Abortion

Doctors Detail Dangerous Pregnancy Care in States With Abortion Restrictions

Plus: APA says social media not inherently harmful for kids, senators propose Artificial Intelligence Regulatory Agency, and more...

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doctor taking blood pressure | Yelena Afonina/ZUMA Press/Newscom
doctor (Yelena Afonina/ZUMA Press/Newscom)

A new report details how doctors in states with strict abortion laws have been forced to offer lower-quality care, including refusing to provide treatment to pregnant women facing complications until their situations became life-threatening.

In "Care Post-Roe: Documenting cases of poor-quality care since the Dobbs decision," the Texas Policy Evaluation Project (TxPEP) reports preliminary findings from a study that asked doctors to evaluate how their practices have changed since the Supreme Court's June 2022 decision in Dobbs v. Jackson Women's Health Organization. Since then, 14 states have either enacted near-total bans on abortion or passed additional restrictions.

"Between September 2022 and March 2023, we received 50 submissions from health care providers describing detailed cases of care that deviated from the usual standard due to new laws restricting abortion," states the report. The submissions were collected as part of the group's Care Post-Roe Study, which allowed health care providers to submit confidential stories that were in some cases followed up on with in-depth interviews.

"The post-Dobbs laws and their interpretations altered the standard of care across [pregnancy] scenarios in ways that contributed to delays, worsened health outcomes, and increased the cost and logistic complexity of care," the report suggests. "In several cases, patients experienced preventable complications, such as severe infection or having the placenta grow deep into the uterine wall and surrounding structures, because clinicians reported their 'hands were tied,' making it impossible for them to provide treatment sooner."

The researchers received multiple reports of cases involving second-trimester rupture of membranes, a condition associated with "a very high neonatal mortality rate," as one 2017 study in the Journal of Perinatal Medicine put it. Managing it "requires balancing the potential neonatal benefits from prolongation of the pregnancy with the risk of intra-amniotic infection and its consequences for the mother and infant." Typically, patients who experience this are offered an abortion; now, patients are being sent home and told to come back when they start going into labor or experience signs of an infection. "In several of the cases, patients developed a severe infection, including cases where the infection required management in the intensive care unit," notes the report.

In a number of cases, patients presenting risky but not-yet-life-threatening symptoms were forced to wait until their conditions worsened before an abortion could be legally performed. For instance, one doctor describes a woman who was 15 to 18 weeks pregnant and experiencing significant bleeding when admitted to the hospital for observation. Doctors couldn't do anything but wait.

"When I objectively look at her case, there is no way that this woman was going to make it to [fetal] viability (6+ [additional] weeks) and [she] was becoming clinically unstable," wrote one doctor. "The paralysis that the overnight team exhibited by not treating this inevitable abortion as such again demonstrated that physicians are perseverating about whether they can legally provide standard-of-care medical treatment."

Another doctor describes a woman going into labor early at around 19–20 weeks: "Anesthesiology colleagues refused to provide an epidural for pain. They believed that providing an epidural could be considered [a crime] under the new law. … 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."

The doctor's interpretation of what counts as "aiding and abetting" seems far-fetched. But the point is that medical providers aren't sure where to draw lines.

In one case, a woman got pregnant despite having an IUD. "In such a situation, the standard of care is to remove the IUD to reduce the risk of infection, miscarriage, and preterm delivery," explains the TxPEP report. But a doctor in a state with an abortion ban was afraid to remove the IUD because doing so could also risk a miscarriage.

Multiple doctors describe having to help patients transfer to out-of-state hospitals for care while those patients are undergoing dangerous complications.

In one case, a patient had an ectopic pregnancy (which is non-viable) implant in a cesarean scar while another fetus implanted normally. A doctor "told her they would not be able to treat her because Twin B [had cardiac activity]. Their 'hands were tied' and there was no way they could treat her. She would have to continue her pregnancy and they would monitor her closely to see if she developed a placenta accreta. She called [our] clinic and asked if she could come back to [state with abortion access] to be seen in the hospital for management. So now we are arranging for her to be treated at the hospital [here]. She will have to drive the many hours back and will likely have to be admitted."

The nature of the TxPEP study is primarily anecdotal—aiming "to describe the range of scenarios that health care providers are facing post-Dobbs"—and it can't estimate the prevalence of such scenarios. "That said, it is important to note that these are not 'one-off' situations, and each category of clinical scenario was described by more than one clinician," states the report.

The Department of Health and Human Services (HHS) is currently investigating two hospitals that refused to provide stabilizing treatment to a pregnant woman whose water broke at 18 weeks. HHS Secretary Xavier Becerra says this violates their duties under the Emergency Medical Treatment and Active Labor Act.

FREE MINDS 

The American Psychological Association (APA) says "using social media is not inherently beneficial or harmful to young people." The statement comes in a new APA "Health advisory on social media use in adolescence." From the advisory:

Adolescents' lives online both reflect and impact their offline lives. In most cases, the effects of social media are dependent on adolescents' own personal and psychological characteristics and social circumstances—intersecting with the specific content, features, or functions that are afforded within many social media platforms. In other words, the effects of social media likely depend on what teens can do and see online, teens' preexisting strengths or vulnerabilities, and the contexts in which they grow up.

Adolescents' experiences online are affected by both 1) how they shape their own social media experiences (e.g., they choose whom to like and follow); and 2) both visible and unknown features built into social media platforms.

Not all findings apply equally to all youth. Scientific findings offer one piece of information that can be used along with knowledge of specific youths' strengths, weaknesses, and context to make decisions that are tailored for each teen, family, and community.

In other words, there's no one-size-fits-all way to best approach internet and social media use by teens and tweens.

But this contradicts the current narrative from the media and politicians "that social media is dangerous for all kids. Full stop," notes Mike Masnick at Techdirt. And both seem totally resistant to data that counter this narrative.

"We've pointed out repeatedly that the data and research on the issues do not support literally any of the claims that politicians (and the media) are making about the impact of social media on kids," Masnick points out. Reason has published similar pieces. And now we've got influential groups like the APA throwing a little cold water on the panic.

"The APA specifically notes that social media may be particularly helpful to marginalized teenagers or those facing mental health challenges," notes Masnick. "They also suggest that when kids are younger, it's appropriate for parents to help kids with social media, to teach them how to use it appropriately and safely, but as they get older, it's important to let them discover things for themselves."

FREE MARKETS 

Today in terrible tech ideas in Congress: a new regulatory agency to handle artificial intelligence. "The creation of a new Artificial Intelligence Regulatory Agency was widely endorsed today during a Senate Judiciary Subcommittee on Privacy, Technology, and the Law hearing on Oversight of A.I.: Rule for Artificial Intelligence," reports Reason's Ron Bailey. "Senators and witnesses cited the Food and Drug Administration (FDA) and the Nuclear Regulatory Commission (NRC) as models for how the new A.I. agency might operate. This is a terrible idea." More here.

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