by Adele
Photo: Amy Eddings /Ideastream Public Media.
The author, David N. Hackney, M.D., M.S., is a doctor of maternal-fetal medicine, a branch of obstetrics-gynecology treating a variety of high-risk pregnancy complications. He describes the devastating impact of the 2022 repeal by the U.S. Supreme Court of Roe v. Wade, which immediately allowed state restrictions and total bans on abortion to take effect and new ones to be imposed. In his home state of Ohio, this was Senate Bill 23 (SB 23), a near-total ban. After six weeks, it only allowed exceptions to save the woman’s life or prevent “substantial and irreversible impairment of a major bodily function.”
Hackney describes some of the many serious medical issues pregnant women and their doctors can face. These include rupture of membranes before viability and loss of blood from issues like placental abruption. Patients can have other illnesses like cancer. The fetus can have severe genetic abnormalities or contract certain infections. Abortion is often medically indicated for severe preeclampsia, which often kills patients. In some of these situations, the need for abortion is straightforward, at other times a complicated decision for doctors and patients. States only randomly include some of these issues as exceptions to their bans.
DOCTORS’ FEARS OF LAWSUITS ENDANGER WOMEN
The situation is further complicated by recent changes in the healthcare system that are normally positive. Instead of one doctor at the top of a hierarchy making all decisions on treating a pregnancy, any doctor or clinician can halt the process to express concerns to avoid medical errors. Now, however, in Ohio and many other states, anyone can be concerned, not so much about a medical error, but that a procedure could cause an arrest or lawsuit. This seems to be a factor in the recent trend of doctors delaying a necessary and extremely safe D&C (dilation and curettage) procedure after a miscarriage, or when an abortion is needed because the fetus has died and is rotting in the womb, leading to patient deaths.
Hackney says, “The criminalization of medicine should concern all physicians, and the diminution of freedoms should alarm all citizens.” A variety of physicians often encounter patients with high-risk pregnancies. These include doctors working in cardiology, cancer treatment, and emergency rooms. Furthermore, any healthy pregnancy can become high-risk. Any woman with a healthy but unwanted pregnancy also needs the right to choose or reject its impact on her life.
The legal system holds doctors to much higher standards than it holds politicians crafting legislation on pregnancy and abortion. Following religious right propaganda, legislators mandate impossibilities like re-implantation of ectopic pregnancies. Legislators and judges now make decisions rather than doctors with medical knowledge or the patients who formerly made the ultimate decision.
Hackney includes many stories of what it is like for patients and doctors to make difficult decisions. He compares doctors’ choices to continue treating patients while under political pressure, to their continuing to treat patients during the COVID epidemic. He describes victories when citizens choose to persist in overturning restrictive reproductive laws.
There is no easy solution to the current situation, but this book provides important information and motivation to continue the fighting.