Lifesaving care for women in Texas is completely legal

“I’m so sorry, but it’s just too dangerous for you to stay pregnant any longer. We’ll have to get you delivered.’

This is one of my least favorite things to say to a pregnant patient, especially if the baby is too young to survive outside the womb. As a gynecologist, my goal is to end up with a healthy mother and a healthy baby, and it breaks my heart when pregnancy complications make this outcome impossible.

But if a patient’s waters break prematurely, it is imperative that I monitor her closely for infection and separate her from her unborn child at the first indication, as it can spread quickly and be life-threatening. Failure to act quickly could result in the loss of both mother and baby.

Unfortunately, in my 21 years of post-residency practice in Texas, I have had to perform my share of previous viable deliveries, knowing that the baby would not survive if I did, but neither the mother nor the baby would survive if I did nothing. The way I deal with these tragic situations has remained the same, both before and after the enactment of the abortion law in my home state.

It is a decision that we as gynecologists do not like to make, but for which we are trained. It is also completely legal.

While I would caution against making a judgment without consulting the medical record, some doctors in Texas have reportedly expressed confusion about whether our state law allows them to do what I just described.

A Texas woman named Josseli Barnica died of sepsis after her hospital waited 40 hours to deliver her 17-week-old fetus when she went into premature labor, ProPublica reported last week. The report claimed that her doctors said it would be a crime to intervene until the fetus no longer had a heartbeat. Yet the standard of care for a potentially life-threatening condition during pregnancy, regardless of the fetus’s heart rate and not prevented by any abortion law in the country, would have been to deliver her earlier. These separations between mother and fetus, which are performed to save the mother’s life, are different from induced abortions, which aim to kill the fetus. Her doctors’ claim that they could not legally intervene is simply not true.

Texas abortion law defines abortion as “the act of using or prescribing an instrument, drug, medicine or other substance, device or agent with the intent to cause the death of an unborn child of a woman known to be pregnant” . The “intention” piece is critical when thinking through cases like Barnica’s. When doctors like me deliver a baby prematurely to save the mother’s life, our intention is not to cause the baby’s death; it is to prevent the death of the mother.

State law further clarifies this point by allowing physicians to terminate a previously viable pregnancy in the event of a medical emergency, defined as “a life-threatening physical condition aggravated by, caused by, or resulting from a pregnancy that, as certified by a doctor places the woman in danger of life or a serious risk of significant impairment of an important bodily function, unless an abortion is performed.” It also notes that “the imminent threat to life or impairment of a major bodily function is not required” for the medical emergency clause to apply, meaning a woman does not have to be on the brink of death before her medical team can intervene.

My team and I regularly provide lifesaving care to women in the exact situations the law describes, such as ectopic pregnancies, early pregnancy losses and other tragic situations that save the life of the mother.

It is important that physicians are well informed about the many laws that regulate our practice, including abortion laws. While we can usually rely on medical professional organizations such as the American College of Obstetricians and Gynecologists to provide guidance to doctors who may be confused, these organizations have not been particularly helpful on the abortion front.

A few weeks ago, ACOG published a statement blaming the abortion laws themselvesnot the misunderstandings and inaccurate information that surrounds them, for the cases we have seen in the news of women not getting the care they need. They describe pro-life state laws as “designed to prevent life- and health-saving reproductive health care” and argue that the only way to ensure women get the timely care they need is to repeal them.

As a physician who provides the kind of life-saving care that ACOG claims is impossible to provide under my state law, I take issue with these claims. In fact, my approach to treating patients with pregnancy complications has not changed since the Texas abortion law went into effect. I suspect the same is true of the many obstetricians in my country who do not perform induced abortions, either due to personal beliefs or their employer’s policies.

Instead of stoking fear about Texas’ abortion law, organizations like ACOG should provide advice on how to properly deal with it.

The medical team at my hospital proves every day that not every woman’s story has to end tragically like Barnica’s. We as physicians are called to do everything in our power to ensure this does not happen, and Texas abortion law does not prevent us from doing so.

Sudheer Jayaprabhu is a board-certified gynecologist in Texarkana.

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