The result has been disarray and confusion for doctors and hospitals in multiple states, and risky delays and complications for patients facing obstetric conditions such as ectopic pregnancies, incomplete miscarriages, placental problems, and premature rupture of membranes.
“It’s terrible,” said Dr. Alan Peaceman, a professor of maternal-fetal medicine at Northwestern University’s Feinberg School of Medicine. “The care providers are treading on eggshells. They don’t want to get sucked into a legal morass. And so they don’t even know what the rules are.”
‘I need you to tell me the truth’
James rushed home from work and drove Elizabeth to the nearby Woodlands Hospital, part of the Houston Methodist hospital system. An ultrasound confirmed she had suffered premature rupture of membranes, which affects about 3% of pregnancies.
A doctor sat down and told her: “There’s very little amniotic fluid left. That’s not a good thing. All you can do now is just hope and pray that things go well.”
The staff remained vague about what would come next, Elizabeth recalled. She was admitted to the hospital, and later that night, when her obstetrician called, she begged her for information.
“I told her, ‘Look, doctor, people around me are telling me to keep hope. And they’re telling me to think of the positives. But I need you to tell me the truth, because I don’t think all the positive things that they’re telling me are real. I need you to give me the facts.’”
The facts were grim. At 18 weeks, the watery, protective cushion of amniotic fluid was gone. There was still a heartbeat, but it could stop at any moment. Both the fetus and Elizabeth were now highly vulnerable to a uterine infection called chorioamnionitis, among other risks.
The OB-GYN, who said she could not speak to a reporter for this article, laid out two options, Elizabeth said.
One was to end the pregnancy; that’s called “a termination for medical reasons.” The other option is called “expectant management,” in which Elizabeth would stay in the hospital and try to stay pregnant until 24 weeks, which for a fetus is considered the beginning of viability outside the womb.