by Megan Burbank

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In April, northern Idaho’s Valor Health Hospital announced it would be closing its labor and delivery unit. It was the second Idaho hospital in as many months to stop delivering babies: Bonner Health had made headlines when it did the same thing in April, citing the state’s political situation as a contributing factor. Idaho is home to some of the country’s most draconian abortion laws, and the state’s long-running hostility toward abortion means patients from Idaho often relied on Eastern Washington abortion providers since long before Roe’s reversal.

But shutting down labor and delivery units is new. And a new report, “Care Post-Roe: Documenting cases of poor-quality care since the Dobbs decision,” from the reproductive policy research organization Advancing New Standards in Reproductive Health (ANSIRH), shows why: As abortion laws keep physicians from providing standard pregnancy care as well as abortion, it’s leading to worse outcomes for pregnant people and their babies — and pushing clinicians to reconsider whether it’s even worth practicing in states where they effectively can no longer do their jobs.

“Care Post-Roe” draws on 50 case studies — one of them from Idaho — “that deviated from the usual standard due to laws restricting abortion that went into effect after Dobbs.” It captures a dynamic that’s left patients in extremely dangerous situations, and frustrated physicians dealing with ambiguous abortion bans that often don’t allow abortion unless it’s the treatment for a life-threatening emergency — the criteria for which is also unclear. “Health care providers described feeling moral distress when they were unable to provide evidence-based care, and some reported considering moving their practices to a state where abortion remains legal,” wrote the researchers in a news release.

“Care Post-Roe” details cases where patients’ care was delayed, denied, or complicated due to abortion bans, and the report aligns with ongoing media accounts of abortion bans restricting care for pregnancy complications as well as elective abortion. In one report, a doctor in a ban state describes meeting with a patient who, despite going into preterm labor between 16 and 18 weeks into her pregnancy, had previously been turned away when she sought treatment.

The patient delivered her fetus — while experiencing “severe sepsis” and a bacterial blood infection — but not her placenta. “We try every medical protocol we can find to help her placenta deliver; none are successful,” the doctor recalled in the report. As the patient developed a serious blood-clotting condition, the doctor recalled the distress of the providers working on this case: “The anesthesiologist cries on the phone when discussing the case with me — if the patient needs to be intubated, no one thinks she will make it out of the OR. I do a D&C” (an abortion procedure to remove the remaining tissue in the patient’s uterus).

The patient bled “from everywhere,” said the doctor, but survived. Despite how close she came to death, the physician recalls, the patient was concerned she had done something illegal by receiving treatment: “She asks me: Could she or I go to jail for this? Or did this count as life-threatening yet?”

Another report details a case where anesthesiology staff denied a patient an epidural while she was in advanced labor, enduring a miscarriage at 19–20 weeks of pregnancy, citing their state’s abortion ban.

“They believed that providing an epidural could be considered [a crime] under the new law,” recalled the physician who handled the case. “The patient received some IV morphine instead and delivered a few hours later but was very uncomfortable through the remainder of her labor. I will never forget this case because I overheard the primary provider say to a nurse that so much as offering a helping hand to a patient getting onto the gurney while in the throes of a miscarriage could be construed as ‘aiding and abetting an abortion.’ Best not to so much as touch the patient who is miscarrying … A gross violation of common sense and the oath I took when I got into this profession to soothe my patients’ suffering.”

These are some of the most extreme reports in “Care Post-Roe.” But it’s worth noting that the report details ramifications for situations that have nothing to do with abortion, including cases involving a patient who needed a D&C after a postpartum hemorrhage and was initially denied care; an elective gynecologic surgery that was delayed; and a liver transplant that was canceled.

Early miscarriage care was also impacted, with several accounts of patients being denied treatment: One patient had just moved from a state that permitted abortion to a ban state when she sought care for a miscarriage. When clinicians refused her appropriate treatment, she had to return to her home state for care.

Abortion bans may single out abortion specifically, but as the report shows, they ignore this reality: Abortion is not always — or even often — an elective procedure. The standard treatment for miscarriage is abortion, whether that takes the form of a dilation and curettage (D&C) in-office procedure or by prescribing the abortion pills misoprostol and mifepristone.

And as emerging data like those captured in “Care Post-Roe” illustrate, abortion bans don’t just prevent people from accessing elective abortion; they cause harm on a nearly unfathomable scale, impacting pregnancy care, timely treatment for life-threatening pregnancy complications, and procedures unrelated to reproductive health, and they result in harmful outcomes broadly, because they ignore the standard of care — and the fact that sometimes abortion is what keeps an uncomfortable but manageable health scenario from escalating into something much more damaging.

When a person has a miscarriage or pregnancy complication, an abortion isn’t used to terminate a pregnancy that would have safely continued. It’s used to prevent unnecessary suffering. And keeping people from accessing appropriate care during a miscarriage just means enduring pregnancy loss will cause more suffering than it otherwise would. People don’t typically choose to become doctors in the hopes of adding to the world’s suffering, and it’s no surprise that many are leaving states where laws are pushing them into situations where that’s exactly what they must do.

As one physician in “Care Post-Roe” put it, recalling a case in which a patient required out-of-state travel for care: ​​“The degree of coordination between Ob/Gyns in different states was heroic; however, this effort took away from other patients that our providers were caring for. The fact that her own Ob/Gyn could not provide evidence-based, standard-of-care treatments because of a state policy is unacceptable.”

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📸 Featured Image: Photo via KieferPix/Shutterstock.com

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