How high-risk pregnancy care is affected by the abortion ban

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Bleeding and in pain, Kyleigh Thurman had no idea that her pregnancy could be fatal.

Emergency room doctors at Ascension Seton Williamson in Texas gave her a pamphlet on miscarriage and told her to “let nature take its course” before releasing her without treatment for her ectopic pregnancy.

When the 25-year-old man came back three days later, still bleeding, the doctors finally agreed to give him an injection to end his pregnancy. It was too late. A fertilized egg growing in Thurman’s fallopian tube exploded, destroying part of her reproductive system.

That is according to the complaint Thurman and the Center for Reproductive Rights filed last week asking the government to investigate whether the hospital violated federal law when the staff failed to treat her in February 2023.

“I was disappointed,” said Thurman. “It was not easy to be misled.”

The Biden administration says hospitals must perform abortions if necessary to save a woman’s life, despite a federal ban after the Supreme Court struck down the constitutional right to an abortion more than two years ago. Texas is challenging that guidance and, earlier this summer, the Supreme Court declined to resolve the issue.

More than 100 pregnant women in medical distress who sought care in emergency rooms were turned away or mistreated since 2022, an Associated Press investigation of a state hospital found.

Two women – one in Florida and one in Texas – suffered miscarriages in public restrooms. In Arkansas, a woman went into septic shock and her fetus died after the emergency room sent her home. At least four other women with ectopic pregnancies had trouble getting treatment, including one from California who needed a blood transfusion after spending nine hours in the emergency room.

Abortion bans complicate the care of high-risk pregnancies

In Texas, where doctors face up to 99 years in prison if convicted of performing illegal abortions, medical and legal experts say the law makes it difficult to make decisions about emergency pregnancy care.

Although state law states that terminating an ectopic pregnancy is not considered an abortion, large penalties deter Texas doctors from treating such patients, the Center for Reproductive Rights said.

“As much as they fear that hospitals and doctors are not complying with this federal abortion ban, they should also be concerned about violating federal law,” said Marc Hearron, an attorney for the center. Hospitals face federal investigations, large fines and threats from Medicare if they violate federal law.

The organization filed complaints last week with the Centers for Medicare and Medicaid Services alleging that different emergency rooms in Texas failed to treat two patients, including Thurman, who had an ectopic pregnancy.

Another complaint claims that Kelsie Norris-De La Cruz, 25, lost her fallopian tube and most of her uterus after an Arlington, Texas, hospital sent her home without treating her ectopic pregnancy, even after a doctor said the removal “didn’t help her at all.” .”

“Doctors knew I needed an abortion, but this ban makes it difficult to get emergency medical care,” he said in a statement. “I am filing this complaint because women like me deserve justice and accountability for those who abuse us.”

Accurately diagnosing an ectopic pregnancy can be difficult. Doctors cannot always find the location of pregnancy on ultrasound, the three doctors interviewed for this article explained. Hormone levels, bleeding, a positive pregnancy test and an ultrasound of an empty uterus all indicate an ectopic pregnancy.

“You can’t be 100% — that’s the tricky part,” says Kate Arnold, an OB-GYN in Washington. “Literally ticking time bombs. It is a growing pregnancy in this thing that can grow so much.”

Texas Right to Life director John Seago said state law protects doctors from prosecution for terminating an ectopic pregnancy, even if the doctor “made a mistake” in the diagnosis.

“Sending a woman home is completely unnecessary, absolutely dangerous,” Seago said.

But state law has made doctors “completely afraid” to treat pregnant patients, said Hannah Gordon, an emergency physician who worked at a Dallas hospital until last year.

He recalled a patient with symptoms of an ectopic pregnancy in his emergency room in Dallas. Because the OB-GYNs said they couldn’t diagnose the problem, they waited to terminate the pregnancy until she returned the next day.

“It left a bad taste in my mouth,” said Gordon, who came from Texas hoping to get pregnant and concerned about the care she would receive there.

“Oh my God, I’m dying”

When Thurman returned to Ascension Seton Williamson for the third time, her OB-GYN told her she would need surgery to remove her fallopian tube, which had ruptured. Thurman, who was bleeding profusely, screamed. Losing the tube can endanger her fertility.

His doctor told him that he risked dying if he continued to wait.

“He came in and he’s like he’s going to get a blood transfusion, or he’s going to have surgery or he’s going to bleed out,” Thurman said through tears. “That’s when I just said, ‘Oh my God, I’m dying.’

The hospital declined to comment on Thurman’s case, but said in a statement that it is “committed to providing the highest quality care to all who seek our services.”

In Florida, a 15-week pregnant woman leaked amniotic fluid for an hour in the Broward Health Coral Springs emergency room, according to agency documents. An ultrasound examination revealed that the patient did not have amniotic fluid around the fetus, a dangerous condition that can cause serious infections.

A woman miscarried in a public bathroom that day, after the emergency room doctor labeled her condition as improved and released her, without consulting the hospital’s OB-GYN.

Paramedics rushed him to another hospital, where he was put on a ventilator and released six days later.

Abortions after 15 weeks were banned in Florida at the time. The director of obstetrics at Broward Health Coral Springs told the investigator that delivering anyone who presents with premature rupture of membranes “is the standard of care, long ago, regardless of heart rate, because of the risk to the mother. “

The hospital declined to comment.

In another Florida case, a doctor agreed that the state’s law contained emergency pregnancy care.

“Because of the new rules … the staff can’t intervene unless there’s a risk to the patient’s life,” a doctor at Memorial Regional Hospital in Hollywood, Florida, told an investigator investigating the hospital’s failure to perform an abortion on a woman who had water. it ruptured at 15 weeks, before the fetus could survive.

The problems extend beyond abortion ban states

Serious violations that endangered the life of the mother or her fetus occurred in states with abortion bans, an AP review found.

Two short-staffed hospitals — in Idaho and Washington — admitted to investigators that they routinely refer pregnant patients to other hospitals.

A pregnant patient in the Bakersfield, California, emergency room was immediately evaluated, but the staff failed to recognize the urgency of her condition, a ruptured uterus. The delay, the coroner concluded, may have contributed to the infant’s death.

Doctors in emergency rooms in California, Nebraska, Arkansas and South Carolina failed to check the baby’s heartbeat or discharged patients who were busy having a C-section, leaving them to give birth at home or in ambulances, according to the documents.

Shortages of nurses and doctors, ultrasound staffing around the clock and new abortion laws are making the emergency room a dangerous place for pregnant women, warned Dara Kass, an emergency medicine physician and former U.S. Health and Human Services official.

“It’s becoming less and less safe to be pregnant and seek urgent care in the emergency department,” he said.

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