By Aria Bendix -
NBC News
The patient was seven weeks pregnant in Texas and had kidney failure, which many doctors would consider a life-threatening condition.
But abortions there are prohibited after a fetal heartbeat is detected (which happens around six weeks of pregnancy), unless "a doctor believes there is a medical emergency that prevents completion of the term."
A total abortion ban will go into effect in Texas in about a month, following the reversal of the Roe v.
Wade.
“I told them, 'Don't give her an appointment,'” recalled Dr. Jessica Rubino, an abortion provider at the Austin Women's Health Center.
“Get her out of state.
Get on the phone with someone at another clinic
and make sure she can get an abortion there because I won't be able to do it here.
I'll have to wait until she's really dying,” she told an aide.
A woman undergoes an ultrasound to verify her pregnancy at a clinic in Louisiana, on April 15, 2022. Gerald Herbert / AP
Rubino no longer performs abortions for fear of being sued in Texas.
The current six-week ban in Texas allows private citizens to sue anyone who helps someone have an abortion after a so-called fetal heartbeat occurs.
If the lawsuit is successful,
the plaintiffs can receive up to $10,000.
Additionally, Texas has a law designed to go into effect 30 days after the Supreme Court's ruling stripped constitutional protections for abortion.
That law makes the voluntary termination of pregnancy a serious crime, with no exceptions for rape or incest.
[Biden supports changing Senate rules to be able to legislate on abortion without Republican blockade]
Many doctors now face a similar situation.
Most of the abortion bans that went into effect on Friday or will become law soon make exceptions for life-threatening situations during pregnancy.
But there is no clear legal definition of what conditions qualify for those exceptions
, or how severe they must be for a doctor to perform an abortion without breaking the law.
“What does the risk of death have to be and how imminent does it have to be?” Professor Lisa Harris, who teaches reproductive health at the University of Michigan, asked in an article in The New England Journal of Medicine.
“Could abortion be permissible in a patient with pulmonary hypertension, for whom there is a 30 to 50% chance of dying with the pregnancy in progress?
Or should it be 100%?
Harris told our sister network NBC News that doctors in states where abortion is now illegal (which is not the case in Michigan) will probably
have to wait "until the last minute to perform the procedure, when it's clear that the patient he
will die
and that is not an ideal time to do any kind of intervention”.
[States say that vetoing abortion does not affect in vitro fertilization. Doctors doubt]
Experts believe that more mothers will die as a result.
Currently about 700 women die each year from pregnancy-related complications in the United States, according to the Centers for Disease Control and Prevention (CDC).
About 3 out of 5 of those deaths are preventable.
A study from last year found that states that restrict access to abortion have higher rates of maternal mortality than those that allow it.
The most obvious threats to a pregnant woman's life
Harris said one condition that likely qualifies as life-threatening is an ectopic pregnancy that ruptures the fallopian tube.
This occurs when the fetus develops outside the uterus and can cause internal bleeding and require immediate surgery.
An infection in the uterus can also be imminently life-threatening, Harris said.
The same is true for patients who begin to bleed from problems such as an ongoing miscarriage or traumatic injury.
Biden administration announces measures after Supreme Court ruling on abortion
June 29, 202200:30
“Often the rule is that you have to be in imminent danger of dying,” said Priscilla Smith, director of the Program for the Study of Reproductive Justice at Yale Law School.
“What that means is that these people are at risk of dying at that point, rather than having that pregnancy endanger their life if it is not terminated.”
But there are many circumstances where it is not clear whether a patient is close to death.
“It's not like a switch that turns on or off and says, 'Okay, this person is bleeding a lot, but not enough to die,' and then all of a sudden they bleed enough to die,” Harris said.
"It's a continuum, so even how does anyone know where a person is in that process is really complicated."
Diseases like cancer might not qualify as a threat
When pregnant women are diagnosed with cancer, or people with cancer become pregnant, they sometimes must decide whether to end the pregnancy to have surgery, radiation, or chemotherapy, since these treatments can harm the fetus.
That situation probably doesn't qualify as risky enough, Smith explained.
[COVID-19 skyrocketed the maternal mortality rate in the US. The fall of Roe v. Wade will make it even worse]
The Dayton Daily News already reported on one such case this week: a woman whose doctors said she needed to end her pregnancy before receiving chemotherapy, and would have to leave the state to do so.
Because Ohio prohibits abortions after six weeks.
"There are so many health conditions that could pre-exist pregnancy or may have first emerged during pregnancy," Harris said.
“This is also where there is a lot of ambiguity, because the patient could be fine early in the pregnancy, but she could have complications later when the body is under more pressure,” she added.
Smith said there are also not many regulations that clarify what to do if a patient has high blood pressure, lung or heart problems.
“Could a patient request an abortion to avoid a 50% chance of dying?
To me, that seems like a very high possibility,” Smith said.
Fear of Lawsuits May Change Medical Practice
Most of the laws that prohibit abortion punish the doctors and health workers who provide it with prison, instead of targeting the patients.
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Smith believes that in many states where abortion is prohibited there are "zealous" prosecutors who "will go to great lengths to shut down clinics and jail doctors or strip them of their licenses."
Therefore, doctors can make decisions detrimental to the health of their patients to protect themselves legally.
If clinics stop performing emergency abortions because they can't afford the cost of lawsuits, hospitals might be able to.
But according to Harris, many hospitals don't have doctors who specialize in emergency dilation and evacuation, a common method of abortion after the first trimester.
[More than a dozen states ban or limit abortion following Supreme Court ruling. This is the access map]
If doctors resort to abdominal surgery in such cases, the risk to the patient is greatly increased and "there's a greater chance of future complications and problems getting the patient pregnant again," Harris said.
Rubino anticipates that there will be more pregnancy-related deaths in her state.
"If you're pregnant in Texas with medical complications or you're sick and you don't go to another state, you're just going to
die from your pregnancy,"
he said.
"I guess that's where we're headed."