What does the Supreme Court’s ruling on Roe v. Wade mean for health in Tennessee?

How will Tennessee’s abortion trigger law change care for pregnant women?
How will Tennessee’s abortion trigger law change care for pregnant women?
Published: Jun. 24, 2022 at 11:36 AM EDT|Updated: Jun. 24, 2022 at 3:32 PM EDT
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KNOXVILLE, Tenn. (WVLT) - With the Supreme Court’s ruling overturning the landmark abortion case Roe v. Wade, Tennessee is now set to enact its Human Life Protection Act, which, as it is written, effectively bans abortions beginning 30 days from the SCOTUS ruling. The act will make it a Class C felony for a person to perform an abortion.

WVLT News spoke to Nikki Zite, MD, MPH, Professor and Vice Chair of Education and Advocacy, Executive Board of the Tennessee American College of Obstetrics and Gynecology about what this means medically for providers and patients in Tennessee.

Q: Tennessee’s trigger law would criminalize abortions with the exception of “cases where it is necessary to prevent the death of pregnant woman or prevent serious risk and irreversible impairment of major bodily functions.” What does this mean, and how does this impact care?

Unfortunately, to those of us who are trained and have been doing this for 20 years, it is still confusing. And when I talk to colleagues and other professionals, it is not clear cut. This is not a black and white issue; it is a really confusing issue with lots of grays.

You know, we have good evidence for some conditions. For example, if the woman has a cardiac defect or injury in the muscle of her heart, we can say that given the way her heart is functioning, she has a 50% chance of dying in pregnancy. I think a lot of people would accept that 50% is high, and that she should be given the option of continuing the pregnancy or not. Not everyone would, and not every patient would choose to end a pregnancy in that situation. But there are situations that are less clear-cut because every clinical situation is a little bit different.

What’s the cutoff? Should we be able to end the pregnancy if she has a one in three chance of dying, or one in five chance of dying? Should it be her decision? And typically, we like to do patient-centered counseling with the best evidence we have and then allow the patients to make this decision for themselves and their families. And then we support them if they continue the pregnancy. We do the best we can to keep them and the pregnancy safe. If they choose to end the pregnancy then we like to do that with compassion as well.

Q: How do practitioners determine what is serious enough to terminate a pregnancy?

In the ban it says ‘physicians’ good faith medical knowledge and decision,’ and we hope that through years of practice and working with patients in these situations we can determine that. But I do think that this law will make people pause. I do think the fear of criminalization, the fear of losing your medical license will potentially delay care until it is much more severe than it would have been prior to this law.

Q: What does this mean for miscarriages?

It really shouldn’t change the care, but sometimes when someone comes in with an early miscarriage on ultrasound we still see cardiac activity. So she’s bleeding, her cervix is open, her uterus is trying to open; her body just hasn’t completed it yet. Physicians typically would offer either medication or a surgical procedure to help the process so she doesn’t continue to bleed and have pain.

I think some providers will be fearful of expediting the process, despite the fact that it is inevitable whenever there is still a heartbeat. Does that mean that we will have to give more blood transfusions or take care of more patients in critical situations? That might be what happens.

What does this mean for birth control?

Ideally, the mechanism of action for contraception is to prevent fertilization. Even our intrauterine contraception predominately works by preventing fertilization. So those things should not be impacted by this law, following the best evidence and science.

Emergency contraception, which you sometimes hear ‘Plan B,’ is taken after intercourse has occurred. It still prevents ovulation, so ideally it still prevents a sperm and egg from meeting, and therefore prevents fertilization. But there are situations where that particular medication may prevent implantation, so that one is going to be a little bit more tricky.

Q: Are there options for pregnant women who are carrying a fetus with abnormalities that are not consistent with life?

The law as written does not provide any exclusions for abnormalities that are not compatible with life.

The classic example would be a pregnancy where the fetus does not have a brain. That is considered terminal and not compatible with life. And some women would not want to continue the pregnancy because of the risk to her, because of the emotional challenges.

You remember when you are pregnant, people want to come up to you, rub your belly and are so excited for you. Imagine if you knew that that pregnancy would never be a baby that you would take home. We typically would offer patients the opportunity to end that pregnancy and begin their healing. That would not be available in Tennessee if this trigger law goes into effect.

Q: Are doctors worried they could be charged with a crime while a mother and father debate what’s best for them and their child?

I think that, while ultimately we all took an oath to do no harm and take care of patients, we also have to fear our own criminalization, our own loss of license and livelihood.

There are definitely physicians who will not know how to interpret this law, and we’ve seen cases of women dying because care is delayed because a physician thought they could not intervene because there was still a heartbeat.

Q: How does this impact training for physicians?

During a four-year residency, it is required that residents get training in handling complications of abortion, miscarriage management, pregnancy loss and all the things we’ve been discussing. They have the opportunity to opt-out if they are not comfortable with any aspect of the care. If we no longer have that training available, we anticipate that they will lose a lot of their education on miscarriage management, handling complications of abortion and in an emergent situation potentially not be able to save a life.

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