Rowe’s end could limit health care for all Americans

If the US Supreme Court overturns Rowe vs. Wade with its final decision in Dobbs v. Jackson Women’s Health Organization, restrictions on abortion can affect all healthcare. Trying to save a complicated pregnancy with twins, I found that US anti-abortion policy is already limiting the medical procedures that doctors can do, the drugs that doctors can prescribe, the surgical instruments they can use, the tests they can perform, and the words they can say.

Dobbs can put medical standards of care out of the reach of most Americans.

Prohibited medical procedures

In the post-Dobbs America, many procedures used in gynecological and obstetric practice may be banned for fear that they may be used for abortion.

Six years ago, my gynecologist first diagnosed me with a “contaminated egg,” a non-developing fertilized egg, and prescribed me dilatation and curettage (D&C) before I became infected. D&Cs are common for removing polyps, tumors, contaminated eggs, and tissue left after a miscarriage from the uterus.

Instead, my doctor could suggest other procedures. Dilation and evacuation (D&E) procedures are sometimes a better choice, especially for a patient who is bleeding from an accident or injury or from placenta previa.

Enlargement and extraction (D&X) is a more complex surgery for patients who are spontaneous, seeking an autopsy of fetal remains or a desire to reduce potential trauma to the uterus during an abortion. However, several states have made D&E and D&X illegal in certain circumstances and Dobbs may allow other countries to do so. Due to the bans on some gynecological procedures, newer doctors may not be trained to perform them.

Dobbs may metastasize these limitations of care beyond gynecology. The treatment of blood clots, for example, affects both the health of the mother and the fetus. The guidelines for medical practice require the pregnant woman to be informed about the risks of treatment for the fetus and to decide how to proceed with the doctors. States may soon ban this co-decision when the life of the fetus is in danger.

Prohibited drugs and procedures

Americans can no longer easily obtain drugs that are commonly used in gynecological practice around the world. The Food and Drug Administration has been analyzing the use of misoprostol for years, but has not approved the use of the drug in gynecology.

Misoprostol treats stomach ulcers and Cushing’s syndrome and is recommended by both the World Health Organization and the American College of Obstetricians and Gynecologists to control blood loss during uterine surgery and childbirth.

US anti-abortion policy prohibits Americans from doing this gynecological standard. Women around the world discreetly use misoprostol, sometimes with mifepristone, to terminate a pregnancy. Despite the abundant evidence that both mifepristone and misoprostol, when used alone and in combination, help the patient with very few adverse outcomes, physicians and patients must go through regulatory rings to receive these drugs.

Dobbs may allow the prohibition of drugs whose adverse effects on fetal health are unknown or suspected. In exchange for America, where all women are “pre-pregnant”, women may be denied access to anti-anxiety and depressant drugs with little evidence of their effect on pregnant and lactating women – or on women at all. Like chemotherapy for cancer or tuberculosis, concerns about potential fetal harm or fertility may limit patients from the medication they need.

Prohibited medical devices

While they were still fetuses in me, my twins needed surgery. The FDA must approve the instruments the surgeon will use: scopes, cameras and lasers. Once the device has been approved by the FDA, the circumstances under which the device may be used are written on the device label. If the physician considers that the use of an off-label device may be beneficial to the patient, the physician may continue after the hospital’s institutional review board (IRB) has authorized it.

My hospital’s permission is required for intrauterine fetal surgery with certain devices. Fetal surgery risks terminating my pregnancy; so IRB blocked the care I wanted and the doctors recommended.

NextDobbsI can’t imagine how fetal surgery instruments will get permission.

Prohibited medical tests

Genetic tests performed by chorionic villus sampling (CVS) and amniocentesis pose a low risk of miscarriage after Dobbs, may be prohibited. CVS is done after 10 weeks of gestation and amniocentesis – about 20 weeks. Both procedures use a large hollow needle to pierce the uterus and remove fetal cells. Cell chromosomes are analyzed for malformations, additions or deletions.

Especially with CVS performed before 11 weeks of gestation, perforation of the uterus can lead to contraction of the patient’s muscles and miscarriage. In America, where all pregnancies must be maintained until birth, effective genetic testing, which some parents use to prepare for the care their children will eventually require, may not be possible.

Disabled discussions of healthcare options

My office as a maternal and fetal specialist was in a Catholic hospital that prohibits contraception, sterilization, many infertility treatments and abortion care, even when the patient’s health or life is in danger because of a miscarriage or ectopic pregnancy. Catholic hospitals also restrict staff from providing patients with complete information and care recommendations that are inconsistent with Catholic religious teachings.

After Dobbsthese restrictions can be multiplied.

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

His hospital policy forbade him from discussing this option with me, but his medical ethics demanded that he help me because I was suffering. Dobbs they could further silence what doctors can say to consult their patients.

Poorer access to health care

The Covid-19 crisis has shown the difficulties all Americans face in accessing adequate health care. Anti-abortion policy only exacerbates these difficulties.

NextDobbsAmericans in need of innovative care for an unexpected and difficult medical problem can be at the mercy of anyone who can treat them with whatever tools are available, whether they are state-of-the-art or just whatever politicians allow.

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

Write about us: Guidelines for the author

Information about the author

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

Leave a Comment

Your email address will not be published.