For Wisconsin women who are pregnant and facing a life-threatening illness – and for the doctors who treat them – the change in access to abortion at night has changed medical care.
Some cancer patients will no longer be able to receive life-saving chemotherapy or radiation therapy. Some people with chronic heart or kidney disease may face the risk of death if they become pregnant unintentionally. And some with a planned pregnancy can die when the disease strikes unexpectedly and cannot be treated because they are pregnant.
The U.S. Supreme Court’s ruling 6-3 on Friday, which repealed federal abortion law, also opened the door to reinstate Wisconsin’s 1849 ban on abortion, a law that allows the procedure only if life-saving is necessary. of the mother. The law has no exceptions to preserve the mother’s health or other circumstances, such as rape or incest.
On Tuesday, Attorney General Josh Cole and Gov. Tony Evers sued to block the restoration of the 1849 law, arguing that it contradicts numerous newer laws governing the procedure. For now, however, doctors are receiving legal advice, suggesting that an almost total ban is in place.
This advice also presupposes a careful reading of how far the only exception to the old law will go.
Choice between treatment or pregnancy
Medical protocols prohibit life-saving treatment for cancer, such as chemotherapy or radiation during pregnancy because of the risk to the embryo or fetus, says Dr. Noel LoConte, a chemotherapy specialist at UW Health. (LoConte says he’s talking about himself, not as a representative of UW’s health care system.)
Chemotherapy is banned during the first trimester of pregnancy and is considered risky, although it is not completely banned in later stages, says LoConte. Radiation therapy is prohibited throughout pregnancy. Such are some uses of X-rays, such as CAT scanning.
Sometimes newly diagnosed cancer patients learn that they are pregnant only at the time of diagnosis. But whether the patient learns that she was pregnant then, or knows that she is already pregnant and subsequently diagnosed with cancer, what followed until the court decision is the same.
The cancer is diagnosed in stages, so doctors can determine how urgent the treatment is, says LoConte. Doctors then discuss with the patient options “that would include trying to maintain the pregnancy and postpone cancer treatment, or have an abortion and then move on to more [immediate] treatment of her cancer. “
With some cancers – leukemia, for example – “we have hours to days to make that decision,” she says. “We don’t have weeks or months.”
Prior to the new court decision, a patient who has chosen to have an abortion will be referred to appropriate medical care in the obstetrics / gynecology department or to a clinic such as Planned Parenthood. “We are currently being told that this situation does not meet the requirements,” with the exception of the 1849 abortion ban, LoConte said.
Chemotherapy pregnancy tests
Sometimes patients become pregnant after starting treatment.
“Before starting chemotherapy, we advise all our patients not to become pregnant and to use two forms of birth control,” says LoConte. Patients of childbearing potential receive a pregnancy test at each treatment visit.
Even then, “it happens,” she says, “the patient’s pregnancy test is positive.” “And that’s very serious, because chemotherapy is very, very bad for a new embryo or fetus.”
Until this week, these patients would also be advised to discontinue treatment to continue the pregnancy or to terminate the pregnancy and continue treatment. Now the options for doctors and patients are unclear.
Sometimes the patient is prescribed additional chemotherapy to reduce the later risk of cancer coming back. “If she doesn’t get this chemotherapy, she has a 10% higher chance of the cancer coming back and then being terminal,” LoConte said. At this point, “all the lawyers say we don’t know for sure, but what we’re being told is that it doesn’t meet the requirements.”
“There is a huge amount of uncertainty for doctors caring for cancer patients,” says LoConte. When the 1849 law was passed, “none of them [cancer] there were treatments, “she said. “So the law doesn’t talk about that.”
“Once abortion is out of the question,” we double the message that they really can’t get pregnant with chemotherapy, “LoConte said. But the lack of clarity now disappointed her.
“Abortion is part of health care,” she said. “And we don’t restrict any other aspects of healthcare.”
Stress test on the body
The conflict between pregnancy and patient health is not limited to cancer patients.
“I often tell my pregnant patients that pregnancy is a stress test for the body,” says Dr. Eliza Bennett, an obstetrician / gynecologist. “And some people just don’t have enough bandwidth to withstand this stress test.”
Pregnancy requires a larger volume of blood, which causes the heart to work harder to pump it through the body. For a person with chronic heart disease, the heart muscle or valves may be too weak to function under the extra load.
The ability to treat congenital heart defects that some people are born with is a modern medical success story. But while most of these patients live to adulthood, Bennett says, they may still not be able to safely go through the pregnancy.
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Other circumstances may be temporary, but as long as they exist, pregnancy would pose a serious risk. Autoimmune diseases that attack the joints, for example, are sometimes treated with methotrexate, a powerful drug that “can have really, really negative effects on fetal development,” Bennett said. For a patient who needs this drug and inadvertently becomes pregnant, “there is a risk that then they could inadvertently cause this fetal abnormality just by taking medication to maintain their own health.”
Pregnancy also requires increased demand for the kidneys. If a patient has severe kidney disease, “pregnancy can actually cause the disease to progress and become the end stage of kidney disease,” she added.
Until this week, doctors could advise pregnant patients with kidney disease about the risk of worsening their disease. “And many people would choose not to continue the pregnancy if they knew it would put them at high risk for dialysis or a kidney transplant,” Bennett said.
Referrals outside the state
With the new legal environment leaving abortion inaccessible in Wisconsin, Bennett and her colleagues have made plans to refer patients who choose to terminate their pregnancies to providers in Illinois or Minnesota, where laws guaranteeing abortion rights are strong. She says it is too early to judge how this works for patients, “especially as we see more and more countries coming online with restrictions and bans on abortion that will lead to more patients having to travel to these states to have access to care. ”
The abortion ban also exposes patients who never think they will want or need an abortion in danger, Bennett said.
In countries with restrictive abortion laws, she says, there are “really striking cases of maternal death” among women with planned pregnancies who have been hospitalized with the disease but are not considered sick enough to qualify for an abortion that would could be life-saving.
“Because from time to time something goes wrong during pregnancy,” says Bennett, “and people are locked up in an institution where they are subject to laws. [preventing abortion]where the intervention is delayed to the point where they become so ill that their lives cannot be saved.
Bennett says she and her colleagues will continue to try to do their best for the patients they care for.
“We will try to protect our patients and take care of them in the best possible way now, as much as possible,” she said. “It will be difficult, but we will continue with it.”
Pregnancy and cancer
In 1995, Racine resident Sarah Bublitz learned she was pregnant by the man she was engaged to.
About two weeks later, she received a report from her last pelvic examination: she had cervical cancer.
It was astounding, says Bublitz.
“I was only 18,” she said. “I didn’t have the financial or mental ability to take care of a child.”
And the cancer diagnosis complicated her fear and anxiety. “I thought, ‘I don’t want to have this child and be able to get sick permanently or anything that might happen,'” she said. “It’s not fair to start life that way.”
Bublitz, supported by her sister, travels to Milwaukee for an abortion at a planned parenting clinic near downtown.
An ultrasound examination was performed inside. She was consulted about her options, including adoption, and the reasons for seeking an abortion.
As she was only five weeks pregnant, Bublitz was told that if the abortion took place that day, she would be at risk of the procedure being incomplete. To make sure everything was comprehensive, she chose to return two weeks later.
On her way back, she passed the abortion protesters across the street. One followed her across the street to the clinic entrance.
“She whispered in a whisper that I was a baby killer,” Bublitz said. She ruled out the woman’s other comments. “My sister put me inside.”
Inside, after another ultrasound examination, she went through the procedure. She was awake. When she finished, she was taken to a room with sun loungers to be monitored to make sure there were no complications.
It wasn’t long before she went for treatment for cervical cancer. It was an outpatient process that involved freezing the suspicious cells to remove them. When it was all over, she says, she was declared cured.
The next few years were not easy. She ended the engagement and went through what she described as “very dark weather.”
In the following years she became the mother of three, a son and two daughters. Her oldest is now 23; this year her youngest turns 18.
Her abortion was absolutely necessary for her future health, says Bublitz. He and all the events in her life that surrounded him were also emotionally draining. But she does not regret the decision.
“There are some things in my life that I would change,” she says. “This is not one of them.”
She considered not using her full name for this story, but then decided it was important to stand up for what she thought was right.
“Women, girls have to have every opportunity,” says Bublitz. “Information is power, and the power to make your own choices about your own body is essential to my being.”
She is also thinking about the world in which her children are growing up.
“I’m thinking about my daughters in the future,” says Bublitz. “And I hope that if something ever happens to them, they will have the opportunity to have safe access to abortion.