Saving the Lives of Women

On June 24, 2022, the Supreme Court overturned “Roe v. Wade” in the “Dobbs” case, ruling that there is no constitutional right to abortion—a decision that, in practice, ended federal protection of reproductive rights. This ruling meant that the legality of abortion would be determined by each individual state, giving rise to a patchwork of extremist laws across the country. The decision has sparked intense debate and activism; while some states have enacted bans or restrictions on abortion, others have adopted measures to protect access to all forms of healthcare.

 

The Dobbs decision, which overturned Roe v. Wade, has significantly impacted doctors, particularly OB-GYNs, by creating uncertainty, legal risks, and hindering their ability to provide evidence-based care, leading to some leaving the field or relocating.

 

Please consider the following effects on our medical community since Dobbs.

 

Legal and Ethical Challenges:

 

Interference with Physician-Patient Relationship:

 

The Dobbs decision has imposed a climate of fear and uncertainty, making it difficult for doctors to provide comprehensive reproductive healthcare options including and potentially putting them in legal peril.

 

Restrictions on Care:

 

Some states have enacted restrictions on medical options, making access more difficult and heightening disparities among states, impacting doctors' ability to provide appropriate care and counsel patients.

 

Moral Distress and Burnout:

 

The inability to provide care they know to be necessary, coupled with the fear of legal repercussions, has led to moral distress and burnout among doctors.

 

Impact on Medical Training:

 

Medical students and residents may be less likely to apply for residencies in states with restrictions, potentially leading to a shortage of trained OB-GYNs in the future.

 

Diminished Training Opportunities:

 

Medical students in states with total bans on terminating pregnancies must seek necessary training out of state. Diminished training opportunities can potentially lead to a decline in clinical skills, knowledge and experience.

 

Patient Care Impacts:

 

Denial of Care:

 

Patients in states with bans or restrictions may be denied access to necessary medical care, including termination and care for miscarriages and other pregnancy-related medical emergencies.

 

Increased Maternal Mortality:

 

Restrictions to access of necessary medical may lead to an increase in maternal mortality rates, especially among marginalized communities.

 

Worsening of Existing Health Disparities:

 

The Dobbs decision may exacerbate existing health disparities, particularly for women of color and those living in poverty.

 

At this important moment in time following the Dobbs v Jackson Women's Health Organization decision in June 2022, 17 US states have functionally banned the medical option for terminating a life endangering pregnancy except in narrow circumstances, and physicians found in violation of these laws face felony charges, loss of their medical license, fines, and prison sentences.

 

As a bishop for the Evangelical Catholic Church and as one who has never accepted the practice of abortion for convenience, I believe that I am being motivated and called upon by the Holy Spirit to employ my voice and energy to protect the lives of women dealing with life threatening pregnancies and to end the nightmare of the Dobbs decision.  Too many women have died because of Dobbs and the draconian actions of 17 states and I cannot sit back and watch the body count of women denied necessary medical care increase because of the unethical portal of Dobbs.    

 

In my research and preparation for this Pastoral Letter, I have come to learn and relearn medical conditions discovered during a pregnancy that can place the life of the patient in jeopardy.  Conditions which I believe cannot be ignored or dismissed.

 

Ectopic Pregnancy

 

An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, such as the fallopian tube (where eggs are carried from the ovaries to the uterus) or ovary. Ectopic pregnancies aren't viable, and if the fertilized egg continues to grow, it can rupture and cause the patient to bleed to death. Ectopic pregnancies are usually discovered during the first trimester, though occasionally later at 12 or 13 weeks. Women with ectopic pregnancies will have excruciating abdominal or pelvic pain as well as vaginal bleeding, extreme lightheadedness, or fainting.

 

Intrauterine Infection

 

Some of the most common causes of intrauterine infections happen from infections that start in the vagina and travel to the uterus. This is more common when a patient's bag of water (amniotic sac) has broken, but it can also happen without the bag breaking. Intrauterine infections can also happen because the fetus has died and the dead products inside the uterus cause an infection, she says. So, if an intrauterine infection is the result of the death of a fetus, removing the fetus is necessary.

 

Placental Abruption/Previa

 

Placental abruption happens when the placenta completely or partially detaches from the uterus due to some sort of trauma. When the placenta detaches from the uterus, it decreases the amount of oxygen and nutrients being delivered to the fetus and can cause severe bleeding.

 

Placental abruption can be managed without delivery until the amount of bleeding causes the pregnant person to become unstable. In the case of life-threatening bleeding, the fetus must be delivered, both for the health of the mother and the fetus if it's viable, she explains. If the fetus is not viable, then abortion is indicated because, without removal of the bleeding placenta, the patient will continue to bleed and hemorrhage to death.

 

This is also true for pregnant people who have placenta previa, where the placenta is covering the cervix and may cause life-threatening bleeding. In cases where the bleeding is severe, a surgical termination to save the patient, regardless of the viability of the fetus, as the mother could die from blood loss. Bleeding from placenta previa usually happens after 20 weeks of pregnancy.

 

Severe Cases of Preeclampsia

 

Preeclampsia is a form of high blood pressure that develops usually after 20 weeks of pregnancy. Preeclampsia poses a danger to the woman and the fetus because it raises blood pressure

 

The exact cause of preeclampsia isn't known. Something abnormal happens during the formation of the placenta, and it causes the blood vessels in the placenta to constrict. This blocks the blood supply to the placenta, and if it's severe, the fetus will die and the life of the women would be in jeopardy.

 

Antepartum Sepsis

 

Antepartum sepsis (sepsis during pregnancy) is the result of an infection that happens anywhere in the body, such as the lungs, gastrointestinal tract, or urinary tract.  Sepsis is life-threatening because it causes the body to damage its own tissues in response to the infection. Antepartum sepsis can cause organ and placental dysfunction and is one of the biggest contributors to maternal and fetal mortality.

 

A fetus which has multiple birth defects that is incompatible for survival

 

There some conditions found in fetus that may cause chronic illness, disability, stillbirth or the death of a baby soon after birth (neonatal death). These conditions are sometimes referred to as fetal anomalies disorders or birth defects. Some rare pregnancy complications can risk the life or long term reproductive health of the women life if they continue the pregnancy.

 

Victims of rape and incest

 

One in 20 women in the United States has experienced a pregnancy from rape, sexual coercion, or both during their lifetimes. Specifically, over three million women have experienced pregnancy resulting from rape during their lifetimes. Nearly five million women have experienced pregnancy resulting from sexual coercion during their lifetimes.

 

Victims often reported other negative health impacts. Among women who experienced pregnancy from rape, 28% experienced a sexually transmitted disease and 66% were injured. Additionally, over 80% were fearful or concerned for their safety. Among women who experienced pregnancy from sexual coercion, about 35% experienced a sexually transmitted disease.

 

The majority of countries worldwide allow for the termination of a pregnancy in cases of rape and/or incest, either through laws enumerating these grounds or by permitting termination on request. Although rape and incest are distinct legal grounds for abortion, they are very commonly paired together in abortion laws and policies. Although a handful of countries only allow termination in cases of rape, and not incest, whereas there are not any countries that allow termination in cases of incest that do not also allow termination in cases of rape. Notably, countries that allow termination on health grounds, particularly mental health grounds, might interpret such exceptions to include cases of rape or incest, even when such are not explicitly articulated in law.

 

Despite the howls of celebration by the proponents of Dobbs, I believe that there remains some sanity of conscious by many who believe that those who become pregnant via rape and/or incest should not a further harmed by being forced to continue with such pregnancies.  The decisions of many states since Dobbs have limited the window of time to discontinue such pregnancies or have completely denied the option to end such pregnancies.