, offers a first-of-its-kind summary of anonymized examples from medical providers across the country.

The two research groups that conducted the report — UCSF’s Advancing New Standards in Reproductive Health and the Texas Policy Evaluation Project at the University of Texas at Austin — support abortion rights.

Individual cases of health complications related to abortion bans have emerged since the June ruling, including stories of women turned away from hospitals with life-threatening pregnancy conditions as doctors and hospital administrators fear the legal risk that could come with terminating even a pregnancy that could jeopardize the mother’s well-being. But the new report, which listed 50 examples shared by providers who chose to participate in a national survey, represented an effort to capture a more expansive picture of how health care has been affected by abortion bans.

Patients “are being harmed in significant ways because care is being denied or delayed,” said Daniel Grossman, a professor at UCSF and the lead author of the report. “These laws are having a broader impact beyond people who are seeking abortion because they have an undesired pregnancy.”

Two friends were denied care after Florida banned abortion. One almost died.

The findings include examples of one patient who developed a severe infection after she was sent home from the hospital, leaving her in critical condition — and another who could not obtain an abortion for a Caesarean scar ectopic pregnancy, a life-threatening condition where a pregnancy implants in the scar of a prior Caesarean section.

The medical exceptions to protect the life of the mother that are included in abortion bans are often described in vague language, Grossman said, creating uncertainty among medical providers who say the laws do not clearly allow them to terminate pregnancies for patients with serious health risks.

Antiabortion lawmakers who drafted existing abortion bans say the language in the laws permits doctors to intervene in a wide range of medical emergencies, with some claiming that doctors are willfully misinterpreting the medical exceptions to make a political point.

“In situations where a doctor is acting in good faith, I believe they can act in that moment,” said former Florida state senator Kelli Stargel, who sponsored Florida’s 15-week abortion ban. “It’s not anyone’s intention to have things go to court.”

Grossman said the responses to the report showed that many doctors did not feel they could safely perform abortions in high-risk situations. Hospitals, he added, often do not provide any additional guidance for physicians beyond the language in the law, leaving doctors unsure of how to act in any given situation.

“Medicine isn’t black and white,” said Grossman. “It’s not like suddenly you know that a patient is at a very high risk of dying in a certain situation. There’s a lot of gray and that risk will slowly change over time.”

To collect submissions for the report, Grossman and his team established an online portal that would allow medical providers to submit their experiences anonymously if they chose, Grossman said, which was important because many hospitals have barred medical providers from speaking to the media about policies related to abortion bans. The research team shared the portal through various medical and nursing associations, soliciting submissions from a wide range of medical providers, including doctors, nurse practitioners, midwives and nurses.

The most common type of complication among the respondents was preterm premature rupture of the membranes, or PPROM, a condition where a woman’s water breaks before the fetus can survive on its own, putting the patient at a high risk for infection and hemorrhage.

When abortion was legal across the country, doctors in all states would typically offer to induce or perform a surgical procedure to end the pregnancy when faced with a pre-viability PPROM case — which is the standard of care, according to the American College of Obstetricians and Gynecologists (ACOG), and an option that many women choose. Especially before the 20-week mark, a fetus is extremely unlikely to survive without any amniotic fluid.

Many doctors have been turning away PPROM patients since Roe was overturned, according to the report, no longer offering the option to induce the pregnancy or perform an abortion.

In one case cited in the report, a patient was sent home after her water broke between 16 and 18 weeks of pregnancy in a state where abortion is banned — only to return to the intensive care unit two days later with a severe infection, according to a physician involved in the case.

“The anesthesiologist cries on the phone when discussing the case with me,” the physician wrote. “If the patient needs to be intubated, no one thinks she will make it out of the [operating room.]”

After the doctor ultimately decided to terminate the pregnancy, the doctor wrote, the patient asked if she or her doctor could face criminal penalties.

“She asks me: could she or I go to jail for this?” the doctor recounted in their submission. “Or did this count as life threatening yet?”

Republican lawmakers have repeatedly said that medical exceptions in abortion bans clearly cover patients with ectopic pregnancies.

But several clinicians in the report said that patients with Caesarean scar ectopic pregnancies experienced delays in their care due to abortion bans, putting patients at a high risk for hemorrhage, the placenta growing into surrounding organs and rupture of the uterus.

After greenlighting an abortion for a patient with a Caesarean scar ectopic pregnancy, one doctor described a situation where other colleagues who were necessary to safely complete the procedure were unwilling to help, saying they did not feel “legally protected.” The physician recommended that the patient travel elsewhere, but the patient did not have the means to leave the state.

The physician said their team continued to monitor the patient, who at the time of the physician’s submission was still pregnant, and developing percreta, a life-threatening pregnancy complication that could prompt heavy bleeding or a uterine rupture any moment.

The research also highlighted a number of other pregnancy complications that medical providers said were impacted by the Supreme Court ruling. Patients were unable to terminate pregnancies with fetal anomalies, medical providers said, while others faced delays in obtaining the medication necessary to treat an early miscarriage.

Concerns surrounding abortion bans led doctors to delay or deny several treatments unrelated to abortion, according to the report. In one case, a clinician refused to remove an intrauterine device (IUD) for a patient who was between 10 and 12 weeks pregnant, despite the fact that the IUD had partially expelled, increasing the patient’s risk of infection or miscarriage.

“The doctor did not feel comfortable removing the IUD because it could cause a miscarriage,” wrote one physician consulted on the case. “The context provided was concern over the recent changes in law that create [the] possibility for felony charges for providers causing abortion in our state.”

One limitation of the report, Grossman said, is that he and his team were not able to collect enough examples to meaningfully observe changes over time. As more time passes, he added, doctors may become more aware of the types of care they can offer under the new laws — something Grossman and his team plan to continue to measure.

To help with these situations, Grossman said, hospitals in states where abortion is banned could provide a list of conditions that doctors can legally treat — specifying, for example, that providers can legally offer to induce a PPROM pregnancy. Alternatively, he said, Republican lawmakers could offer further laws or amendments to clarify the medical exceptions.

“It may be a first step,” Grossman said. “But I don’t think any list can ever be comprehensive. There will always be conditions that are not on the list that are dangerous.”

Last month in Florida, during debate on a proposed six-week abortion ban, a Democratic lawmaker, Rep. Robin Bartleman, introduced an amendment that would have explicitly allowed doctors to induce or perform an abortion if a woman presents at a hospital with PPROM.

Rep. Jenna Persons-Mulicka (R), who sponsored the six-week ban in the Republican-led legislature, said the medical exception already included in the bill covered that kind of situation, despite stories recounted on the House floor demonstrating that doctors did not feel they could act in a PPROM situation.

The amendment was defeated by a party-line vote of 33-80.

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