A woman in Poland named Izabela died in September in her 22nd week of pregnancy. The hospital team caring for her had been aware of severe problems related to the fetus, including extreme lack of amniotic fluid in her uterus. However, they did not feel empowered to end the pregnancy via abortion as fetal cardiac activity could still be detected. The team was fearful of breaking the new Polish law that deemed doctors who provide abortion care should be subject to criminal penalties including imprisonment.
Then, in late December, a second patient, Agnieszka T., who’d been pregnant with twins, arrived at a Polish hospital in medical distress. One fetus she was carrying had already died, but for eight days doctors refused to intervene and remove the dead fetus, again fearing consequences because of Poland’s abortion ban. Both the second fetus and Agnieszka, the woman, died.
This occurred in the only European nation with an abortion ban. This is the kind of situation that could transpire anywhere politics curtail lifesaving treatments, including here in Florida if the abortion ban being fast-tracked right now in our Legislature becomes law. The ban would criminalize doctors who provide most abortion care past 15 weeks of pregnancy.
I am aghast that politicians with no medical training are attempting to impose a one-size-fits-all regulation on an extremely precarious, sensitive area of medical practice.
As a maternal fetal medicine specialist, I have dedicated my life to ensuring my patients have healthy pregnancies and positive birth outcomes. However, in some cases a pregnancy must be ended before birth. The reasons are varied. At times patients have underlying health conditions that cause serious complications, making continuing a pregnancy untenable. Other times, problems with the pregnancy emerge, like a major malformation or genetic abnormality. The health of my patients always guide important medical decisions.
I am thinking of patients like Ms. H.D. and how happy she was at the beginning of her 16-week appointment. This was her second pregnancy, after five years trying to conceive. The pregnancy had been uneventful up to that moment.
Bad news came after the ultrasound was performed. There was no amniotic fluid around the fetus and there was a significant complex cardiac defect. Having no fluid meant that the possibility of fetal development was very low and would make it very difficult for the cardiac team to perform surgery after delivery. Ms. H.D. and her husband were seen by a pediatric cardiologist to confirm the diagnosis, then followed up with me for a fluid recheck. But the ultrasound showed the same: no fluid.
The couple was facing the difficult decision of continuing the pregnancy or ending it. There was a monumental factor involved in this case as the pregnancy was very high risk for adverse outcomes. If the fetus survived, the newborn would require multiple surgeries and extended hospital care. The decision before the family was not trivial as it not only involved the pregnant patient but the family as a whole. Who would take care of this baby likely to need specialized care? How would their finances be impacted? Were they emotionally and physically prepared to handle a situation like this? What about the impact on their 7-year-old son?
I encounter situations like Ms. H.D.’s very often. Up until now, I have been lucky to practice in the state of Florida, where I can use my best medical judgment, consistent with accepted clinical practices, to guide and inform the care needed to ensure the well-being of my patients. This is crucial, especially in the late diagnosis of complex fetal anomalies.
Making me a criminal for providing a vital, essential health care service for a patient would be an affront to all I have been trained to do.
Every person and every pregnancy is different. The complexities of this must be acknowledged. Patients’ and families’ decisions must be listened to and their lives must be cherished.
Mayra Cruz Ithier is a Maternal Fetal Medicine specialist at Johns Hopkins All Children’s Hospital. She is originally from Puerto Rico and did her obstetrics and gynecology training at Bayfront Health St. Petersburg. She did her fellowship at Rutgers-Robert Wood Johnson. Her main interest is prenatal diagnosis with emphasis on the importance of the first trimester ultrasound.
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