According to STAT survey, hospitals remain silent on maternal care since Dobbs

TThe Supreme Court’s decision to overturn Roe v. Wade has transformed not only access to abortion, but also maternal health care in the United States, causing doctors in states with restrictive laws to change the treatment of conditions such as ectopic pregnancy and abortion involuntary The full scale of the impact, however, has been obscured in a polarized political climate where doctors are often afraid to speak out, or their hospitals prevent them from talking about their experiences after Dobbs.

The extent to which the conversation has been muted is evident from a STAT survey of 100 hospitals, two in each state, asking to talk to doctors about changes in maternal health care since the Dobbs ruling . Only six institutions made doctors available to talk about their work, and five of those were in states where access to abortion remains protected.

Representatives from five additional hospitals said they would ask the doctors if they were interested in speaking, but could not confirm a time; the rest rejected the request without providing a reason or simply did not respond to STAT’s request.

Several reproductive health doctors said the lack of response reflects a climate where fear of political scrutiny and financial repercussions have stifled transparency.

There’s so much uncertainty about what’s allowed that the safe conservative approach is not to talk about it, said Aileen Gariepy, director of complex family planning at Weill Cornell Medicine. Even in an incredibly progressive state like New York, for those in the C-suite, advertising and PR, there has always been a lot of concern and stigma surrounding abortion care. This has been magnified.

Hospitals employ PR and marketing teams that usually respond quickly to reporters’ requests for interviews on other topics, but in this case, the response was very different. STAT reached out to a variety of hospitals, including major for-profit chains like HCA Healthcares Grand Strand Medical Center in South Carolina, teaching hospitals like the University of Iowa Hospital and OSF Heart of Mary Medical Center, a Catholic hospital in Illinois, all declined interview requests. Doctors were given the option of three days for an interview and were given the option to suggest other times that would be preferable.

STAT asked to talk to doctors not about abortion specifically, but about changes in maternal health care more broadly after Dobbs, such as whether there were changes in the number of appointments for pregnant patients during the first trimester or in the monitoring and treatment of conditions. such as ectopic pregnancy and miscarriage.

Of the six hospitals that accepted interviews, doctors at Weill Cornell, Women’s and Children’s Hospital of Rhode Island, Stamford Hospital in Connecticut, and Massachusetts General Hospital, all in states with permissive laws abortion, they said they had not personally had to change care in response. until the fall of Roe.

We all know that the case in Massachusetts is not the case elsewhere, said Jeff Ecker, chief of obstetrics and gynecology at Mass General. As we listen to colleagues, we share their anguish to some extent. It makes us feel lucky.

In many other states, Dobbs’ implications go beyond abortion. Doctors in Louisiana have responded to preterm premature rupture of membranes (PPROM), which makes pregnancy unviable and leads to infection and sepsis in the mother if left untreated, by performing C-sections instead of providing medication, which is not standard of care and creates risks such as bleeding and fertility complications. Other patients have been denied miscarriage care and standard prenatal appointments during the first trimester. And sometimes doctors have turned away patients with an ectopic pregnancy, where the embryo implants outside the uterus. If left untreated, ectopic pregnancies rupture the fallopian tubes, causing serious health risks, including death.

Heather Spies, an obstetrician at Sanford Health in Sioux Falls, South Dakota, told STAT that the ban on all but life-saving abortions has changed the approach to treatment for PPROM and lethal fetal abnormalities. . For the former, he said, doctors now take extra steps to collaborate with maternal-fetal medicine specialists and confirm the diagnosis and risk to the mother’s life, and may also consult with legal support teams before proceeding. .

For example, he said, there are cases where the membranes rupture long before a fetus can survive outside the womb, the fetus is expelled halfway through, but there is still a fetal heartbeat. This does put us in a difficult spot. It can create a conflict with the standard of care in some cases, he said. Before Dobbs, doctors could provide drugs to expel the fetus completely, thereby reducing the risk of infection and bleeding. But now, if there’s still a heartbeat, Spies said, that could interfere with how quickly doctors intervene.

And when there are abnormalities that mean the fetus won’t survive outside the womb, he said, doctors can no longer offer an abortion even if the pregnancy has serious health implications, as long as it doesn’t endanger the woman’s life. mother It could cause damage to the uterus, she said. If there is maternal heart disease or a kidney condition, something that can make it worse, it would not be under the law.

Similarly, Abigail Cutler, an obstetrician at UW Health in Wisconsin, told STAT that she experienced a change in the management of early pregnancy issues immediately after Dobbs, before a Wisconsin judge last year invalidated a pre-Civil War law that had banned abortion. Management of patients with nonviable intrauterine pregnancies became more conservative, he said, as in the early days he said he knew some providers who were unsure whether they could perform the standard care of providing drugs or surgery to end non-viable pregnancy for an ectopic. pregnancy and PPROM.

She also felt pressure to wait for miscarriages to develop past the point of early bleeding and rising hormone levels to make absolutely sure the fetus was not viable, whereas, before Dobbs, she leaving current patients with a range of treatment options, including medication to hasten miscarriage. process

When we had the threat of a criminal ban on abortion, there were times of pause when we had to make sure we were obeying the law, which sometimes meant we couldn’t keep patients’ preferences at the forefront and in the center, Cutler said.

Doctors who spoke about their experiences, however, were in the absolute minority, and several expressed frustration at the difficulty colleagues at other institutions have in discussing their work. People want to talk, but a lot of people are afraid for their jobs, said Melissa Russo, a maternal-fetal medicine specialist at Women’s and Children’s Hospital of Rhode Island. They could get in trouble just for talking to a reporter.

Some are personally wary of speaking out publicly, doctors said, fearing both personal attacks and legal repercussions. Even when doctors do communicate with each other, Gariepy said, for example, when states with abortion bans try to find care for patients elsewhere, they are often extremely conservative, choosing phone calls over writing. Messages and requests for help can be quite cryptic. They say that this ectopic pregnancy is a threat to maternal health, which is obvious to us, he said. There is a lot of muddy water about what is allowed and what is not. Doctors don’t want to go to jail, we want to take care of people.

And when doctors feel comfortable speaking up, they are often prevented from doing so, several doctors said. Similarly, hospitals fear political and legal scrutiny, as well as potential backlash from donors for being associated with abortion. “I know a lot of doctors who provide abortion care in hospital systems that frown on them because they don’t want to broadcast that they provide abortion care for fear of losing funding, local political figures retaliate,” said Chelsea Daniels, a physician at a Planned Parenthood clinic. in Miami, who said these doctors fear losing their jobs if they speak out.

Similarly, Damla Karsan, a Houston-based obstetrician-gynecologist who sought and was denied legal permission to abort her patient Kate Cox last year on the grounds that the pregnancy threatened her fertility and health, said she was only able to be so open about her patients’ lives because she is employed by a clinic, Comprehensive Womens Healthcare, rather than a hospital.

She also knew of colleagues who had been scared to death of losing their jobs, she said, and she worried that the conversation about abortion and how Dobbs has affected health care had been silenced. This has been one of my frustrations, that there hasn’t been more seasickness [of physicians speaking out].

Ultimately, restrictions on talking about Dobbs’ impact hurt patients, Gariepy said, especially marginalized populations, such as teenagers and non-English speakers, who already struggle to access accurate information about abortion-related health care.

Even in New York, he said, his work is not publicized the way his colleagues in other disciplines care. You’ll see billboards about how he was number one in orthopedic care, here’s a heartwarming story of a baby who got a heart transplant and is now an Olympian, he said. There are no billboards about how we were able to provide abortion care for PPROM at 19 weeks and now the mother has healthy children.

This story is part of ongoing coverage of reproductive health care supported by a grant from theCommonwealth Fund.