Louisiana hospitals rarely performed abortions, even before the ban | Healthcare/Hospitals

The first sign that Victoria Shaheen’s 12-week pregnancy might not end the way she hoped was the look on the ultrasound technician’s face.

The technician was silent as she typed measurements in the dark room of Ochsner Baptist in New Orleans, but her face betrayed her concern. Shaheen knew that look. It was her fourth pregnancy. She and her husband were still childless.

The doctor came in and explained that a sac of fluid around the baby’s skull was too thick. Where an abdomen should have formed, there was a gaping hole. And organs were forming outside the body.

A small piece of tissue from her placenta extracted by a large needle confirmed trisomy 18, a serious genetic condition that causes stillbirth about three-quarters of the time. For those who survive, life expectancy is brutally short; 90-95% do not live more than a year.

Knowing this, continuing the pregnancy was agony for Shaheen, then 43, who could not imagine putting her child through this. She requested dilation and curettage, a procedure that would remove the fetus and tissue. She had previously undergone the procedure in Boston, where she lived.

“No, we can’t do that in this hospital,” she recalls telling the doctor. Instead, the doctor scribbled two numbers on a piece of paper. One was the abortion clinic in New Orleans. The other was the number of a doctor who ran a private practice in a downtown house.

Under Louisiana’s current “medical futility” law, pregnant women carrying a fetus with trisomy 18 would be eligible for an exception to Louisiana’s near-total abortion ban. But as Shaheen discovered when she was diagnosed in 2018, Louisiana hospitals typically sent pregnant women with “incompatible with life” diagnoses to abortion clinics long before Dobbs v. Jackson Women’s Health does trigger an abortion ban in the state.

Without clinics to handle “medically futile” abortions, women face uncertain access to medical abortion as providers and hospitals weigh legal risk and skill against patient options.

“Something I can’t really handle here”

Hope Medical Center in Shreveport, one of three abortion clinics that operated in Louisiana before they closed Aug. 1, was a frequent target of these cases.

“These were even tougher cases,” said administrator Kathaleen Pittman. “Most of the time, I found in these situations that the pregnancies were very desired.”

It was not uncommon for doctors to call Pittman on behalf of patients with fetal abnormalities. Some did not have the training to deal with it themselves. But more often than not, it was because the hospital, especially if it had a religious affiliation, wouldn’t allow it.

“Their opening salvo would be, ‘It’s something I can’t really handle here,'” Pittman recalled.

The majority were linked to some sort of trisomy, which is when a specific gene has three copies of a chromosome instead of two. Sometimes it was also because the woman’s health was at risk due to cancer, deep vein thrombosis or a history of haemorrhage at birth.

Without clinics to transport patients to, many will likely be sent even further afield, if they can afford to travel, miss work and arrange childcare, Pittman said. There will also be a decrease in the number of doctors who know how to perform abortions later in pregnancy. Depending on the timing of their first ultrasound, many women do not discover the abnormalities until the anatomical exam at 20 weeks. The Shreveport Clinic has provided training for the majority of Louisiana residency programs.

“Not every hospital will have physicians ready and willing to care for these patients,” Pittman said. “They haven’t had enough training because they haven’t had to.”

The law allows exceptions

The reasons for referring patients from hospitals to clinics were not always that the hospital or doctor did not want to do so.

“Patients who go to particular health systems, even before Dobbs, may have heard that they cannot receive some type of abortion care at that facility for various reasons,” Dr. Pooja said. Mehta, OB-GYN and former physician. director of the Louisiana Perinatal Quality Collaborative who now works in Boston.

Louisiana state employees, for example, were barred from providing abortions in certain situations even before Dobbs, Mehta said. Medicaid insurance, which is used for the majority of births in Louisiana, covered abortion only in cases of life-threatening, rape or incest.

The clinics charged a fraction of what it would cost to terminate a medically futile pregnancy in a hospital.

Private hospitals were unwilling to routinely provide the service for fetal anomalies, especially in the second trimester. This may not change with a law that sets out a number of conditions under which abortion is permitted. Physicians who have never performed later-stage abortions are unlikely to start because of a list of conditions.

“The provider at this point may feel they are no longer competent to provide the service and may not receive support to achieve competence,” Mehta said.

Representatives for Ochsner, LCMC Health, Woman’s Hospital, Franciscan Missionaries of Our Lady Health System and HCA Healthcare did not respond to questions about the number of “medically futile” abortions they have performed since Dobbs or their policies. on abortion before the ban.

“The vast majority of care provided by Ochsner Health is unaffected and within legal parameters under pre- and post-Dobbs law,” said Dr. Robert Hart, executive vice president and chief medical officer, in a statement. prepared statement. “Ochsner has never performed a non-medically indicated termination of pregnancy. In accordance with state and federal laws, we will continue to provide life-saving care to patients with miscarriages and ectopic pregnancies and to appropriately treat medically futile pregnancies and situations where the life and health of the mother is at risk. Game. ”

Doctors said the ability to terminate a pregnancy for medical reasons may depend on who you know or where you live.

“Certainly in many other hospitals, I don’t think there are a lot of doctors willing to go out of their way,” said a New Orleans-area OB-GYN who did not want to be identified because he was not allowed to speak by their employer. “You can mess with paperwork all weekend and call the lawyers and stuff.”

Termination of pregnancies performed in Louisiana under the permitted exceptions—because the fetus is medically futile or the life of the mother is in danger—must be reported to the Louisiana Department of Health. Since August 1, not a single abortion has been recorded by the LDH.

A “well-known secret”

When Shaheen called the New Orleans Abortion Clinic in 2018, they said she would have to pay upfront for counseling. She tried to explain that she didn’t need counseling or another ultrasound, but they said it was necessary. She hung up the phone and screamed.

“Every minute that passes while carrying this pregnancy has been painful,” said Shaheen, who imagined her baby’s pain if he survived the birth. “You never want someone you love to go through this.”

When she called the other number, the doctor told her that she could not provide anesthesia during the procedure because it was not in a hospital, but that she could take a seaweed suppository for help dilate the cervix. She flew to Boston the next day, where a team from Brigham and Women’s Hospital administered the procedure.

At the time, the idea of ​​going without anesthesia for surgery and not having a hospital team on duty scared him.

“Looking back, I guess in Louisiana we would be lucky to have that option now,” Shaheen said. She recently moved to the North East with her husband and 2 year old child.

Victoria Shaheen poses in Uptown New Orleans, Saturday, Oct. 29, 2022. Victoria was denied an abortion for trisomy 18 a few years prior before Louisiana put trisomy 18 on a list of exceptions to the ban on abortion. state abortion. Shaheen went to Boston for simple surgery for a medically futile pregnancy. (Photo by Sophia Germer, NOLA.com, The Times-Picayune | The New Orleans Advocate)

This Uptown doctor was the same one who performed the majority of abortions at the last clinic in New Orleans until August. She has provided terminations for many medical anomalies over the years.

“I was a well-known secret,” said the doctor, 82, who did not want to use his name for security reasons. “As long as there was an abortion clinic, (hospitals) could walk away and say, ‘Oh, we don’t want to do this. “”

That reluctance didn’t change with the Medical Futility Act, the doctor said, pointing to Nancy Davis, a Baton Rouge woman who was denied an abortion by Woman’s Hospital for a skullless fetus.

Anti-abortion group Louisiana Right to Life said in public comments submitted at a recent hearing that it does not support medical futility exceptions, particularly trisomies 18 and 13. The group wrote that the “best way forward that supports the mother and respects the life of the living baby is to accompany families and perinatal palliative care from the moment of diagnosis through the natural lifespan of the child.”

Fear of scrutiny by the attorney general’s office, lawmakers, and anti-abortion groups has allowed health care providers to continue to refuse women or present them with other options, such as induction or expecting a natural miscarriage later in pregnancy, which carries its own risks.

“I could see I had a deathly fear that if I do this they’re definitely going to sue me,” said the 82-year-old doctor, who retired when clinics closed in Louisiana. “They just say no. And so women lose.

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