In the Post-Roe Era, Letting Pregnant Patients Get Sicker--by Design

Parkland Memorial Hospital is an elegantly landscaped, blue-glass facility gleaming in the concrete expanse of what was once a manufacturing district in Dallas. The sole public hospital in a city of nearly 1.3 million people, it’s also a beacon in the state. People in medical distress travel to see its doctors from rural towns hundreds of miles away, and some of those distressed patients are pregnant.

Half of the counties in Texas, according to state data, lack a single specialist in women’s health: no ob-gyn, no nurse, no midwife who can treat mothers and their babies. But Parkland, one of thirty-two hospitals credentialled to treat high-risk-pregnancy cases, takes all comers. More than ten thousand babies are born there every year, and pregnant people also show up in its hectic emergency room with conditions that threaten their lives. Some patients have hemorrhages and spiralling infections; some are critically ill with cancer or heart disease; some are at acute risk of stroke if they bring their pregnancies to term.

In states with liberal abortion laws, such as New Mexico, California, and Massachusetts, the decision about treatment for such dangerous conditions is usually left to the patient and her family, and abortion is an option. But, in 2021, when the Texas legislature passed a law known as S.B. 8, that option was largely ruled out. Once a fetal heartbeat could be detected, typically around the sixth week of pregnancy, doctors could propose abortion as a treatment only when a woman’s life was at risk. So doctors trained to prevent disease and avert emergencies had to set aside the principles they’d learned in medical school. Instead, they had to let patients’ conditions deteriorate before informing them that their fetuses weren’t viable and an abortion might save their lives. An ob-gyn at Parkland told me, “We essentially watched those patients in labor and delivery until they became infected. As long as there was a heartbeat, we couldn’t do anything.”

A mile down the boulevard from Parkland, past a wild-bird sanctuary, is Clements Hospital, which is a University of Texas health facility. It, too, takes on high-risk cases. An ob-gyn there said that working conditions for doctors like her became “traumatic” after S.B. 8, and still more so after the Supreme Court reversal of the Roe decision, the following year. She told me, “It would be like if all of a sudden an orthopedic surgeon was told, ‘You have a patient with an open fracture, the bone is sticking out of their arm.’ The suffering goes without saying. But the government is telling you that you’re not allowed to repair that until the patient develops an infection.”

https://www.newyorker.com/news/dispatch/in-the-post-roe-era-letting-pregnant-patients-get-sicker-by-design