New abortion laws are especially cruel to my patients with high-risk pregnancies

What happens when a pregnancy goes wrong at 18 or 20 weeks.

By Chavi Eve Karkowsky
Chavi Eve Karkowsky, MD is a Maternal-Fetal Medicine physician (also known as a high-risk obstetrician). She has a book, "High Risk: A Doctor's Notes on Pregnancy, Birth, and the Unexpected" coming out March 2020 from Liveright/W.W. Norton.
May 24

When I walk into a room of a woman whose water has broken at 16 weeks or 18 weeks or 20 weeks of pregnancy, I introduce myself as her high-risk pregnancy doctor. Then I tell her, “You’re the most important one in this room.”

I say this because I was taught to say this; I say this because it’s true. But most of all, I say this because it’s so easy to forget. Women forget, so focused on their baby, how important they are; all too often, doctors forget. The eight states — including Missouri, Alabama, Ohio, and Georgia — that have passed abortion bans have also forgotten, though perhaps it would be more precise to say that they just don’t think that it’s true. But the legislation they’ve passed will also make it hard for anyone else to remember.

When a woman’s water breaks prematurely -- the rupture of membranes at very early gestational age -- it most often ends in tragedy. Twenty weeks is much too early for a newborn to live outside the uterus. Technology has brought the age of viability, when a fetus can survive outside a woman’s body, to somewhere around 23 weeks. Even then, survival rates are low, and complications are high.

In the majority of these cases, women go into labor right away and deliver quickly. For those who don’t, the odds are still very low. Those women usually develop an infection or go into labor within a week or two — long before viability, long before any hope of a baby they could take home. Even if the fetus gets to a viable gestational age, there are complications from growing without fluid: lungs that don’t develop or facial deformities or limb contractures. And there are the risks to the woman herself from the ongoing pregnancy: infection, bleeding, sepsis and worse.

Because of that, the American College of Obstetrics and Gynecology recommends that “immediate delivery should be offered.” This language is opaque, but here is what it means: Delivery at this gestational age is a termination of pregnancy and should be an option for any woman in this situation.

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