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Roe’s End Could Restrict Health Care for All Americans

May 31, 2022, 8:00 AM

If the U.S. Supreme Court overturns Roe v. Wade with its final ruling in Dobbs v. Jackson Women’s Health Organization, anti-abortion restrictions could affect all of health care. Trying to save a complicated twin pregnancy, I found American anti-abortion politics already limit the medical procedures doctors may do, the medicines doctors can prescribe, the surgical tools they can use, the tests they can conduct, and the words they may say.

Dobbs could place medical standards of care beyond the access of most Americans.

Prohibited Medical Procedures

In a post-Dobbs America, many procedures used in gynecological and obstetric practice could be prohibited, for fear that these could be used for an abortion.

Six years ago, my gynecologist initially diagnosed me with a “blighted ovum,” a non-developing fertilized egg, and prescribed a dilation and curettage (D&C) before I became infected. D&Cs are common to remove from the uterus polyps, tumors, blighted ovum, and tissue that remains after a miscarriage.

My doctor could have offered me other procedures instead. A dilation and evacuation procedure (D&E) is sometimes a better choice, especially for a patient who is hemorrhaging from an accident or trauma or from placenta previa.

Dilation and extraction (D&X) is a more complex surgery for patients who are miscarrying, seeking an autopsy of fetal remains, or desiring reduced potential trauma to the uterus during an abortion. However, several states have made D&E and D&X illegal in certain circumstances, and Dobbs could permit other states to do so. Because of prohibitions on certain gynecological procedures, newer doctors may not be trained to perform them.

Dobbs could metastasize these care limitations beyond gynecology. Treatment for blood clots, for example, affects both maternal and fetal health. Medical practice guidelines call for the pregnant person to be informed of the treatment risks to the fetus and to decide how doctors should proceed. States may soon prohibit this shared decision making where fetal life is imperiled.

Prohibited Medications and Procedures

Americans already cannot easily obtain medications that are typically used in gynecological practice worldwide. The Food and Drug Administration has been analyzing the use of misoprostol for years but has not approved this drug’s use in gynecology.

Misoprostol treats stomach ulcers and Cushing’s syndrome, and both the World Health Organization and the American College of Obstetricians and Gynecologists recommend it to control blood loss in uterine surgery and childbirth.

American antiabortion politics bars Americans from this gynecological standard. Women throughout the world discreetly use misoprostol, sometimes with mifepristone, to terminate pregnancies. Despite the ample evidence that both mifepristone and misoprostol, when used individually and in combination, help the patient with very few adverse outcomes, doctors and patients must jump through regulatory hoops to obtain these medications.

Dobbs could permit prohibitions of medications whose adverse effect on fetal health is unknown or presumed. In return to an America where all women are “pre-pregnant,” women could be denied access to anti-anxiety and depression medications with a paucity of data on their effect on pregnant and lactating people—or on women at all. Like with chemotherapy for cancer or tuberculosis, concern over potential fetal or fertility harm could restrict patients from needed medicines.

Prohibited Medical Devices

While they were still fetuses inside of me, my twins required surgery. The FDA must approve tools the surgeon would use: the scopes, cameras, and lasers. Once the FDA approves a device, the circumstances under which the device may be used are written on the device’s label. If a doctor believes using a device in an “off label” manner could benefit the patient, the doctor may proceed once a hospital institutional review board (IRB) allows.

My hospital’s permission was required for intrauterine fetal surgery with certain devices. Fetal surgery risked terminating my pregnancy; so, the IRB blocked the care I desired, and that my doctors recommended.

Post-Dobbs, I cannot envision how fetal surgery implements will receive authorization.

Proscribed Medical Tests

Genetic tests conducted through chorionic villus sampling (CVS) and amniocentesis pose a slight risk of miscarriage and, after Dobbs, could be proscribed. CVS is done after 10 weeks of gestation, and amniocentesis, around 20 weeks. With both procedures, a large hollow needle is used to puncture the uterus and remove fetal cells. The cells’ chromosomes are analyzed for malformations, additions, or deletions.

Especially with CVS conducted before 11 weeks of gestation, perforating the uterus can cause the patient’s muscles to contract and expel the fetus. In an America where all pregnancies must be maintained until birth, effective genetic testing—which some parents use to prepare themselves for the care their children eventually will require—could be impossible.

Banned Discussions of Health Care Options

My maternal-fetal specialist’s office was in a Catholic hospital, which prohibit contraception, sterilization, many infertility treatments, and abortion care, even when the patient’s health or life is in danger because she is miscarrying or has an ectopic pregnancy. Catholic hospitals also restrict staff from providing patients with full information and referrals for care that conflicts with Catholic religious teachings.

After Dobbs, these restrictions could multiply.

My pregnancy was going poorly, with little chance of my twins being born alive. My doctor pulled me aside and whispered that I might wish to terminate.

Hospital policy prohibited him from discussing this option with me, but his medical ethics demanded he help me because I was suffering. Dobbs could further muzzle what doctors can say to counsel their patients.

Worse Access to Health Care

The Covid-19 crisis made plain the difficulty all Americans have in accessing adequate health care. Anti-abortion politics only exacerbates these difficulties.

Post-Dobbs, Americans who require innovative care for an unanticipated and difficult medical issue could be at the mercy of whomever can treat them with whatever tools available, regardless of whether they are the state-of-the-art or just whatever politicians permit.

This article does not necessarily reflect the opinion of The Bureau of National Affairs, Inc., the publisher of Bloomberg Law and Bloomberg Tax, or its owners.

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Genevieve Grabman is the author of “Challenging Pregnancy: A Journey through the Politics and Science of Healthcare in America” (Univ. Iowa Press 2022). She is a lawyer with the Office of the UN High Commissioner for Refugees, whose views and member states she does not represent. She also is a public health expert and mom to four children.