I’m a Kansas City OB-GYN. The Supreme Court might put my patients in danger | Opinion
How much bleeding is considered dying? The Supreme Court is set to make a major decision April 24 that could have wide-ranging effects on physicians like me — and put women’s lives on the line.
This is a question I found myself asking late at night earlier this year. My patient had lost about half a liter of blood. Her baby still had a heartbeat, was still moving around on my bedside ultrasound, despite having no fluid to do so in, holding on as best as he could. The mother’s heart rate began to rise — not dangerously high, but higher than her baseline. Her temperature was slightly elevated, but not yet a true fever. Her blood pressure was lowering, but she was still conversational.
At 20 weeks gestation, there was nothing we could do to save her baby. At 20 weeks pregnant in Missouri with its extreme ban on almost all abortions, there are no easy ways out of this situation.
Our team knows where a woman like this patient is headed, as we have seen many times before. If we do not intervene, she will continue to bleed as the placenta is coming undone. She will develop a fever, her uterus becoming infected, which will spread to her blood and threaten her life. Her uterus is too small, too weak to labor on its own at this point.
The standard of care would be to immediately offer pregnancy termination — abortion. This is a choice, and the patient will always be allowed to say no. Based on her own personal beliefs, she may decline until it is truly the only option.
In Missouri, we must be careful about our wording. I feel shame admitting that I approach the situation in fear — of losing her life, but also of losing my job, which has taken so much of my life the past 14 years. I want to put all my effort into saving her life, into saving the life of the fetus if that is her wish. I am angry that I must think of my own legal consequences alongside my recommendations. Ultimately, those who have put these limitations on my work have never felt the pain of these moments: sharing bad news, holding women as they cry, looking at them as they get sicker and sicker, knocking on the door of death.
On Wednesday, the Supreme Court will hear the case of Idaho v. United States, which challenges that hospitals must stabilize individuals prior to transport, including when those cases involve emergency abortions. The Emergency Medical Treatment and Labor Act established this guideline in 1986 — however, specifics regarding abortion care were not included.
How common is the need for an emergency abortion? Much more common than you may think: Several have occurred within our city limits so far this year, and there have been many more around the country. These are individuals who knock on the door of death prior to proceeding with an abortion. All patients that I have taken care of in these situations strongly desired their babies. Their hearts break along with their bodies. We cry together, with a shared understanding of what could have been, what we both wanted to happen. Another mother’s newborn cries down the hall, adding to our sorrow.
My job as an obstetrician isn’t a job — it is a vocation. It is impossible and heartbreaking and beautiful, and above all I am grateful to be able to walk alongside my patients through the best and worst days of their lives. My ability to offer lifesaving care is in the hands of the Supreme Court, and I anxiously await the justices’ decision.
Lucy Smith is an OB-GYN in Kansas City.
