It is getting very crowded in my exam room. As a practicing obstetrician, I have counseled women for more than the past 36 years and our conversations have always been private. Suddenly, for the first time in 50 years, judges and politicians are vying to join me in these intimate moments that can involve the life or death of the mother. This is impossible for me to comprehend or accept.
The definition of when life begins has been seen differently by different people. Still, as a practicing obstetrician, it is impossible for a fetus to live outside the mother’s womb before 22 weeks at the earliest. So, the life of the mother becomes paramount in the equation.
Our country already has a significant problem with maternal mortality: the worst of any developed nation. Women who seek abortion are disproportionately poor and low income. We know that a Black woman dies at a rate of 3 to 4 times that of a white woman during pregnancy. The decision to repeal Roe puts many women at risk; the most recent count is 26 states with trigger or longstanding bills that will go into effect when this law is overturned. Abortion decisions are some of the most difficult decisions a person and her partner can ever make, especially when a pregnancy is desired.
There are conditions that occur during a pregnancy that put any mother’s life at risk. These conditions do not wait for a fetus to be able to live outside of a mother on its own. We, fortunately, have not seen maternal mortality increase due to hemorrhage and abnormal growth of the placenta, as we can manage these heart-breaking conditions in women with these high-risk situations through appropriate abortion care with outcomes that preserve the life of the mother and her potential to have more children.
Severe preeclampsia can occur as early as 20 weeks of pregnancy and can cause stroke, seizure, and death in the mother. The only treatment is to terminate the pregnancy. The concept that someone with no medical training can make decisions for a pregnant person facing life-threatening and reproduction threatening is one we have not seen in our country in the past 50 years. There is no other situation when someone outside an exam room can limit health choices for another person, especially when that person’s life is at risk.
Ectopic or tubal pregnancy occurs in 1 to 2 percent of all pregnancies, one of every 50 to 100 pregnancies. There is no option to preserve a fetus growing outside the uterus. Yet lawmakers are some states are attempting to write laws to make physicians try to re-implant a fetus in a uterus which is not a known medical procedure. These pregnancies are not always detected before a woman has internal bleeding and require immediate surgical or medical treatment. In this scenario, the risk is death to the mother and no further options to have a desired pregnancy, and potential loss of a mother to any already existing children.
Pregnancy resulting from rape or incest is something that a person can never fully recover from. There is no “good outcome” for someone who suffers this fate, especially if that person is a child who can be as young as twelve. Once again, how do I uphold my oath when faced with the decision of others who do not see the long-term repercussions that these patients suffer, and then to make them carry a baby to term is the ultimate form of torture.
These changes on the horizon for our country are unlike anything we have ever experienced. We have only experienced an expansion of rights for those who have been denied fair treatment. Going backwards only infringes our ability to pursue life, liberty, and the pursuit of happiness. Future laws that could be overturned include Griswold v. Connecticut, protecting the right of marital privacy against state restrictions on contraception.
As an experienced physician with a strong interest in patient safety, I feel the need to educate our patients about potential changes in their health care because of this possible decision and ask for their partnership in getting out the vote for candidates that would support women’s rights. Time is of the essence.
Susan Mann and Haywood L. Brown are obstetrician-gynecologists.
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