Three women hold signs at a May 3 protest in Nashville over a leaked U.S. Supreme Court document indicating the court may roll back Roe v. Wade. (Photo: John Partipilo)
The days of safe and legal abortion are limited in Tennessee.
Our state has a “trigger ban” on abortion, scheduled to go into effect when the Supreme Court ruling on Dobbs v. Jackson becomes final and Roe v. Wade is overturned. When this happens, it means that emgergency physicians like me will no longer be able to refer my patients who need an abortion to a facility where they can obtain one safely within our state.
The only exception for the new abortion ban in Tennessee would be for the “life of the mother,” a term deliberately vague enough to give many doctors and healthcare workers pause. What does the “life of the mother” exception really mean? How threatened must someone’s life be before we can intervene and help them medically?
Take ectopic pregnancies. In an ectopic pregnancy, a fertilized egg implants itself outside the uterus, typically in the fallopian tubes or an ovary, but occasionally into other sites in the abdominal cavity. I’ve seen a case report of an ectopic pregnancy in someone’s liver.
These pregnancies are not viable. Contrary to the belief of some politicians, there is no medical way to salvage them or reimplant them into the uterus. Eventually, an ectopic pregnancy will grow large enough to rupture the organ in which it is growing and cause the patient to hemorrhage.
In current practice, if I diagnose an ectopic pregnancy in my emergency department, I call my obstetric/gynecology colleague and we discuss the case. If the patient is not too far along in the pregnancy and there are no signs of rupture, we treat the patient with a medical abortion. The patient takes a pill called methotrexate and follows up in the clinic for a repeat ultrasound and check of her hormone levels. If there is cardiac activity on ultrasound, hormone levels are high, the ectopic pregnancy is large or there are any signs of rupture, the Ob/Gyn physician takes the patient for an operation to remove the ectopic pregnancy, thus aborting the nonviable fetus.
In a post-Roe state where abortion is illegal from the moment of conception with only “life of the mother” exceptions, a physician may hesitate to act until the patient is hemorrhaging and their life is at risk. But we know from years of scientific study that treating ectopic pregnancies prior to rupture leads to better outcomes and fewer deaths. I worry that the vaguely-worded abortion laws about to take effect in Tennessee will cause women to suffer and die as a result.
Another case would be that of a pregnant patient who goes into labor before the fetus is viable, or before 24 weeks.The first step is an ultrasound, done in the emergency department, before the patient is admitted to the labor and delivery ward and my OB colleague takes over treatment. The treatment involves trying to stop the labor with medications. If that is unsuccessful and the patient’s water breaks, then an abortion is necessary to save the mother’s life.
There have been several cases around the world where patients have not been given abortions when they’ve gone into preterm labor with nonviable fetuses because of anti-abortion laws. These patients have become septic from severe infections allowed to fester in their wombs and spread throughout their bodies until they go into multi-system organ failure and die.
I know other emergency and OB/Gyn physicians who are incredibly concerned about these two scenarios and countless others. What will the OB physicians who specialize in high risk pregnancies do when their high risk patients suffer? How will in-vitro fertilization be affected by the new laws?
And where is that line where a patient’s life is so at risk that doctors are allowed to do their jobs?
If I, an emergency physician, don’t know the answer to these questions, you can bet most other doctors in our state don’t either. What I do know is our patients will suffer and some will die.
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