This story originally published online at NC Policy Watch.
Many Duke Health physicians say new abortion restrictions—and those on the horizon—hurt their ability to treat pregnant patients and are likely to lead to more maternal deaths.
The doctors gathered online Tuesday to discuss the ramifications of the U.S. Supreme Court’s decision to overturn Roe v. Wade. The ruling eliminated the constitutional right to abortion, leaving its legality up to the states. As a result North Carolina has become a destination for women from surrounding states where abortion access is extremely limited or completely banned.
Yet the decision lit the fuse on new restrictions in North Carolina as well, with leaders of the state legislature’s GOP majority asking a federal judge to reinstate North Carolina’s 20-week abortion ban. Conservative lawmakers promised that new restrictions will be a “top priority” when the General Assembly returns to Raleigh in January. Should Republicans win a super-majority in November, they will be able to overturn Gov. Roy Cooper’s veto of new abortion-related bills.
Dr. Megan Clowse, a rheumatologist with Duke Health, said patients are already anticipating new restrictions and changing how they think about having children. Some patients are concerned about whether they could have an abortion to save their own lives or to prevent the birth of a child who could die or live with debilitating health problems or birth defects, she said.
“I’m hearing women who are afraid of having something bad happen to them during a pregnancy,” Clowse said. “To the point where they’re willing to sacrifice their desire for future children even though they’re not entirely sure they don’t want children.”
Clowse said she has heard more interest from women considering permanent sterilization—tubal ligations—rather than reversible forms of birth control, like an IUD.
The legal and political uncertainty is also changing how doctors talk with patients about certain medications, she said – like methotrexate, which can be prescribed for psoriasis, rheumatoid arthritis and some forms of cancer. However, pregnant people who take the drug risk having a miscarriage or having a child with birth defects.
Even in a state that hasn’t yet passed new abortion restrictions, the doctors said, they and their patients are already thinking about alternatives should abortion access be sharply limited or even outlawed in North Carolina.
“Many of my patients are asking, ‘If something is seen, how soon do I have to make a decision if there’s something major wrong with my baby and I may not want my baby to live with a major birth defect and a severely compromised quality of life?’” said Dr. Maria Small, a maternal and fetal medicine specialist with Duke Health.
“These are decisions that individuals make on a regular basis,” Small said. “When they have a change in guidelines where those decisions need to be made earlier, it becomes more challenging and it becomes more painful. No one can say for sure what they would do in the circumstance many are put in.”
For that reason, Small said, doctors and patients need to retain all options. Those conversations also need to stay between pregnant patients and their doctors, Small said. Too often that isn’t that case.
“Pediatricians are involved, maternal fetal medicine specialists are often involved, rheumatologists are often involved, and these folks are working with that individual to make a very difficult decision,” Small said. “And you contrast that to Individuals who are making decisions about women’s lives and they don’t know the very basics of reproductive anatomy.”
Small recounted the story of Idaho state legislator Vito Barbieri asking in 2015 whether a woman could swallow a camera and have it end up in her uterus.
“For us as healthcare providers and for our patients, this is a disservice,” Small said.
The politicization of maternal health care and the quickly shifting legal landscape are both serious dangers, said Dr. Beverly Gray, obstetrician and gynecologist with Duke Health.
“Patients are confused. Physicians are confused. Ethicists, lawyers are getting involved in care,” Gray said. “That’s just clouding the issue and creating a situation where we’re offering worse care for patients.”
When people without medical knowledge and experience make these critical decisions about reproductive care, maternal death rates are likely to increase.
The term ‘late-term abortion’ is a good example of the chasm between medicine as it is practiced and as it is discussed by politicians, Gray said.
“A ‘late-term abortion’ is not a medical term,” Gray said. “It’s not a term that we physicians use. It’s a term that’s very politicized, that politicians use to make it appear that the vast majority of abortions are happening in the late second, third trimester. Which is absolutely not the case.”
“We know the vast majority of abortion care that occurs in our country happens in the first eight weeks of pregnancy,” Gray said. “Only 1.2 percent of care happens after 20 weeks, and that’s typically before viability. It’s right around the 20th week. In North Carolina that rate is even lower.”
Doctors and patients are most often striving to have a pregnancy result in a healthy birth, Gray said. It is dangerous, she said, to demonize the instances when a family and doctor decide that an abortion is the best option.
“We all know or care for someone or love someone who’s had an abortion,” Gray said. “I think when we’re allowed that window into people’s lives and understanding what they’re facing, we’re able to understand how decisions are made, how folks are approaching their lives and their futures.”
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