Editor's Forum

Miscarriage of Justice

“This is bringing back some bad memories,” my patient said nervously, making the most severe understatement I’ve heard in residency.

About 10 years prior to our conversation, she had experienced a nightmare beyond words. In the third trimester of a very wanted pregnancy, her fetus died in her uterus. To make this devastating loss even worse, this went undetected for a few days as she became increasingly septic at home, and by the time she was transferred from a smaller ED to mine, she was in septic shock. She decompensated further, lost consciousness, and had a cardiac arrest requiring a resuscitative hysterotomy. The stillborn fetus was removed, and the patient was cannulated for ECMO, which she depended on for months afterwards. She spent the following year cycling through near-fatal complications including severe dilated cardiomyopathy necessitating a heart transplant and prolonged ventilator dependence requiring a tracheostomy, all while experiencing the emotional trauma of both her own hospitalization and the stillbirth of a desired third-trimester pregnancy.

Seeing her now, wearing her business casual work attire in the OB triage area, only a tracheostomy scar betrayed the long and arduous battle for her life she had fought years before. Despite her efforts to consistently use birth control with her husband, she was pregnant again. And she was scared.

These may not be the extreme circumstances of every person facing a pregnancy and considering termination, but many face other challenges that make pregnancy and childbirth life-threatening dilemmas. You have cared for patients with ectopic pregnancies, patients with precarious comorbidities, and patients who delivered a term fetus known in-utero to have severe unsurvivable malformations. For these people and so many more, legislation that forces them to continue a pregnancy can be extremely dangerous. For their obstetricians and emergency physicians, such laws make improving these people’s chance of survival by ending their pregnancy a crime for which doctors could potentially be prosecuted.

Even measures that do not illegalize abortion but restrict it to life-threatening situations or cases of sexual assault and incest are fraught with inequity in how they are implemented. Attempts by lawmakers to prohibit some abortions before viability but not others often form logistical hurdles causing dangerous delays in care and worse medical outcomes for the pregnant person. These hurdles also disproportionately restrict treatment options for patients with limited resources. Those without transportation to far-away clinics, access to legal counsel, or money for abortion services are forced to proceed with a pregnancy that a person with more resources could terminate.

As emergency physicians, we care for patients of all backgrounds and means. We are often the ones to look into their eyes and break the news that they are pregnant. To put it bluntly, after residency we will also be some of the most wealthy and well-resourced people in some of our patients’ lives. Though I felt powerless when reading the leaked majority opinion of the Supreme Court that, if finalized, would overturn the decision ofRoe v. Wade, this is only one battle in the war to protect our patients’ reproductive rights. If it is officially overruled, the stakes will be higher than ever for us to use what power we do have as physicians and voters at the state level.

Starting now, share your clinical experiences with legislators, friends, and family. Tell the de-identified stories of patients who have suffered from ectopic and high-risk pregnancies. Talk about your patient with endometritis or hemorrhage from an abortion done without medical supervision. Make the impact of this legislation as personal to lawmakers and voters as it is to the woman who has just learned she has a pregnancy that she may not survive. She was my patient. Now she's yours, too.

 

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