The Pulse

Abortion limits NC Republicans are considering would endanger patients’ lives, Duke doctors say

By: - February 19, 2023 9:00 am

Duke University doctors warned that abortion restrictions North Carolina Republicans are considering will endanger patients’ health and drive up the already high maternal mortality rate.

Three Duke OB/GYNs said during a video news conference that other states’ bad experiences with abortion bans offer North Carolina a look into the future if legislators impose more limits here.

Dr. Beverly Gray

Legislative leaders have discussed bans after 6 weeks or 13 weeks. House Speaker Tim Moore told reporters last month that House and Senate Republicans would get together work on a bill.

A 13-week ban is an arbitrary limit that will prevent doctors from providing patients with evidence-based care, said Dr. Beverly Gray, division chief of women’s community and population health.

Women in other states, including Texas, Louisiana, and Florida  have reported being sent home from hospitals while they were having miscarriages or forced to carry to term a pregnancy where the baby is not expected to live more than a few hours because doctors fear violating abortion laws.

“We’ve moved beyond the theoretical,” said Dr. Brenna Hughes, chief of Maternal-Fetal Medicine. “We are seeing that these bans are impacting patients, making them less safe. It is leading to physicians feeling unable to move forward and care for patients the way that they would want to, for fear of being prosecuted for providing appropriate patient care.”

Abortions in North Carolina are banned after 20 weeks, with an exception for medical emergencies.

In North Carolina now, some patients who were not able to receive anatomy ultrasounds before 20 weeks are forced to carry pregnancies to term when they know the infants will not survive, Hughes said.

“It is a trauma they endure for the entire time and leaves them, unfortunately, with birth trauma,” she said.

More people would face that trauma with a six-week or 13-week ban. Most people don’t know that they’re pregnant at six weeks, and 13 weeks is too soon to see most fetal abnormalities, Hughes said. Most people have just started to receive prenatal care at about 12 weeks, said, and most have not had an ultrasound.

“Unless there was essentially a completely fatal abnormality that could be seen very early, it would mean that we would miss the vast majority, over 90% of anomalies if we were to start evaluating before 13 weeks and think about providing care at that time,” she said.

Patients in states with strict bans face obstacles receiving treatment for ectopic pregnancies, said Gray.

An ectopic pregnancy is when a fertilized egg implants outside the uterus, usually in a fallopian tube.  “Ectopic pregnancy is the number one cause of maternal mortality in the first trimester,” Gray said. “We have physicians who are hesitant to treat ectopic pregnancy because of restrictive bans.”

Dr. Jonas Swartz

Women in states with abortion bans have had trouble obtaining a medicine that treats lupus, even if they’re not pregnant, because the drug also can cause miscarriage or severe birth defects. The same drug is also used to treat rheumatoid arthritis and cancer.

“Overall, what the effect is, is that women simply aren’t able to get the same standard of medical care as their male counterparts,” said Dr. Jonas Swartz. “That is totally unjust. It is, I think, outside what legislators intend with this legislation, but it is a byproduct.”

Swartz referred to a study of two Texas hospitals published last year that looked at what happened to patients whose water broke early, leaving no amniotic fluid. The standard of care is to offer compassionate counselling and an abortion because the fetuses’ lungs cannot develop and the mothers are a risk of developing a life-threatening infection or life-threatening bleeding, Swartz said.

Patients who went to the Texas hospitals with pregnancy complications at 22 weeks or less were not treated until they became seriously ill with infections and blood loss. Some had to go into intensive care and one woman had to have a hysterectomy, according to the October 2022 report in the American Journal of Obstetrics & Gynecology.

“My colleagues are discharging people into the world waiting for them to get sick,” Swartz said.

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Lynn Bonner
Lynn Bonner

Investigative Reporter Lynn Bonner covers the state legislature and politics, as well as elections, the state budget, public and mental health, safety net programs and issues of racial equality.