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Whether Roe vs. Wade is reversed, laws further restricting abortion care and services will come into effect in many states. Following the leak of the Supreme Court’s draft opinion in which the justices seem ready to reverse roe deerwe asked you what questions you had for our experts on abortion care and access in the United States
Many of you have written to learn more about the impact this decision could have on hospitals, in vitro fertilization and the management of miscarriages. To answer these questions, we reached out to Kristyn Brandi, an obstetrician-gynecologist and family planning physician, who is also chair of the board of Physicians for Reproductive Health, and NPR health policy correspondent Selena Simmons. -Duffin.
How will miscarriage treatment be impacted? What conversations should I have now with my OB, and will women have to prove their miscarriages are accidents? — Erika Parr, Memphis, Tenn.
Miscarriage care is definitely going to be impacted — it’s already happening in Texas.
Often people think that a miscarriage is something spontaneous, over which no one has any control. This may be true, but it may also be something people have to make decisions about. The standard of care for treating a miscarriage is the same as the standard of care for providing an abortion.
The way this can happen is if someone has a miscarriage and they have to take medicine to empty the uterus so they don’t risk infection, that same medicine is the one that is used for the medical abortion. There have already been many reports of pharmacists in Texas not filling these prescriptions for people who suffer from miscarriages.
There’s nothing in these laws that says if there’s a miscarriage someone has to prove it, but there are reports, including one from a woman in Texas, about doctors asking patients about medications they might have taken or how they might have caused a miscarriage. Concretely, getting the right treatment, on time, without barriers or questions, can still be very difficult.
— Selena Simmons Duffin
What medical conditions are definitely life threatening to the mother and would medically require a life threatening intervention for the mother or child? —Keston Smith, Fort Wayne, Ind.
The question of whether someone will die of pregnancy is rarely black or white. Restrictive abortion laws often provide exemptions for medical emergencies that require treatment that may involve the termination of a pregnancy.
There are approximately 700 pregnancy deaths per year in the United States, according to the Centers for Disease Control and Prevention. A third of these deaths are due to heart disease and stroke. But, under these new restrictions, if you develop a condition like preeclampsia early in pregnancy – which could put you at high risk of stroke – the exemption would not necessarily apply. You may need to continue the pregnancy despite the risks.
A very urgent medical situation that can arise is when someone’s water breaks too soon. That’s what happened 10 years ago to Savita Halappanavar, an Irish dentist whose waters broke at 17 weeks pregnant. A heartbeat was still detectable, so she was refused an abortion because it was illegal in Ireland and she ended up developing an infection and dying. His death pushed Ireland to legalize abortion in 2018.
We are already seeing similar stories in Texas, despite the emergency exemption enshrined in that law.
— Selena Simmons Duffin
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In states that post-roe deer do not allow termination of pregnancy for fatal fetal abnormalities, what are the implications for parents of fetuses and newborns who have problems incompatible with life? — Dr. Emily Hamburg-Shields, Cleveland, Ohio
In other words, could people be forced to carry a pregnancy to term even though it is clear that the fetus will not survive outside the womb?
According to Brandi, the answer to that might be yes.
“When I have a patient facing this outcome, I want to talk to her about her options and make sure she can decide if, when and how to terminate this pregnancy,” she says.
“Under these abortion bans, there is not much language that allows abortion in cases of fatal fetal abnormalities. People who are in abortion-restricted states will likely have to continue these pregnancies. at term and they would give birth normally would give birth either through natural birth, potentially even a caesarean, and they probably couldn’t be supported by the palliative care system in an outcome that would help them, you know, mourn the potential loss of this child. ”
Are hospitals ready for this change? Many rural areas and southern states that did not expand Medicaid lost hospitals. Are there enough beds for non-ICU labor and delivery? Will we see an increase in medical care and insurance costs due to increased charitable care for maternity services?
— A questioner who asked us not to mention his name because he works for a large hospital system in the South
It’s an important question, Brandi says, adding that she also wonders if the health care system is prepared for the growing number of patients who will come to hospitals for labor and delivery care because that they were unable to access abortion care. .
“Rural areas, even before COVID, faced a lot of hospital closures and especially labor and delivery wards,” she says. “People were already traveling long distances to get all types of care, and women’s healthcare providers were leaving these areas. Now imagine that we double or triple the number of deliveries that occur in these communities.”
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How will IVF be affected if abortion is banned? Will IVF be banned? —Elaine Foe, Greeley, Colo.
The short answer is in vitro fertilization, or IVF, could be affected by these laws. This is because the way certain words are defined in many of these new laws often do not match medical definitions.
In Texas, current law states that pregnancy begins with “fertilization” – when a sperm and egg meet. But in medicine, pregnancy is defined as starting after the division, growth and growth of the fertilized egg. implants in the uterus.
Many laws also include a line that says “an ‘unborn child’ means a human fetus or embryo at any stage of gestation, from fertilization to birth.” By this definition, unused embryos that were created for IVF are unborn children, and often when people go through IVF, many of the embryos created end up being unused and are routinely discarded.
The question of whether IVF will be limited by these laws or by future laws is still open, according to Liz Seper, professor of law at the University of Texas at Austin. “The anti-abortion movement is, to some extent, a religious fundamentalist movement that takes part of Catholic theology and combines it with part of evangelical Christian tradition and politics,” she said. “Conservative Catholics are opposed to fertility treatments, to IVF, but this has not been a target for evangelical Christians who support IVF in order to procreate.”
Overall, it is difficult to predict the consequences that a reversal roe deer could have on IVF because it seems that the anti-abortion movement is not united on this point.
— Selena Simmons Duffin
We talk a lot about birth control for women, but what about men? What are the birth control options for men and how can they help us? — Meagen Voss, Charlotte, North Carolina
Yes, there are condoms and vasectomies. But what about new advances in male contraception?
“I really wish I had better news to share about new innovations in male contraception,” says Brandi. “Unfortunately, there hasn’t been a lot of push for men to use birth control as far as things go.”
Several clinical trials of pills, injections and other procedures for men are underway, but Brandi said it will be several years before these options become available. Condoms and vasectomy are the best options available to men who want to help prevent pregnancy in their relationships, she added.