If the United States Supreme Court overturns Roe vs. Wade with its final decision in Dobbs v. Jackson Women’s Health Organization, anti-abortion restrictions could affect all health care. While trying to save a complicated twin pregnancy, I discovered that US anti-abortion policy already limits the medical procedures doctors can do, the drugs doctors can prescribe, the surgical tools they can use, the tests they can perform and the words they can say.
Dobbs could place medical standards of care beyond the reach of most Americans.
Prohibited medical procedures
In a post-Dobbs In America, many procedures used in gynecological and obstetrical practice could be banned, lest they be used for an abortion.
Six years ago, my gynecologist first diagnosed me with an “impaired egg,” a fertilized egg that did not develop, and prescribed me dilation and curettage (D&C) before I got infected. D&Cs are common for removing polyps, tumors, damaged eggs, and tissue left over after a miscarriage from the uterus.
My doctor could have offered me other procedures instead. A dilation and evacuation (D&E) procedure is sometimes a better choice, especially for a patient who is bleeding from an accident or trauma or placenta previa.
Dilation and extraction (D&X) is a more complex surgery for patients who have a miscarriage, requesting an autopsy of the fetal remains or wishing to reduce the potential for trauma to the uterus during an abortion. However, several states have made D&E and D&X illegal under certain circumstances, and Dobbs could allow other states to do so. Due to the prohibition of certain gynecological procedures, new doctors may not be trained to perform them.
Dobbs could metastasize these limits of care beyond gynecology. The treatment of blood clots, for example, affects both maternal and fetal health. Medical practice guidelines require that the pregnant person be informed of the risks of treatment to the fetus and decide how doctors should proceed. States could soon ban this shared decision-making when the life of the fetus is at risk.
Prohibited drugs and procedures
Americans already cannot easily obtain drugs that are commonly used in gynecological practice around the world. The Food and Drug Administration has been analyzing the use of misoprostol for years but has not approved the drug for use in gynecology.
Misoprostol treats stomach ulcers and Cushing’s syndrome, and the World Health Organization and the American College of Obstetricians and Gynecologists recommend it to control blood loss during uterine surgery and childbirth.
The American anti-abortion policy excludes Americans from this gynecological standard. Women around the world discreetly use misoprostol, sometimes combined with mifepristone, to terminate a pregnancy. Despite ample evidence that mifepristone and misoprostol, when used individually and in combination, help the patient with very few adverse outcomes, physicians and patients must go through regulatory steps to obtain these drugs.
Dobbs could authorize the prohibition of drugs whose adverse effects on the health of the fetus are unknown or suspected. Back to an America where all women are “pre-pregnant,” women could be denied access to anxiety and depression medications with a lack of data on their effects on pregnant and breastfeeding women — or on women at all. As with chemotherapy for cancer or tuberculosis, concerns about potential harm to the fetus or fertility could prevent patients from getting the drugs they need.
Prohibited medical devices
While still fetuses inside me, my twins had to be operated on. The FDA must approve the tools the surgeon would use: endoscopes, cameras, and lasers. Once the FDA has approved a device, the circumstances in which the device can be used are written on the device label. If a physician believes that using a device in an “off-label” manner could benefit the patient, the physician may proceed once a hospital Institutional Review Board (IRB) authorized.
Permission from my hospital was required for intrauterine fetal surgery with certain devices. The fetal surgery risked terminating my pregnancy; therefore, the IRB blocked the care that I wanted, and that my doctors recommended.
Job-DobbsI don’t see how fetal surgery instruments will be allowed.
Prohibited medical tests
Genetic testing by chorionic villus sampling (CVS) and amniocentesis poses a slight risk of miscarriage and, after Dobbs, could be prohibited. CVS is done after 10 weeks of gestation, and amniocentesis, around 20 weeks. With both procedures, a large, hollow needle is used to puncture the uterus and remove fetal cells. Cell chromosomes are analyzed for malformations, additions or deletions.
Especially with CVS performed before 11 weeks of gestation, perforation of the uterus may cause the patient’s muscles to contract and the fetus to be expelled. In an America where all pregnancies must be maintained until birth, effective genetic testing — which some parents use to prepare for the care their children will eventually need — might be impossible.
Prohibited discussions of health care options
My maternal-fetal specialist’s office was in a Catholic hospital, which prohibits contraception, sterilization, many infertility treatments and abortion care, even when the patient’s health or life is in danger because she is having a miscarriage or an ectopic pregnancy. Catholic hospitals also prevent staff from providing patients with comprehensive information and referrals for care that conflicts with Catholic religious teachings.
After Dobbsthese restrictions could multiply.
My pregnancy was going badly, with little chance of my twins being born alive. My doctor pulled me aside and whispered that I might want to quit.
Hospital policy forbade him from discussing this option with me, but his medical ethics required that he help me because I was in pain. Dobbs could still muzzle what doctors can say to advise their patients.
Worst access to health care
The Covid-19 crisis has highlighted the difficulty all Americans have in accessing adequate health care. The anti-abortion policy only exacerbates these difficulties.
Job-DobbsAmericans who need innovative care for an unforeseen and difficult medical problem could be at the mercy of anyone who can treat them with every tool available, whether they’re on the cutting edge of technology or just what politicians allow.
This article does not necessarily reflect the views of the Bureau of National Affairs, Inc., publisher of Bloomberg Law and Bloomberg Tax, or its owners.
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Genevieve Grabman is the author of “Challenging Pregnancy: A Journey through the Politics and Science of Healthcare in America” (Univ. Iowa Press 2022). She is a lawyer at the Office of the United Nations High Commissioner for Refugees, of which she does not represent the opinions and the Member States. She is also a public health expert and a mother of four.