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Confusion post-Roe spurs delays, denials for some lifesaving pregnancy care

Miscarriages, ectopic pregnancies and other common complications are now scrutinized, jeopardizing maternal health

(source)

 

A woman with a life-threatening ectopic pregnancy sought emergency care at the University of Michigan Hospital after a doctor in her home state worried that the presence of a fetal heartbeat meant treating her might run afoul of new restrictions on abortion.

 

At one Kansas City, Mo., hospital, administrators temporarily required “pharmacist approval” before dispensing medications used to stop postpartum hemorrhages, because they can also be also used for abortions.

 

And in Wisconsin, a woman bled for more than 10 days from an incomplete miscarriage after emergency room staff would not remove the fetal tissue amid a confusing legal landscape that has roiled obstetric care.

 

In the three weeks of turmoil since the Supreme Court overturned the constitutional right to abortion, many physicians and patients have been navigating a new reality in which the standard of care for incomplete miscarriages, ectopic pregnancies and other common complications is being scrutinized, delayed — even denied — jeopardizing maternal health, according to the accounts of doctors in multiple states where new laws have gone into effect.

 

While state abortion bans typically carve out exceptions when a woman’s life is endangered, the laws can be murky, prompting some obstetricians to consult lawyers and hospital ethics committees on decisions around routine care.

 

...

 

The need to intervene in a pregnancy with the same medication or surgical procedure used in elective abortions is not unusual.

As many as 30 percent of pregnancies end in miscarriage, the spontaneous demise of a fetus, commonly because of chromosomal abnormalities. The methods of managing a miscarriage are the same as for abortion, using a combination of drugs — mifepristone and misoprostol — or a brief surgery known as dilation and curettage, or D&C, to dilate the cervix and scrape tissue from the uterus.

 

Left untreated, some miscarriages resolve naturally; others lead to complications such as infection or profuse bleeding.

It’s important for people to realize early pregnancy failure is common,” said Rashmi Kudesia, a fertility specialist in Houston.

Doctors in Texas — where since last September abortion has been illegal after the detection of fetal cardiac activity, around six weeks of pregnancy — report that pharmacists have begun questioning patients about miscarriage medications, suspecting they may be used instead for abortions.

 

...

 

Carley Zeal, an OB/GYN in southern Wisconsin and a fellow with Physicians for Reproductive Health, said she recently treated a woman at risk of infection after a miscarriage. Zeal said providers at another hospital had wrestled with what services they could perform — with an 1849 law banning almost all abortions back in effect — and ultimately refused to remove the fetal tissue from the patient’s uterus.

 

“It really delayed her care,” Zeal said. “I saw her a week and a half later with an ongoing miscarriage and bleeding, increasing the risk of severe bleeding as well as infections.”

 

...

 

Zeal said another physician in her practice contacted her the week after the Supreme Court decision as she treated a patient with a ruptured ectopic pregnancy. “She knew exactly what she had to do because [the woman] was bleeding and was clearly going to die if nothing was done,” Zeal said. “But she wasn’t sure what she needed to document to be sure she wouldn’t be charged with a felony.

 

...

 

It turned my attention away from the bedside of the critical-care patient toward documentation,” Wistrom said.

 

...

 

Many state laws with new restrictions on abortion make exceptions for ectopics, but uncertainties can arise if a fetus implants on Caesarean scar tissue on the uterus wall or if it cannot be located.

 

Patricia Nahn, another OB/GYN in Zeal’s practice, said she recently had a patient displaying signs of an ectopic pregnancy, including abdominal pain. But because this was not a clear-cut case in which an ultrasound showed the fetus developing outside the uterus, Nahn faced the potential of terminating a fetus that was in the uterus and violating Wisconsin’s abortion ban.

 

Instead of prescribing medication to terminate the pregnancy in the safest manner, as she would have done before last month’s ruling, Nahn said, she was forced to perform a riskier invasive surgical procedure to confirm the location of the ectopic pregnancy before ending it.

 

If you had just waited and done nothing because you were afraid, she could have died,” Nahn said.

 

...

 

 

New abortion bans oversimplify the reality of obstetric care, physicians say, placing a binary on what is a continuous spectrum of increasing risk. Pregnancy puts huge stress on a patient’s body, sometimes exacerbating existing health problems such as diabetes or hypertension until they become life threatening.

 

 

...

 

Delaying treatment for an ectopic pregnancy is so dangerous it would amount to malpractice, said Pamela Parker, an OB/GYN in Texas’s Rio Grande Valley, who has decided to practice in Arizona because of Texas’s restrictions and the overturning of Roe.

 

...

 

Indiana lawmakers are considering new restrictions on abortion in a special session in late July. At least one legislator has floated a total ban with no exceptions to save the patient’s life. 

 

...

 

Although Ohio’s abortion ban makes an exception to save a patient’s life, Winchester considered a pregnant woman she treated last year who had a malignant tumor on her cervix that threatened her life, but not imminently. The woman had two children in high school who begged her to terminate the pregnancy and get treatment for the cancer.

 

“They wanted her to see them graduate,” said Winchester, who performed an abortion on the woman. “That’s something I don’t know if I would be allowed to do here in Ohio anymore.”

 

...

 

Other women are planning ahead in an effort to avoid situations where they may be denied abortions.

 

Kelly Walters, 37, who developed preeclampsia in two of her four pregnancies, said she was so rattled by the abortion ban in Missouri, where she lives, that she is now preparing to have a hysterectomy.

 

“I was told I absolutely can’t get pregnant again,” said Walters, who has residual damage from strokes caused by the preeclampsia.

“I don’t think I could survive it.”

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2 hours ago, ChiGoose said:


One of those extremists is a sitting Supreme Court Justice. 

I couldn’t disagree more. To some, following the directions as written may be “ extreme” , but it’s really quite the opposite. 

1 hour ago, ChiGoose said:

Confusion post-Roe spurs delays, denials for some lifesaving pregnancy care

Miscarriages, ectopic pregnancies and other common complications are now scrutinized, jeopardizing maternal health

(source)

 

A woman with a life-threatening ectopic pregnancy sought emergency care at the University of Michigan Hospital after a doctor in her home state worried that the presence of a fetal heartbeat meant treating her might run afoul of new restrictions on abortion.

 

At one Kansas City, Mo., hospital, administrators temporarily required “pharmacist approval” before dispensing medications used to stop postpartum hemorrhages, because they can also be also used for abortions.

 

And in Wisconsin, a woman bled for more than 10 days from an incomplete miscarriage after emergency room staff would not remove the fetal tissue amid a confusing legal landscape that has roiled obstetric care.

 

In the three weeks of turmoil since the Supreme Court overturned the constitutional right to abortion, many physicians and patients have been navigating a new reality in which the standard of care for incomplete miscarriages, ectopic pregnancies and other common complications is being scrutinized, delayed — even denied — jeopardizing maternal health, according to the accounts of doctors in multiple states where new laws have gone into effect.

 

While state abortion bans typically carve out exceptions when a woman’s life is endangered, the laws can be murky, prompting some obstetricians to consult lawyers and hospital ethics committees on decisions around routine care.

 

...

 

The need to intervene in a pregnancy with the same medication or surgical procedure used in elective abortions is not unusual.

As many as 30 percent of pregnancies end in miscarriage, the spontaneous demise of a fetus, commonly because of chromosomal abnormalities. The methods of managing a miscarriage are the same as for abortion, using a combination of drugs — mifepristone and misoprostol — or a brief surgery known as dilation and curettage, or D&C, to dilate the cervix and scrape tissue from the uterus.

 

Left untreated, some miscarriages resolve naturally; others lead to complications such as infection or profuse bleeding.

It’s important for people to realize early pregnancy failure is common,” said Rashmi Kudesia, a fertility specialist in Houston.

Doctors in Texas — where since last September abortion has been illegal after the detection of fetal cardiac activity, around six weeks of pregnancy — report that pharmacists have begun questioning patients about miscarriage medications, suspecting they may be used instead for abortions.

 

...

 

Carley Zeal, an OB/GYN in southern Wisconsin and a fellow with Physicians for Reproductive Health, said she recently treated a woman at risk of infection after a miscarriage. Zeal said providers at another hospital had wrestled with what services they could perform — with an 1849 law banning almost all abortions back in effect — and ultimately refused to remove the fetal tissue from the patient’s uterus.

 

“It really delayed her care,” Zeal said. “I saw her a week and a half later with an ongoing miscarriage and bleeding, increasing the risk of severe bleeding as well as infections.”

 

...

 

Zeal said another physician in her practice contacted her the week after the Supreme Court decision as she treated a patient with a ruptured ectopic pregnancy. “She knew exactly what she had to do because [the woman] was bleeding and was clearly going to die if nothing was done,” Zeal said. “But she wasn’t sure what she needed to document to be sure she wouldn’t be charged with a felony.

 

...

 

It turned my attention away from the bedside of the critical-care patient toward documentation,” Wistrom said.

 

...

 

Many state laws with new restrictions on abortion make exceptions for ectopics, but uncertainties can arise if a fetus implants on Caesarean scar tissue on the uterus wall or if it cannot be located.

 

Patricia Nahn, another OB/GYN in Zeal’s practice, said she recently had a patient displaying signs of an ectopic pregnancy, including abdominal pain. But because this was not a clear-cut case in which an ultrasound showed the fetus developing outside the uterus, Nahn faced the potential of terminating a fetus that was in the uterus and violating Wisconsin’s abortion ban.

 

Instead of prescribing medication to terminate the pregnancy in the safest manner, as she would have done before last month’s ruling, Nahn said, she was forced to perform a riskier invasive surgical procedure to confirm the location of the ectopic pregnancy before ending it.

 

If you had just waited and done nothing because you were afraid, she could have died,” Nahn said.

 

...

 

 

New abortion bans oversimplify the reality of obstetric care, physicians say, placing a binary on what is a continuous spectrum of increasing risk. Pregnancy puts huge stress on a patient’s body, sometimes exacerbating existing health problems such as diabetes or hypertension until they become life threatening.

 

 

...

 

Delaying treatment for an ectopic pregnancy is so dangerous it would amount to malpractice, said Pamela Parker, an OB/GYN in Texas’s Rio Grande Valley, who has decided to practice in Arizona because of Texas’s restrictions and the overturning of Roe.

 

...

 

Indiana lawmakers are considering new restrictions on abortion in a special session in late July. At least one legislator has floated a total ban with no exceptions to save the patient’s life. 

 

...

 

Although Ohio’s abortion ban makes an exception to save a patient’s life, Winchester considered a pregnant woman she treated last year who had a malignant tumor on her cervix that threatened her life, but not imminently. The woman had two children in high school who begged her to terminate the pregnancy and get treatment for the cancer.

 

“They wanted her to see them graduate,” said Winchester, who performed an abortion on the woman. “That’s something I don’t know if I would be allowed to do here in Ohio anymore.”

 

...

 

Other women are planning ahead in an effort to avoid situations where they may be denied abortions.

 

Kelly Walters, 37, who developed preeclampsia in two of her four pregnancies, said she was so rattled by the abortion ban in Missouri, where she lives, that she is now preparing to have a hysterectomy.

 

“I was told I absolutely can’t get pregnant again,” said Walters, who has residual damage from strokes caused by the preeclampsia.

“I don’t think I could survive it.”

These appear to be very bad ideas. I doubt they would get enough support in very many states to actually become law. It’s in the hand of the people to make sure they don’t. Many horrendous laws and policies have been passed by Democrats in states they control though , so I guess anything is possible. 

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7 minutes ago, Boatdrinks said:

I couldn’t disagree more. To some, following the directions as written may be “ extreme” , but it’s really quite the opposite. 

 

 

So you don't think repealing the right to contraceptives is extreme?

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Just now, ChiGoose said:

 

So you don't think repealing the right to contraceptives is extreme?

Yes it would be to me and probably north of 90% of Americans. That’s why it won’t happen. Many ideas are extreme , but not explicitly banned by the Constitution. It doesn’t mean they have any chance of becoming law, because there is no political will by the people to do so. Condoms, the pill, plan B etc are still going to be around regardless of fear mongering politicians and their election year histrionics. We have representative government in the USA, so we generally don’t have to worry about dictators telling us what to do. Unless it’s a Dem telling us to wear a face diaper or get a jab. 

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1 minute ago, Boatdrinks said:

Yes it would be to me and probably north of 90% of Americans. That’s why it won’t happen. Many ideas are extreme , but not explicitly banned by the Constitution. It doesn’t mean they have any chance of becoming law, because there is no political will by the people to do so. Condoms, the pill, plan B etc are still going to be around regardless of fear mongering politicians and their election year histrionics. We have representative government in the USA, so we generally don’t have to worry about dictators telling us what to do. Unless it’s a Dem telling us to wear a face diaper or get a jab. 

 

So when I said that one of the people who wants to do a thing that is extreme is on the Supreme Court and you said that he's just following the rules and isn't extreme, but then you said that doing the thing that he wants to do is extreme, what you meant was...?

 

Because I'm confused. It sounds like you're saying the guy who wants to do the thing that you say is extreme is not extreme and he's just following directions, but not to worry because the thing that he wants is so extreme nobody will go for it.

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12 minutes ago, ChiGoose said:

 

So when I said that one of the people who wants to do a thing that is extreme is on the Supreme Court and you said that he's just following the rules and isn't extreme, but then you said that doing the thing that he wants to do is extreme, what you meant was...?

 

Because I'm confused. It sounds like you're saying the guy who wants to do the thing that you say is extreme is not extreme and he's just following directions, but not to worry because the thing that he wants is so extreme nobody will go for it.

It means there is no “ Constitutional right “ explicitly implied for a lot of things. That’s following the document.  You are talking about a Supreme Court justice, who by design does not make law. Therefore he cannot “ Do” what you are describing. It’s not confusing at all. There is nothing to lose sleep over. Contraceptives are not going away. 

Edited by Boatdrinks
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13 minutes ago, Boatdrinks said:

It means there is no “ Constitutional right “ explicitly implied for a lot of things. That’s following the document. 

 

So you agree with Clarence Thomas that there is no constitutional right to contraceptives and that Griswold v. Connecticut should be overturned?

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54 minutes ago, ChiGoose said:

 

So you agree with Clarence Thomas that there is no constitutional right to contraceptives and that Griswold v. Connecticut should be overturned?

I confess I’m not at all familiar with the case, so I cannot comment on it. As for Thomas, one could probably make a sound argument to that effect, but it wouldn’t mean it would/ should be outlawed. Countless “ disaster” scenarios that simply will never come to be can be imagined if one wants to. It seems a pointless exercise. Do you feel you have a “ constitutional right” to do whatever you wish, or just the freedom to do it? 

Edited by Boatdrinks
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48 minutes ago, Boatdrinks said:

I confess I’m not at all familiar with the case, so I cannot comment on it. As for Thomas, one could probably make a sound argument to that effect, but it wouldn’t mean it would/ should be outlawed. Countless “ disaster” scenarios that simply will never come to be can be imagined if one wants to. It seems a pointless exercise. Do you feel you have a “ constitutional right” to do whatever you wish, or just the freedom to do it? 

Based off his concurrent opinion on Roe v. Wade, he said the Supreme Court should revisit Supreme Court decisions that ruled married couples can buy and use contraceptives, that two adults are allowed to engage in same sex intimacy, and the ruling that made same sex marriages legal.  I would say the first two are pretty extreme.

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3 hours ago, Boatdrinks said:

I confess I’m not at all familiar with the case, so I cannot comment on it. As for Thomas, one could probably make a sound argument to that effect, but it wouldn’t mean it would/ should be outlawed. Countless “ disaster” scenarios that simply will never come to be can be imagined if one wants to. It seems a pointless exercise. Do you feel you have a “ constitutional right” to do whatever you wish, or just the freedom to do it? 

 

Griswold v. Connecticut is a case that involves the Right to Privacy. The case centered on the question on whether the Constitution protected the right of marital privacy against state restrictions on a couple's ability to be counseled in the use of contraceptives. Notably, the Constitution does not explicitly grant a right to privacy and you will not find that word in the text.

 

However, the Supreme Court found that several amendments (First, Third, Fourth, Fifth, and Ninth) implied a right to privacy. The 14th amendment is also mentioned in a concurrence and becomes important for privacy as well. Importantly, the Ninth amendment was passed specifically to make it clear that just because a right was not explicitly enumerated in the Constitution does not mean that said right does not exist:

 

"The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people."

 

Following Griswold, the Court identified other areas in which it believed a right to privacy exists:

  • Eisenstadt v. Baird: Even unmarried people also have a right to contraceptives as the "constitutionally protected right of privacy inheres in the individual, not the marital couple."
  • Roe v. Wade: The right to privacy is broad enough to encompass a woman's decision whether or not to terminate her pregnancy.
  • Lawrence v. Texas: The right of privacy includes persons of the same sex being able to engage in sexual conduct.

According to Thomas, these cases were wrong when they were decided (I don't believe he specifically mentioned Eisenstadt, but he does mention Griswold and Lawrence, as well as Obergefell) and the court should take them up in light of the new standard laid down in Dobbs.

 

Notably, Lawrence was decided in 2003, when Texas still had a law making it illegal to have sex with a member of the same sex. At that time, there were still laws against sex between members of the same sex, as well as more general sex laws (prohibiting non-procreative sexual acts), on the books in multiple states.

 

Personally, I don't like the idea of leaving it up to the legislature to dictate whether oral sex is ok, or what consenting adults do in the privacy of their own bedrooms. Clarence Thomas disagrees, and I would suspect he's not the only one.

Edited by ChiGoose
Apparently a very common word for laws regulated sex is banned...
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On 5/2/2022 at 10:47 PM, LeviF said:

Overturn Griswold while you’re at it. The Warren Court was a disaster. 

 

7 hours ago, ChiGoose said:

 

So you agree with Clarence Thomas that there is no constitutional right to contraceptives and that Griswold v. Connecticut should be overturned?

 

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8 hours ago, ChiGoose said:

 

Griswold v. Connecticut is a case that involves the Right to Privacy. The case centered on the question on whether the Constitution protected the right of marital privacy against state restrictions on a couple's ability to be counseled in the use of contraceptives. Notably, the Constitution does not explicitly grant a right to privacy and you will not find that word in the text.

 

However, the Supreme Court found that several amendments (First, Third, Fourth, Fifth, and Ninth) implied a right to privacy. The 14th amendment is also mentioned in a concurrence and becomes important for privacy as well. Importantly, the Ninth amendment was passed specifically to make it clear that just because a right was not explicitly enumerated in the Constitution does not mean that said right does not exist:

 

"The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people."

 

Following Griswold, the Court identified other areas in which it believed a right to privacy exists:

  • Eisenstadt v. Baird: Even unmarried people also have a right to contraceptives as the "constitutionally protected right of privacy inheres in the individual, not the marital couple."
  • Roe v. Wade: The right to privacy is broad enough to encompass a woman's decision whether or not to terminate her pregnancy.
  • Lawrence v. Texas: The right of privacy includes persons of the same sex being able to engage in sexual conduct.

According to Thomas, these cases were wrong when they were decided (I don't believe he specifically mentioned Eisenstadt, but he does mention Griswold and Lawrence, as well as Obergefell) and the court should take them up in light of the new standard laid down in Dobbs.

 

Notably, Lawrence was decided in 2003, when Texas still had a law making it illegal to have sex with a member of the same sex. At that time, there were still laws against sex between members of the same sex, as well as more general sex laws (prohibiting non-procreative sexual acts), on the books in multiple states.

 

Personally, I don't like the idea of leaving it up to the legislature to dictate whether oral sex is ok, or what consenting adults do in the privacy of their own bedrooms. Clarence Thomas disagrees, and I would suspect he's not the only one.

A lot of outdated laws were probably on the books in many states at that time, and some may still be. I highly doubt these laws are ever enforced or even enforceable. Heck, Dems don’t want to enforce laws that actually affect other people and their property or physical well being. They’re too busy finding new ways to coddle criminals and hamper Police departments. I doubt there is any political will to legislate who can receive oral sex from whom. It’s just not something many people care about ; maybe they did when Leave it to Beaver was a prime time TV show. Abortion is a huge wedge issue and has been for decades. 

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10 hours ago, Doc Brown said:

Based off his concurrent opinion on Roe v. Wade, he said the Supreme Court should revisit Supreme Court decisions that ruled married couples can buy and use contraceptives, that two adults are allowed to engage in same sex intimacy, and the ruling that made same sex marriages legal.  I would say the first two are pretty extreme.

I would agree with your opinion. I’m not aware of Thomas saying that these rulings should be revisited by the Court. However, I’ll take your word for it. I disagree with Thomas on that because almost no one in America wants to legislate against it in any way. It would be a complete waste of time. 

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