This past summer, we planned a family vacation with our two adult daughters and their significant others to the Outer Banks of North Carolina. The trip was scheduled for July 6. After we planned our vacation, our older daughter announced her pregnancy, and to our surprise and delight, she was expecting twins! She consulted with her OB/GYN and was permitted to go on the trip under the condition that she would take frequent breaks, wear compression socks, and hydrate during the drive from Pittsburgh to the beach.
On June 28, I read an article in the New York Times about the situation in Idaho where a woman had to be life-flighted out of the state after suffering a placental abruption, an obstetrical emergency. Idaho has a near-total abortion ban. There are exceptions, but they have caused confusion among hospital clinical staff, who fear losing their professional licenses or even facing jail time in an untested system.
In 2022, the Biden administration sued the state of Idaho under the four-decade-old Emergency Medical Treatment and Labor Act (EMTALA). The administration’s position is that if a hospital system accepts Medicare, it must provide abortion care if the life of a woman is in jeopardy. The outcome of the lawsuit is unresolved. According to an online Washington Post headline from June 27, “Supreme Court officially allows emergency abortions in Idaho, for now.”
The Times and the Post articles report that the situation is far from resolved in Idaho, resulting in the loss of almost twenty-five percent of its practicing OB-GYNs and more than half of its maternal-fetal medical specialists. The Times reported that six patients had been airlifted from the most extensive hospital system in the state of Idaho, St. Luke’s, to other states to receive life-saving care that clinicians were afraid to perform in Idaho for fear of legal repercussions, including “charges, jail time, large fines and loss of their medical licenses if they provide care a prosecutor says was not necessary.”
I am a CRNA who has worked in two states, both Pennsylvania and Maine, since the reversal of Roe v. Wade. I have treated patients who required abortion care when medically necessary. These cases include an ectopic pregnancy in which the mother was actively bleeding, and the only way to stop the bleeding was the removal of the non-viable fetus and removal of the fallopian tube. I provided anesthesia services for spontaneous abortions (miscarriages) that required a dilation and curettage (D&C) to remove retained products of conception and prevent bleeding or sepsis in the mother. Both of these conditions can affect not only the life and health of the mother but also future fertility.
As a professional, this affects my practice directly in two ways. Before Roe v. Wade was overturned, I never considered providing care in the above circumstances illegal or controversial. I believe that my role is to provide life-saving care when necessary, and it is the job of medical professionals to decide essential medical care, not prosecutors. Second, I am also in the position of taking care of and providing emotional support for devastated families who have just experienced a horrific loss. My personal view on abortion in general, while irrelevant, is simply put: it’s none of my business. I would not refuse to provide anesthesia in any case where the mother’s life is at stake, regardless of the law.
Because I am a licensed professional and I travel to other states, I have limited the states that I will consider practicing in based on the laws of those states pertaining to abortion care. I will not work in a state where I would face legal liability for helping to provide such care. I am sure I am not the only medical professional who feels this way.
Personally, this affected our family vacation plans. The day I read about the Idaho decision in two major newspapers, I looked up the current law in North Carolina. We were traveling with my daughter, who was currently experiencing a high-risk pregnancy, to a state that, since Roe v. Wade, has enacted restrictive abortion laws. If my daughter had an obstetrical emergency, would she be able to get the care she needed based on the stage of her pregnancy while we were at the beach? I wasn’t sure. So, my husband and I devised a plan. If we had time, we would take her back to Virginia, where there would be no question about her receiving the needed care. I did not tell my daughter about my concerns. I will say that without any type of standards in place from state to state regarding abortion care, the choice of where I choose to live, work, and even visit will be affected.
While we were away, she quickly fatigued and had some swelling in her feet and ankles. I made her check her blood pressure frequently and take frequent breaks from the heat. Everyone returned happy and healthy from the beach. Upon our return home, her twenty-week ultrasound revealed two healthy baby boys. She delivered at 31 weeks, and both babies needed a little support in the NICU, but are otherwise healthy and are doing well.
These babies were planned (well, one was planned, the other a joyous surprise), wanted, and deeply loved. However, I want to make it very clear: if my daughter needed emergency care at any point during her pregnancy, nothing would stand in my way of getting my daughter the health care she needed.
Christine King is a nurse anesthetist.
