Trapped: How Pregnant People are Unable to Access Life-Saving Care
By: Megan Savage, MD
My patient – let’s call her Cara – presented to the emergency department at 18 weeks gestation and was quickly taken to the cardiac intensive care unit. Her heart was barely functioning, and continuing pregnancy would have led to severe complications that would put Cara’s life at risk. Due to the immediate danger, she underwent an emergent, medically indicated dilation and evacuation. After her breathing tube was removed five days later, she thanked our team for saving her life.
But this is not where Cara’s story begins. I first saw Cara at her eight-week prenatal appointment. She was like many of my patients. She lived in a small town in south Louisiana and had to borrow a car to travel to her appointment. Typically, she relied on public transportation to get to her minimum-wage job or to travel to the store to buy essentials for her young children at home. She was the sole provider for her family.
Cara came into pregnancy with a rare, severe, cardiac condition that would make her pregnancy dangerous. At that eight-week appointment, I counseled her about the risks associated with remaining pregnant. We discussed her options and, ultimately, she decided to end the pregnancy. Her cardiologist provided medical clearance to perform the abortion in the outpatient setting.
In the subsequent weeks, Cara tried to terminate her pregnancy. However, none of the clinics she visited were willing provide abortions. Clinics and providers were fearful of a state law, Act 620 – which at the time was held up in the courts and had not yet gone into effect – that would require abortion providers to maintain admitting privileges at a hospital within 30 miles of their outpatient clinics. Passed under the guise of improved patient safety, this policy and others like it (commonly referred to as TRAP laws) would not improve patient outcomes, but only make it harder for women to access abortion care. If Act 620 ultimately went into effect, abortions could only be provided by several qualifying doctors in the state.
Cara was trapped. She was unable to get the healthcare necessary to protect her life and health. As her pregnancy progressed and with limited options to receive abortion care, her cardiac condition worsened. By 18 weeks pregnant, she was in the emergency department struggling to breath. She nearly lost her life and her children nearly lost their mother.
When I recall Cara’s journey, I am struck by the barriers she had to overcome to get necessary healthcare. For each appointment, she borrowed a car from her neighbor, asked a friend to care for her children, and took unpaid leave from her job. As her cardiac function declined, she met the largest and insurmountable barrier: anticipation of the enactment of Louisiana’s Act 620. In this tragic reality, Cara overcame the restriction for inpatient admitting privileges only by becoming sick enough to require an inpatient admission. What should have been an uncomplicated, outpatient, same-day surgery at eight weeks pregnant deteriorated into a life-threatening complication, with inpatient admission to the intensive care unit, months of cardiac rehabilitation, and lifelong cardiac health implications. Laws erroneously created to protect a life nearly ended hers.
Medically unnecessary laws do not stop abortions. These unjust burdens make abortion access more tenuous, dangerous, and for my patient and other high-risk women, more life threatening. These laws target marginalized and vulnerable women impacted by multiple forms of poverty, including educational poverty, fiscal poverty, generational poverty, geographical poverty, food poverty, healthcare poverty, employment opportunity poverty, and poverty linked to years of racial and ethnic discrimination. When women lack access to reproductive health, a new and additional form of poverty is created. It is the poverty of choice. The poverty or inability to make a decision for your own safety, health, and well being.
On June 29, 2020, the Supreme Court of the United States upheld precedent and struck down Louisiana’s Act 620. The decision was a victory for women’s ability to continue to make decisions about their safety, health, and well being. It was a victory for providers striving to care for and protect the health of women experiencing high-risk pregnancies. But it was a tenuous victory at best. States around the country are actively advancing legislation to limit access to abortions or outright outlaw them. In order to safeguard abortion services and abortion providers throughout the United States, Congress must pass the Women's Health Protection Act. This legislation would protect access to abortion care from:
- bans on abortion prior to viability;
- requirements that doctors provide medically inaccurate and, at times, false information to people seeking abortion care;
- restrictions on the ability to safely access medication abortion in the earliest weeks of pregnancy; and
- state-mandated medical procedures and protocols, such as forcing pregnant people to undergo ultrasounds and endure waiting periods for no medical reason.
Do you part to advance this legislation by calling on your Member of Congress to support the Women’s Health Protection Act. Patients like Cara are depending on you to fight for her access to health care.
