Recent studies in Cell Metabolism and the Proceedings of the National Academy of Sciences found that pregnancy was associated with acceleration of the aging process. The studies were picked up in a number of lay publications, including Time and the Washington Post. Their results also received extensive attention on social media. The widespread coverage had the media and commenters speculating about potential mechanisms for this rapid aging. One hypothesis is that the energy required for reproduction is being drawn away from bodily maintenance throughout the pregnancy. While further research is needed to fully understand why this accelerated aging occurs, on the upside, researchers also found that the process stopped, and to some degree reversed, after delivery.
The conversation the studies and their coverage generated about the effects of pregnancy on the body sparked a broader question: is pregnancy safe for everyone?
As a hospitalist at a tertiary care safety net hospital, I worry about the implications for the medically complex patient population I care for at a time when abortion access is becoming increasingly restricted around the country.
The health system I practice in does not offer abortion care except in cases where the pregnancy is endangering the life of the pregnant person. I recall a patient admitted with acute liver failure. She was pregnant, and it was a pregnancy she and her husband very much desired. She’d had a toothache and knew the only medication she could safely take while pregnant was acetaminophen. Tragically, she didn’t know there was a limit to how much acetaminophen she could use. When she started turning yellow, her husband brought her in, and she was quickly admitted to the ICU. Soon, she developed multiorgan system failure. After countless interventions, most of which have unknown effects in pregnancy, she survived. The medical team could not definitively say what the effect of her liver failure or all the measures taken to save her life would be on her fetus. She was still looking at months of recovery to regain her own health. With her ongoing liver disease and the increased risk of bleeding it brought delivery would become high risk. She and her husband asked about abortion. In this case, given her ongoing critical illness, the hospital approved an inpatient abortion. At the time, abortion was legal up to 24 weeks in the state.
Another patient was admitted with endocarditis. She found out in the Emergency Department that she was pregnant. It was not a pregnancy that she wished to continue. She was battling severe opiate use disorder and actively using IV drugs. She was experiencing homelessness. She had no support system. She needed to remain in the hospital for six weeks of IV antibiotics to treat her endocarditis. That six weeks would put her past the gestational age for legal abortion in the state by the time she was discharged. The hospital declined the request for an inpatient abortion as her situation failed to reach the bar of life-threatening. The patient was, therefore, left with the choice of continuing the pregnancy or leaving the hospital without completing her antibiotic treatment to seek abortion care.
More recently, admission to one of our internal medicine teaching teams was a patient with a rheumatologic disease who presented due to severe uncontrolled pain despite high doses of steroids. During that admission, she found out she was pregnant. She did not want to continue the pregnancy. During her previous pregnancies, her rheumatologic disease had flared terribly, and she was already experiencing significant debility. She did not see how she could care for her young children, maintain her health, and continue this pregnancy.
This patient’s abortion care seemed all the more urgent with the impending 6-week abortion ban taking effect May 1 and the additional barriers to care this poses for our patients. This patient’s care required tremendous advocacy efforts from her health care team. It necessitated a full day of phone calls, involvement of hospital leadership, consultation with OB/GYN, and crafting an argument for why this patient’s pregnancy was detrimental to her health.
All this is for the patient to receive legal abortion care.
Was this patient’s pregnancy endangering her life? Is unremitting pain life-threatening? Is opiate use disorder? Is liver failure if the patient is stabilizing? Where do we set the line for the threat to life?
As evolving science causes us to ask if pregnancy is safe for everyone, what happens when the answer is no?
Jennifer Caputo-Seidler is an internal medicine physician.
