Louisiana hospitals rarely performed abortions, even before the ban Health Care / Hospitals

The first sign of Victoria Shaheen’s 12-week pregnancy isn’t going to end as she expected was on the ultrasound technician’s face.

The tech was silent as he taped off measurements in the dim room at Ochsner Baptist in New Orleans, but his face betrayed his concern. Shaheen knew that look. This was her fourth pregnancy. She and her husband were still childless.

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

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

Knowing that it was painful to continue with the pregnancy for Shaheen, 43, who could not fathom putting her child through this. She asked for a dilation and curettage, a procedure that would remove the fetus and tissue. She had an earlier procedure in Boston, where she lives.

“No, we can’t do that in this hospital,” she remembers the doctor saying. Instead, the doctor wrote down two numbers on a piece of paper. One was an abortion clinic in New Orleans. The second was the number of a doctor who ran a private office out of a house in Uptown.

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

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

‘There’s something I really can’t handle here’

Hope Medical Center in Shreveport, one of three abortion clinics that operated in Louisiana before its August 1 closure, was often on the receiving end of those cases.

“These were even more difficult cases,” said Administrator Kathleen Pitman. “Most times, I found in those situations the pregnancy left much to be desired.”

It was not uncommon for physicians to call on Pitman on behalf of patients with fetal anomalies. Some didn’t have the training to handle it themselves. But more often it was because the hospital, especially if it had a religious affiliation, didn’t allow it.

“His opening salvo would be, ‘This is something I really can’t handle here,'” Pitman recalled.

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

Pitman said that without clinics to shuttle patients, many people would be sent far away even if they could travel, take time off from work and child care. There will also be a dwindling number of doctors who know how to perform abortions later in pregnancy. Depending on the timing of their first ultrasound, many women do not learn about anomalies until an anatomy scan at 20 weeks. The Shreveport Clinic provided training for most of Louisiana’s residency programs.

“Not all hospitals will have physicians who are ready and willing to take care of these patients,” Pitman said. “They didn’t have enough training because they didn’t have them.”

the law allows exceptions

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

OB-GYN and pre-med Dr. Pooja Mehta said, “Patients who go to specialty health systems, even pre-obs, may have heard that they can’t get the type of abortion care they want at that institution for a variety of reasons. Could.” director of the Louisiana Perinatal Quality Collaborative who now works in Boston.

Louisiana state employees, for example, were prohibited from performing abortions in certain situations even before Dobbs, Mehta said. Medicaid insurance, which is used for most births in Louisiana, only covers abortions for life-threatening, rape or incest.

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

Private hospitals were not willing to provide continuous service for fetal anomalies especially in the second trimester. That may not change with legislation that spells out the many conditions that allow abortion. Doctors who have never performed a late-stage abortion will likely not start because of a list of conditions.

“At that point the provider may feel as though they are no longer competent to provide the service and may not receive support to qualify,” Mehta said.

Representatives from Ochsner, LCMC Health, Woman’s Hospital, Franciscan Missionaries of Our Lady Health System and HCA Healthcare answered questions about how many “medically redundant” abortions they have performed since Dobbs or what their abortion policies were before the ban. did not answer.

Dr. Robert Hart, executive vice president and chief medical officer, said in a prepared statement, “The vast majority of care provided by Ochsner Health remains unaffected and remains within legal parameters under both pre- and post-Dobbs legislation ” “Ochsner has never terminated a pregnancy for a non-medically indicated reason. In accordance with state and federal law, we will continue to provide life-saving care for patients experiencing miscarriages and ectopic pregnancies, and as medically appropriate will address non-viable pregnancies and situations where the life and health of the mother is at stake.

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

“Certainly in a lot of other hospitals, I don’t think a lot of doctors are willing to stick their necks out,” said one New Orleans-area OB-GYN, who did not want to be identified because he was not authorized. speak through their employer. “You can tie yourself up all weekend doing paperwork and calling lawyers and all these things.”

Termination of pregnancies performed in Louisiana under permitted exceptions – because the fetus is medically nonviable 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 a New Orleans abortion clinic back in 2018, they said she’d need to pay for the consultation ahead of time. He tried to explain that he did not need a consultation or another ultrasound, but he said that it was needed. She hung up the phone and shouted.

“Every minute that this pregnancy carried was painful,” said Shaheen, who was imagining the pain of living through the birth of her child. “You never want someone to be the one you care about.”

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

At the time, the thought of going in for a surgical procedure without anesthesia and not having a hospital team on call scared her.

“Looking back, I think we in Louisiana will be lucky to have that option now,” Shaheen said. She recently moved back to the Northeast with her husband and 2-year-old.

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

That Uptown doctor was the one who by August had provided most abortions at the last remaining clinic in New Orleans. He provided closure for many medical anomalies over the years.

“I was a famous secret,” said the 82-year-old doctor, who did not want his name used for security reasons. “Until there was an abortion clinic,[hospitals]could walk away and say, ‘Oh, we don’t want to do that.'”

This reluctance hasn’t changed with the medical futility law, the doctor said, pointing to Nancy Davis, a Baton Rouge woman who was denied an abortion by Women’s Hospital for a fetus without a skull.

Anti-abortion group Louisiana Right to Life said in public comments presented during a recent hearing that it does not support medical futility exceptions, specifically trisomy 18 and 13. The group wrote that “the best way forward that supports the mother and respects life is to provide support for families and perinatal palliative care from the moment of diagnosis to the duration of the child’s natural life.”

Fear of being investigated by the attorney general’s office, lawmakers and anti-abortion groups has made it easier for healthcare providers to turn women away, or present them with other options, such as waiting for a natural abortion later in pregnancy. do or wait Which comes with its own risk.

“I could see that if I do this, they’re definitely going to come after me,” said the 82-year-old doctor who retired after the Louisiana clinic closed. “They just say no. And so women lose out.

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