When Louisiana adopted one of the strictest anti-abortion laws in the country nearly two years ago, there were predictions that the near-total ban would impact not just women who seek to end pregnancies, but pregnancy care in general.
Newsflash: That’s exactly what happened.
And yet a new report documenting the state’s fraught new health care landscape for women since the U.S. Supreme Court overturned Roe v. Wade still has the power to shock.
In interviews for Lift Louisiana, Physicians for Human Rights, Reproductive Health Impact and the Center for Reproductive Rights, people who care for pregnant women and some patients described an agonizing minefield that didn’t exist before 2022.
For miscarriages where the standard treatment is the same procedure used in abortion, doctors and hospitals are hesitating or steering patients toward more invasive procedures, including C-sections that carry more risk and affect patients’ future ability to give birth vaginally.
And practitioners are operating defensively, keenly aware that the law carries criminal penalties that could be applied in situations that aren’t nearly as clearcut as legislators imagine them to be.
“Every doctor in Louisiana is afraid of being made the very first example of criminal intent,” one told interviewers. Several mentioned a threatening letter sent by then-Attorney General and now Gov. Jeff Landry soon after the ban went into effect as remaining very much on their minds.
And then there the effects that surprised even researchers.
One is that some pregnant patients struggle to even see a doctor until they’re in the second trimester, after the risk of miscarriage goes down.
“One of first interviews I conducted was with someone who was pregnant, and she could not get prenatal care before 12 weeks. (She) was literally told ‘We don’t even want to see you,’ " said Nia Mitchell, vice president of RH Impact. “She went to multiple providers. At ten weeks, she began to cramp and bleed. She miscarried.”
Michele Heisler, medical director at Physicians for Human Rights and a professor at the University of Michigan, said this scenario is particularly dangerous to patients with conditions such as uncontrolled diabetes and obesity.
“You need to see them earlier. It’s the women who are at the highest risk who are more likely to have a complication during pregnancy,” she said.
The researchers did not quote the subjects by name, which enabled them to speak freely despite the culture of fear that now surrounds pregnancy care. That fear is affecting patients as well as providers, the report notes.
“I had a patient who had a pregnancy with multiple abnormalities, and we were talking about her options, and she asked me, ‘Do I need to get a lawyer?’ And that wouldn’t have been something that a patient would have asked me prior to Dobbs,” one doctor reported.
Doctors interviewed said the law has even impacted trust between patients and providers. Some patients aren’t clear on what they’re allowed to ask, or delay seeking care longer than they would have before.
Providers have been forced to delay too, because the law contains no exception for the pregnant woman’s health. That can lead to truly dangerous situations, Heisler said.
“Often women are healthy until they’re not,” she said. “Bodies compensate, compensate, compensate, and then they crash.”
Here’s one such account from a maternal fetal specialist:
The patient “was quite sick, and they said, ‘No. We have to maximize all medical management options before we could offer any sort of termination procedure.’ And I’m thinking, but what if she doesn’t want to wait that long because she could have a heart attack and die?”
It goes on from there. Patients who are miscarrying are being transferred long distances to medical centers rather than getting treatment in the emergency room, because “they don’t want to take any risk of making a decision that might be medically correct but might be perceived as an [illegal] abortion,” as one specialist put it.
Doctors are struggling to fit complex situations into the list of allowable conditions under which termination is legal.
And — again, as predicted — practitioners are wrestling with the painful decision of whether practicing in this state is worth it.
If nothing else in this disturbing report gets the lawmakers’ attention, this should. Louisiana already suffers poor overall health outcomes and vast inequities. It already has among the worst outcomes for pregnant women and newborn babies. It needs all the expert care it can get.
And yet, as the report documents, it also makes staying a truly fraught choice for providers.
“Fewer people will want to practice here, and fewer people will want to come here to train. [The bans are] going to be driving away a number of really strong clinicians who are dedicated to taking care of really vulnerable populations,” one doctor told researchers. “I think it’s going to leave our populations in Louisiana further disadvantaged and experiencing more harm.”
Sounds like it already is.