Weeks after the fall of Roe v. Wade treated Dr. Grace Ferguson, a woman whose waters ruptured in mid-pregnancy. The baby would never survive, and the patient’s chance of developing a potentially life-threatening infection grew by the hour.
By the time she made it to Pittsburgh to see Ferguson, the woman had spent two days in a West Virginia hospital, unable to have an abortion due to a state ban. The law makes an exception for medical emergencies, but the patient’s life was not in danger at that moment.
“She just stood on the edge of the cliff,” Ferguson said, “waiting for an emergency to happen or for the baby to die.”
In Pennsylvania, at a hospital four hours’ drive away, Ferguson was able to induce labor to terminate the pregnancy.
A growing number of doctors and families are telling similar stories as a post-Roe scare hits: Pregnant women with dangerous medical conditions are showing up in hospitals and doctor’s offices, only to be denied the abortions that could help treat them. Some doctors in states with restrictive abortion laws say they have referred or referred more patients than ever before. Some women face harmful, potentially fatal delays.
Doctors say they are being forced to weigh medical judgment against possible penalties, including jail time. Although even the strictest laws allow abortion to save a mother’s life, one important question remains: How close does the patient have to be to death?
“You don’t automatically go from living to dead,” Ferguson said. “You’re getting sicker and sicker.”
It’s impossible to say when that limit will be crossed, said Dr. Alison Haddock, board member of the American College of Emergency Physicians. “There’s just not a moment when I stand in front of a seriously ill patient where I know: OK, before that their health was only in danger. But now her life is in danger,” she said.
Experts say it is difficult to obtain data on abortion refusal when serious complications arise. Employers often discourage healthcare workers from talking about them, although The Associated Press reached more than a dozen doctors and patients who shared stories of such refusals.
And many doctors and researchers agree that evidence, while mostly anecdotal, shows a widespread problem. In Texas, for example, a medical association sent a letter to the state medical board saying some hospitals are refusing to treat patients with serious complications because of the state’s abortion ban.
And at the University of California, San Francisco, researchers who invited health care workers nationwide to anonymously send examples of poor care due to abortion restrictions said they were surprised by the initial volume of responses. In the first six weeks, 25 submissions were received. Among them were descriptions of patients who were sent home after a second trimester ruptured membrane and later returned with serious infections. One told of an ectopic pregnancy being allowed to grow on a scar left by a previous caesarean section – which can lead to uterine rupture, bleeding and death.
“Legislators are playing with fire,” said Dr. Dan Grossman, leader of the project.
dr Cara Heuser, a mother-fetal specialist in Utah, recalled a patient who was denied an abortion in Idaho even though she developed severe heart disease mid-pregnancy. The woman had to be transported to Utah for the procedure.
dr Lauren Miller, a maternal and fetal specialist in Boise, said she regularly sees patients whose waters rupture at 15-19 weeks of pregnancy and all doctors could do is help them make the difficult decision: “Stay do they come here for their care and just wait for something bad to happen, or do we make it easier for them to find out-of-state care?
dr David Eisenberg, an associate professor at Washington University in St. Louis, said that doctors and hospitals in Missouri regularly “take on that responsibility for care” when people show up with serious complications. They end up at the university-affiliated medical center where he works — one of the few in Missouri that performs abortions in such cases.
He said patients in crisis are told, “I have to call the hospital’s lawyer before I can figure out what to do.
“It’s just totally insane and totally inappropriate and a real shame.”
The stories are similar when pregnancy is complicated by cancer — which is diagnosed in about 1 in 1,000 pregnant women each year.
dr Karen Knudsen, CEO of the American Cancer Society, said some oncologists are confused about treating pregnant cancer patients, especially when therapies could cause miscarriage. dr Kristina Tocce, medical director of Planned Parenthood of the Rocky Mountains, said she’s seen patients with life-threatening diagnoses who have been forced to drive 10 hours or more or be flown out of state to have abortions so they can have one chemotherapy or radiation treatment can begin.
Tocce said she recently treated a Texas woman whose cancer had gone into remission but came back aggressively after she became pregnant with her second child. She sought an abortion to resume cancer treatment that promised to keep her alive for their toddler. During the visit she repeatedly thanked Tocce.
“I finally said to the patient, ‘You can’t thank us anymore. We’re doing our job,” Tocce said. “I said, ‘I’m so disturbed that you’ve had to travel so far with your family and the hurdles you’ve had to overcome.'”
Some anti-abortion advocates say doctors may unnecessarily refuse abortions in life-threatening situations out of fear. dr Patti Giebink, a former abortion doctor who described how her views changed in her book, Unexpected Choice: An Abortion Doctor’s Journey to Pro-Life, said intention matters. If you intend to save the mother and not end the life of the fetus, she said, “You are doing good medicine.”
“We’re kind of in a time where all these questions are coming up,” she said. “Legislators will work to address some of these issues.”
dr Paul LaRose, a member of the American Association of Pro-Life Obstetricians and Gynecologists, said he thinks the issue has been overblown and those who raise concerns have exaggerated.
“Or they’re misinformed,” he said. “Most pro-life doctors would attend to the mother and do what is necessary without intentionally taking the life of the unborn child.”
But some women say restrictive abortion laws have put them at risk.
Kristina Cruickshank, of Rosenberg, Texas, thought her life was in danger after being diagnosed with a non-viable “partial molar” pregnancy, in which the fetus has too many chromosomes and develops incompletely. Cruickshank, 35, had thyroid problems and massive cysts around both ovaries. She vomited, bled and was in pain.
It was early June, just before Roe fell, when Texas banned nearly all abortions after about six weeks of pregnancy. She endured three agonizing days in one hospital before her doctor could find another who agreed to the termination process. She thought, “What am I supposed to do, just lie here and die?”
Mylissa Farmer of Joplin, Missouri, faced similar delays in August. Her waters ruptured at 17 1/2 weeks gestation and sent her to the emergency room. Tests showed that she had lost all of her amniotic fluid. The fetus she and her boyfriend had named Maeve was unlikely to survive.
Despite the risk of infection and blood loss, she was unable to have an abortion. The fetus still had a heartbeat. Doctors told her that Missouri law superseded her sentence, medical records show.
She tried for days to get an out-of-state abortion, but many hospitals said they couldn’t accept her. Eventually, an abortion hotline connected Farmer to a clinic in Granite City, Illinois. She drove 4 1/2 hours from home – during labor – and had the procedure.
After news outlets reported Farmer’s story and it appeared in a political ad, the Missouri Department of Health launched an investigation into whether Joplin Hospital, which declined to comment on the case, had violated federal law. The state has shared its preliminary findings with the federal government.
Farmer said the experience was so traumatic that she took a lasting step to ensure something like this didn’t happen to her again.
Her hoses were tied.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.