Health

What a high-risk pregnancy looks like after eating dobbs


Pregnancy can be dangerous – sometimes fatal – for both a woman and the fetus they hope to give birth to. Fetal conditions, like a force majeure twin that threatens the health of its sibling, can also frighten the mother. So can disorders like cancer, heart disease, kidney dysfunction, diabetes and lupus. Even simple things like age – getting pregnant when you’re younger than 17 or over 35 – or carrying twins or having a history of multiple miscarriages can put a woman and her pregnancy at risk. That’s why so many obstetricians see the possibility of abortion as essential: Doctors need access to abortion procedures so that they can provide care and save lives.

Catrina Rainey and James Packwood and their 9-year-old son at home, in August, a month before her due date. In May, Catrina learned that one of the twins she was carrying had a severe brain birth defect, meaning it couldn’t live past six months outside of the womb and could threaten her ability to live. of the remaining fetus until birth. A drop – terminating an unhealthy fetus to protect a healthy sibling – took place in May. It was one of the last such proceedings to be carried out in Ohio, after the state deemed them illegal, according to Dobbs’ decision.


The Cleveland Clinic’s maternal-fetal medicine department, one of the largest in the country, was established to handle high-risk pregnancies and the dangers that may come with them. It manages more than 5,000 such pregnancies each year. In August, less than two months after the Supreme Court Judgment on Dobbs v. Jackson Women’s Health OrganizationOverturning Roe against Wade and abolishing the constitutional right to abortion, photographer Stephanie Sinclair spent two weeks capturing the unsettling new world inside the Cleveland Clinic.

Everything changed on the day of Dobbs’ decision, June 24. Later that Friday, a three-year-old law went into effect, the so-called “heartbeat bill” that made abortion a crime. after a fetal heartbeat has been detected. A heartbeat can usually be detected around the sixth week of pregnancy, before many women know they are pregnant; abortion was previously permitted, with restrictions, until 22 weeks of gestation. Suddenly, most termination procedures scheduled a week earlier by the Cleveland Clinic are now criminal. There are only three exceptions where abortions are allowed after the new term: to prevent the death of the mother; to prevent “the serious risk of significant and irreversible impairment of a major bodily function of a pregnant woman”; and in response to an ectopic pregnancy in which a fertilized egg implants itself outside the uterus.


Every morning, obstetricians and gynecologists, nurses, the NICU team, and pharmacists meet to discuss their patients. The increasingly restrictive abortion laws have created concern that they will not be able to provide the care they need. Dr Tristi Muir said: “We want the best for them emotionally and medically, and the rulings will affect that. “Health care decisions can be very complex, and they are best made between the doctor and the patient.”


Uncertainty about how to interpret and provide care for those exceptions means that Cleveland Clinic staff must continue to do their jobs under dubious legal circumstances. How do you know if a mother’s life is at risk? How do you predict, then prove, that the mother faces irreversible bodily harm? Dr Stacey Ehrenberg, who specializes in high-risk pregnancies at the Cleveland Clinic, said: “As doctors, we are truly committed to patient care. “And now we’re handcuffed.”

Once the heartbeat bill becomes law, routine procedures for treating miscarriages – that is, the way in which at least 1 in 10 pregnancies end – could be considered abortions. The most effective drugs used in miscarriages, mifepristone and misoprostol, are also the ones used for medical abortions; A hysterectomy is another procedure used with miscarriages that is also an abortion method. The new law means that most patients admitted to the Cleveland Clinic Emergency Department with a miscarriage must wait 24 hours before receiving treatment — earlier treatment could be considered an illegal abortion. Ashley Brant, an obstetrician and gynecologist at the Cleveland Clinic, says they have a core group of doctors who provide abortion care who are well versed in the law. But the new law, she said, “opens up who can provide this kind of care.” For example, a doctor in the emergency room, accustomed to treating a miscarriage with certain procedures, is now potentially breaking the law. That risk has the potential to affect medical care.


Dr. Maeve Hopkins with a patient, before amniocentesis to check previous indications from blood tests and ultrasound that her fetus has Down syndrome. The patient, worried about both the financial stress of caring for a child with special needs and the impact on her daughter, who is almost 2 years old, decided to abort the pregnancy if a diagnosis of Down syndrome was confirmed. accepted, although she will be traveling outside of Ohio to do so.


Ohio has been changing the parameters of reproductive care for decades. Physicians must ask patients who want and qualify for an abortion if they want to hear the fetal heartbeat or see its images; doctors and other health care providers, including pharmacists, are allowed to withhold medical care based on their moral, religious or ethical beliefs; Physicians are required to submit an official record to the state department of health for every eligible abortion patient. And each patient who wants to have an abortion must be provided with a 21-page booklet titled “Fetal Development & Family Planning”. Those changes happened over the course of many years. The heartbeat bill went into effect so quickly that even powerful organizations like the Cleveland Clinic caught off guard. “I have lived in confinement for most of my career and have gone through changes in legislation that limit my rights,” said Dr. Justin Lappen, head of fetal medicine at Cleveland. approach, but not to this extent. Clinic.

Lappen, Brant and the clinic’s attorneys held an emergency meeting on Monday following the Supreme Court’s decision to impart medical and legal guidance to more than 600 doctors, nurses and administrators remote participants. Dr Amanda Kalan, an expert in fetal medicine, said: “Everybody is really emotional and sad that this has actually happened. “The people who make the laws are not doctors, and they don’t understand the meaning of all these laws.”


Megan Keeton, 31, shortly after the cesarean section. Complications from two previous pregnancies – one resulting in stillbirth, the other in the birth of daughter Aryia, now 7, with quadriplegic cerebral palsy – prompted doctors to advise Jones that she should not be pregnant. pregnant again because of the risks to the baby. Health. (She suffered a stroke shortly after giving birth to her daughter.) But just before she had an appointment for a tubal ligation late last year, she discovered she was pregnant for the third time. “I was asked if I wanted an abortion, and I said no,” Jones said.


Elizabeth Whitmarsh, communications director for the Ohio Right to Life, which campaigned for the heartbeat bill, denied that the bill itself was responsible for any adverse ramifications. “The only thing that’s not legal in Ohio right now is the murder of a child,” she said, when asked about the bill’s consequences. Ohio State Representative Adam Holmes, along with Representative Steve Chabot and former Governor John Kasich, did not respond to a request for comment.

On July 11, two and a half weeks after Dobbs’ decision, an Ohio representative named Gary Click introduced a two-sentence “humanity” bill that would further limit abortion. The bill is intended to “protect the constitutional rights, of all human individuals not yet born from the moment of conception,” unless the mother’s life is at stake. For now, says Lappen, “We have some patients at 5 or 6 weeks who can still get abortion care if no heartbeat is detected.” But if the bill becomes law, he added, “there would really be no abortion care left on the table in Ohio.”

Mary Lynch, 36, with her children, during a checkup with Dr. Stacey Ehrenberg. Lynch’s previous pregnancy resulted in a child with a fatal genetic defect. “After two days, we couldn’t let him suffer anymore, so we moved him to comfortable care where they gave him lots of morphine and I kept him for hours,” Lynch said. speak. After learning that there was a 25% chance of the same condition occurring in future pregnancies, she and her husband opted for in vitro fertilization so the embryos could undergo genetic testing. But Lynch worries that if the “identity bill” passes in Ohio, it could affect IVF, which typically requires the removal of fertilized embryos; If that happens, Lynch plans to go to Illinois for any future IVF treatments.


Maeve Hopkins, an obstetrician and gynecologist specializing in high-risk pregnancies at the Cleveland Clinic, grew up outside of Cleveland and returned to the city after working in Pennsylvania and North Carolina. Now she questions the move. “I don’t know of an obstetrician-gynecologist in Ohio who wasn’t thinking about leaving,” she said. U.S. News & World Report currently ranks Cleveland Clinic’s obstetrics and gynecological care as the fourth best in the nation, but Dr. Tristi Muir, president of the Institute of Obstetrics and Gynecology and Women there, points out that the condition This—and even more importantly, the quality of women’s health care for Ohioans—has become vulnerable: “Physicians may not come to our state to practice or train. “.

Sarah Stacy at home in a daycare where she prepared for a pregnancy that ended in an abortion. Her 12 week CT scan results showed her fetus had fluid cysts around the head and neck and congenital heart and brain defects. She was told if the pregnancy was full term, it would last anywhere from a few hours to a few days. In Ohio, it’s illegal to terminate a pregnancy for birth defects, so Stacy had to travel out of state on her own to get the procedure done. “I found out it was a girl too,” Stacy said. “And I have two boys at home. So it was like, this is my girl. She was planned. “


Stephanie Sinclair is a Pulitzer Prize-winning photographer, known for her focus on human rights issues. She founded Too Young to Wed, a charity that seeks to empower girls and end child marriage globally. Jaime Lowe is a regular contributor to the magazine and author of the book “Breathing Fire: Female In Prison Fire Fireers on Frontline of California’s Wild Firefires.”



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