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An obstetrician's opinion

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  • An obstetrician's opinion

    It seems that the new anti-abortion law in Texas may jeopardise the lives of pregnant women and risks forcing doctors to gamble with the possibility of litigation. As Dr Karkowsky notes she is an an obstetrician who specialises in high-risk cases.

    https://www.theatlantic.com/ideas/ar...suffer/619997/

    Once again, politicians and judges are limiting abortion without any understanding of what pregnancy can, and often does, ask of the human body. To conservative legislators in Texas, a new law banning abortion after about six weeks of gestation is a ploy to subvert Roe v. Wade. But to doctors like me, the measure reveals how thoughtless its designers are and how willing they are to let pregnant patients suffer and die.

    I’m an obstetrician who specializes in high-risk cases. Last month, I saw a woman whose water broke 19 weeks into a long-desired pregnancy. This patient, who had conceived after a previous miscarriage, was eager to have a child. When she came to the hospital, my colleagues and I told her the truth: Without an intact amniotic sac, she and her fetus were extraordinarily vulnerable to bacteria from the outside world. She might stay pregnant for the time being. But her chances of getting to 23 weeks—the point at which a baby might be able to survive outside her body, albeit with extensive, lifelong medical problems—were almost zero. While waiting to deliver, she faced a high probability of infection in her uterus, despite the antibiotics that we would give her. She was very likely to develop a serious infection, even sepsis, which could require a hysterectomy or, though unlikely, lead to death.

    We told her that she could watch and wait, despite the risks. Medical standards also dictated that my patient be offered a termination of pregnancy right away, before she could become sick. We outlined ways to terminate her pregnancy: a procedure to evacuate her uterus in the operating room or an induction of labor with the understanding that the newborn would not survive.

    This situation comes up at my hospital at least a few times a month, every month. Working with high-risk patients means I need to be able to discuss, recommend, and perform abortions somewhat regularly. This is not because I want to kill babies or end desired pregnancies. It is because, in many cases, I am walking patients and their families through a nightmare. Sometimes, abortion turns out to be the least terrible of all the progressively terrible options they face.

    My patient last month thought about her choices for 12 hours and then asked us to induce labor—an option that would keep her safe but allow her to hold her baby’s body. We administered the same medications used for all medical abortions. A few hours later, she delivered a baby quietly, weeping the whole time. She held her baby for the four minutes of its life in this world, and our team wept with her.

    I practice in New York, where I can offer patients the choices they need. But in Texas, a new law, Senate Bill 8, prohibits abortion after a fetal heartbeat is detected—generally about six weeks into a pregnancy. People who perform or even assist in an abortion after that point can be sued by any person for a minimum of $10,000. Under this law, a medical team would have been taking an enormous risk by offering my patient any option besides waiting. But by the time a patient develops a fever and chills, and their heart rate goes up and their blood pressure goes down, they might be too sick for doctors to help anymore. In the tragic case of Savita Halappanavar in Ireland in 2012, a medical team refused to terminate a pregnancy as long as a fetal heartbeat was detectable. The shock of Halappanavar’s death led to far-reaching reform of Irish laws.

    Although S.B. 8 makes an exception when the health of a pregnant patient is at stake, doctors who perform an abortion in such a case would be gambling that they’d be safe from the punitive intent of the law. The threat of litigation inevitably changes the practice of medicine. To feel safe from legal jeopardy in my patient’s case, we might have waited until she’d become febrile or showed other signs of infection before concluding that her health was in jeopardy. That point might have come too late to save her uterus, or her.

    If putting patients and doctors in that situation sounds cruel and stupid, that’s because it is.

    Every week, I see examples of morally necessary pregnancy terminations that, under the Texas law, could put doctors in legal jeopardy. In one case, a 14-year-old with brain damage had been raped by a caregiver. In another, my diagnostic ultrasound 15 weeks into a patient’s pregnancy showed that her fetus had developed an empty space where a brain should be and would not survive more than a few hours past birth. In another case, a patient, whose heart had become weak during her previous pregnancy and had never fully recovered, sought an abortion so she could live to care for her toddler.

    If I worked in Texas, anyone could sue me under the new law. But not just me. Anybody could also sue you, should you be the secretary who made the appointment; or the neighbor who watched other kids to make the appointment possible; or the Uber driver who took the patient to the clinic. The payout is at minimum $10,000 per defendant, with no upper limit.

    In this way, the law creates a mercenary and adversarial relationship between a community and its medical providers. Reproductive health care depends entirely on trust. You must feel free to talk with doctors like me about postpartum depression, sexual dysfunction, abusive boyfriends, or the occasional cigarettes you still smoke when stressed. And doctors must be able to honestly discuss the options, including pregnancy termination, that could save your life. If your doctor has to worry that any conversation could lead to a patient, or their disgruntled partner or disapproving relative, filing a report in order to make $10,000, that doctor may not be able to keep practicing.

    Who would provide complex pregnancy care in such a setting? About half of U.S. counties already lack an obstetrics-and-gynecology provider. I cannot imagine why a newly trained obstetrician would agree to work in Texas under the current law.

    And yet when the law took effect, and when the Supreme Court declined to block it, I couldn’t feel any outrage, or surprise; all I have left is a familiar deadening sadness. The United States has been heading in this direction for years, or even decades, as small and large legal actions have chipped away at abortion access by requiring ultrasounds that serve no medical need, and inappropriate but legally mandated counseling, and waiting periods that exist purely to add another logistical barrier for people who have already made up their mind to end a pregancy. Eighty-seven percent of counties in the U.S. already do not have an abortion provider; many of the ones that do have a doctor flown in one day a week, at considerable personal risk. Getting an abortion in most of the United States is already generally the privilege of people who are wealthy or who live in the right jurisdiction, or both.

    This is true despite the fact that most Americans think Roe v. Wade should not be overturned; a significant majority of Americans support some level of legal abortion. Texas has enacted just another poorly thought-out law—an extreme measure, like the ones banning pandemic-control precautions and promoting the proliferation of guns, that most Americans do not support but somehow find themselves living with. If allowed to stand, the Texas abortion law will be replicated in other states—further steps in constructing a world that endangers patients like mine, that most of us don’t want to live in, and that we certainly do not want to hand off to our children.
    "It ain't necessarily so
    The things that you're liable
    To read in the Bible
    It ain't necessarily so
    ."

    Sportin' Life
    Porgy & Bess, DuBose Heyward, George & Ira Gershwin

  • #2
    A) You coulda just named the thread "Texas Bounty Hunter II"
    2) A NEW YORK obstetrician is giving her OPINION citing a case in IRELAND....
    C) She goes beyond "Bounty Hunter" to "Mercenary".

    Good work, H_A
    The first to state his case seems right until another comes and cross-examines him.

    Comment


    • #3
      Originally posted by Cow Poke View Post
      A) You coulda just named the thread "Texas Bounty Hunter II"
      2) A NEW YORK obstetrician is giving her OPINION citing a case in IRELAND....
      C) She goes beyond "Bounty Hunter" to "Mercenary".

      Good work, H_A
      And she's selling a book.
      The first to state his case seems right until another comes and cross-examines him.

      Comment


      • #4
        Originally posted by Cow Poke View Post
        And?
        "It ain't necessarily so
        The things that you're liable
        To read in the Bible
        It ain't necessarily so
        ."

        Sportin' Life
        Porgy & Bess, DuBose Heyward, George & Ira Gershwin

        Comment


        • #5
          Originally posted by Cow Poke View Post
          A) You coulda just named the thread "Texas Bounty Hunter II"
          2) A NEW YORK obstetrician is giving her OPINION citing a case in IRELAND....
          C) She goes beyond "Bounty Hunter" to "Mercenary".

          Good work, H_A
          She cites her own experience in New York. Did you miss that bit? As she also wrote, "The shock of Halappanavar’s death led to far-reaching reform of Irish laws."
          "It ain't necessarily so
          The things that you're liable
          To read in the Bible
          It ain't necessarily so
          ."

          Sportin' Life
          Porgy & Bess, DuBose Heyward, George & Ira Gershwin

          Comment


          • #6
            Originally posted by Hypatia_Alexandria View Post

            And?
            That came before "She's selling a book".
            The first to state his case seems right until another comes and cross-examines him.

            Comment


            • #7
              Originally posted by Hypatia_Alexandria View Post

              She cites her own experience in New York. Did you miss that bit? As she also wrote, "The shock of Halappanavar’s death led to far-reaching reform of Irish laws."
              And she went beyond the dopey "Bounty Hunter" crap to "Mercenaries".

              That's the kind of thing people do when they're writing a book and they want more attention.

              Kind of "follow the money". Which, of course, is why the Abortion Industry pretends to be all about women's health in general, rather than abortion specifically.
              The first to state his case seems right until another comes and cross-examines him.

              Comment


              • #8
                Originally posted by Cow Poke View Post

                And she went beyond the dopey "Bounty Hunter" crap to "Mercenaries".
                She clearly sees this legislation in that context.

                Originally posted by Cow Poke View Post
                That's the kind of thing people do when they're writing a book and they want more attention.
                Really? On what evidence?

                Originally posted by Cow Poke View Post
                Kind of "follow the money". Which, of course, is why the Abortion Industry pretends to be all about women's health in general, rather than abortion specifically.
                Again, on what evidence?



                "It ain't necessarily so
                The things that you're liable
                To read in the Bible
                It ain't necessarily so
                ."

                Sportin' Life
                Porgy & Bess, DuBose Heyward, George & Ira Gershwin

                Comment


                • #9
                  Originally posted by Hypatia_Alexandria View Post
                  She clearly sees this legislation in that context.
                  That's your opinion.
                  The first to state his case seems right until another comes and cross-examines him.

                  Comment


                  • #10
                    Originally posted by Hypatia_Alexandria View Post
                    It seems that the new anti-abortion law in Texas may jeopardise the lives of pregnant women and risks forcing doctors to gamble with the possibility of litigation. As Dr Karkowsky notes she is an an obstetrician who specialises in high-risk cases.

                    https://www.theatlantic.com/ideas/ar...suffer/619997/

                    Once again, politicians and judges are limiting abortion without any understanding of what pregnancy can, and often does, ask of the human body. To conservative legislators in Texas, a new law banning abortion after about six weeks of gestation is a ploy to subvert Roe v. Wade. But to doctors like me, the measure reveals how thoughtless its designers are and how willing they are to let pregnant patients suffer and die.

                    I’m an obstetrician who specializes in high-risk cases. Last month, I saw a woman whose water broke 19 weeks into a long-desired pregnancy. This patient, who had conceived after a previous miscarriage, was eager to have a child. When she came to the hospital, my colleagues and I told her the truth: Without an intact amniotic sac, she and her fetus were extraordinarily vulnerable to bacteria from the outside world. She might stay pregnant for the time being. But her chances of getting to 23 weeks—the point at which a baby might be able to survive outside her body, albeit with extensive, lifelong medical problems—were almost zero. While waiting to deliver, she faced a high probability of infection in her uterus, despite the antibiotics that we would give her. She was very likely to develop a serious infection, even sepsis, which could require a hysterectomy or, though unlikely, lead to death.

                    We told her that she could watch and wait, despite the risks. Medical standards also dictated that my patient be offered a termination of pregnancy right away, before she could become sick. We outlined ways to terminate her pregnancy: a procedure to evacuate her uterus in the operating room or an induction of labor with the understanding that the newborn would not survive.

                    This situation comes up at my hospital at least a few times a month, every month. Working with high-risk patients means I need to be able to discuss, recommend, and perform abortions somewhat regularly. This is not because I want to kill babies or end desired pregnancies. It is because, in many cases, I am walking patients and their families through a nightmare. Sometimes, abortion turns out to be the least terrible of all the progressively terrible options they face.

                    My patient last month thought about her choices for 12 hours and then asked us to induce labor—an option that would keep her safe but allow her to hold her baby’s body. We administered the same medications used for all medical abortions. A few hours later, she delivered a baby quietly, weeping the whole time. She held her baby for the four minutes of its life in this world, and our team wept with her.

                    I practice in New York, where I can offer patients the choices they need. But in Texas, a new law, Senate Bill 8, prohibits abortion after a fetal heartbeat is detected—generally about six weeks into a pregnancy. People who perform or even assist in an abortion after that point can be sued by any person for a minimum of $10,000. Under this law, a medical team would have been taking an enormous risk by offering my patient any option besides waiting. But by the time a patient develops a fever and chills, and their heart rate goes up and their blood pressure goes down, they might be too sick for doctors to help anymore. In the tragic case of Savita Halappanavar in Ireland in 2012, a medical team refused to terminate a pregnancy as long as a fetal heartbeat was detectable. The shock of Halappanavar’s death led to far-reaching reform of Irish laws.

                    Although S.B. 8 makes an exception when the health of a pregnant patient is at stake, doctors who perform an abortion in such a case would be gambling that they’d be safe from the punitive intent of the law. The threat of litigation inevitably changes the practice of medicine. To feel safe from legal jeopardy in my patient’s case, we might have waited until she’d become febrile or showed other signs of infection before concluding that her health was in jeopardy. That point might have come too late to save her uterus, or her.

                    If putting patients and doctors in that situation sounds cruel and stupid, that’s because it is.

                    Every week, I see examples of morally necessary pregnancy terminations that, under the Texas law, could put doctors in legal jeopardy. In one case, a 14-year-old with brain damage had been raped by a caregiver. In another, my diagnostic ultrasound 15 weeks into a patient’s pregnancy showed that her fetus had developed an empty space where a brain should be and would not survive more than a few hours past birth. In another case, a patient, whose heart had become weak during her previous pregnancy and had never fully recovered, sought an abortion so she could live to care for her toddler.

                    If I worked in Texas, anyone could sue me under the new law. But not just me. Anybody could also sue you, should you be the secretary who made the appointment; or the neighbor who watched other kids to make the appointment possible; or the Uber driver who took the patient to the clinic. The payout is at minimum $10,000 per defendant, with no upper limit.

                    In this way, the law creates a mercenary and adversarial relationship between a community and its medical providers. Reproductive health care depends entirely on trust. You must feel free to talk with doctors like me about postpartum depression, sexual dysfunction, abusive boyfriends, or the occasional cigarettes you still smoke when stressed. And doctors must be able to honestly discuss the options, including pregnancy termination, that could save your life. If your doctor has to worry that any conversation could lead to a patient, or their disgruntled partner or disapproving relative, filing a report in order to make $10,000, that doctor may not be able to keep practicing.

                    Who would provide complex pregnancy care in such a setting? About half of U.S. counties already lack an obstetrics-and-gynecology provider. I cannot imagine why a newly trained obstetrician would agree to work in Texas under the current law.

                    And yet when the law took effect, and when the Supreme Court declined to block it, I couldn’t feel any outrage, or surprise; all I have left is a familiar deadening sadness. The United States has been heading in this direction for years, or even decades, as small and large legal actions have chipped away at abortion access by requiring ultrasounds that serve no medical need, and inappropriate but legally mandated counseling, and waiting periods that exist purely to add another logistical barrier for people who have already made up their mind to end a pregancy. Eighty-seven percent of counties in the U.S. already do not have an abortion provider; many of the ones that do have a doctor flown in one day a week, at considerable personal risk. Getting an abortion in most of the United States is already generally the privilege of people who are wealthy or who live in the right jurisdiction, or both.

                    This is true despite the fact that most Americans think Roe v. Wade should not be overturned; a significant majority of Americans support some level of legal abortion. Texas has enacted just another poorly thought-out law—an extreme measure, like the ones banning pandemic-control precautions and promoting the proliferation of guns, that most Americans do not support but somehow find themselves living with. If allowed to stand, the Texas abortion law will be replicated in other states—further steps in constructing a world that endangers patients like mine, that most of us don’t want to live in, and that we certainly do not want to hand off to our children.
                    So, given that this is another one of your "Opinion by Proxy" threads.

                    Do you have an actual Opinion in this topic, or if we talk about how you are complaining about the Texas law, will you just point at this opinion piece and say "take it up with the Author"?

                    Comment


                    • #11

                      Originally posted by CivilDiscourse View Post

                      So, given that this is another one of your "Opinion by Proxy" threads.

                      Do you have an actual Opinion in this topic, or if we talk about how you are complaining about the Texas law, will you just point at this opinion piece and say "take it up with the Author"?


                      priceless.jpg
                      Attached Files
                      The first to state his case seems right until another comes and cross-examines him.

                      Comment


                      • #12
                        She admits that there is an exception for maternal health issues, but then goes on to fear monger about "what if's".

                        McKayla.gif
                        That's what
                        - She

                        Without a clear-cut definition of sin, morality becomes a mere argument over the best way to train animals
                        - Manya the Holy Szin (The Quintara Marathon)

                        I may not be as old as dirt, but me and dirt are starting to have an awful lot in common
                        Stephen R. Donaldson

                        Comment


                        • #13
                          Does the Texas law in fact prohibit abortion in cases such as that described?
                          sigpic1 Cor 15:34 εκνηψατε δικαιως και μη αμαρτανετε αγνωσιαν γαρ θεου τινες εχουσιν προς εντροπην υμιν λεγω

                          Comment


                          • #14
                            Originally posted by tabibito View Post
                            Does the Texas law in fact prohibit abortion in cases such as that described?
                            No. It makes an allowance for medical necessity.

                            From the article:

                            "Although S.B. 8 makes an exception when the health of a pregnant patient is at stake, doctors who perform an abortion in such a case would be gambling that they’d be safe from the punitive intent of the law. "
                            That's what
                            - She

                            Without a clear-cut definition of sin, morality becomes a mere argument over the best way to train animals
                            - Manya the Holy Szin (The Quintara Marathon)

                            I may not be as old as dirt, but me and dirt are starting to have an awful lot in common
                            Stephen R. Donaldson

                            Comment


                            • #15
                              Originally posted by CivilDiscourse View Post

                              So, given that this is another one of your "Opinion by Proxy" threads.

                              Do you have an actual Opinion in this topic, or if we talk about how you are complaining about the Texas law, will you just point at this opinion piece and say "take it up with the Author"?
                              I consider Dr Karkowsky's opinion to be perfectly valid and as she points out in Texas this legislation may imperil the lives of pregnant women "Under this law, a medical team would have been taking an enormous risk by offering my patient any option besides waiting. But by the time a patient develops a fever and chills, and their heart rate goes up and their blood pressure goes down, they might be too sick for doctors to help anymore".

                              As she also notes "Every week, I see examples of morally necessary pregnancy terminations that, under the Texas law, could put doctors in legal jeopardy."

                              This legislation therefore has real health implications for high risk pregnant women.

                              As to my own view on abortion, I hold that it is a women's right to choose. Although, I will add the caveat that [apart from maternal health and abnormal foetal development] I do have an issue with late abortions. However, those procedures often occur in countries where a woman cannot get an abortion in the early stages of her pregnancy because of other factors, i.e. the cost of travelling to a clinic at some distance, the cost of the actual procedure, or obtaining leave from work. Those elements may delay her obtaining an abortion until the pregnancy has progressed further than she would have wished.

                              However, at the end of the day it remains a woman's right to choose and if a woman decides [for whatever reason] to end a pregnancy she has the right to do so.
                              "It ain't necessarily so
                              The things that you're liable
                              To read in the Bible
                              It ain't necessarily so
                              ."

                              Sportin' Life
                              Porgy & Bess, DuBose Heyward, George & Ira Gershwin

                              Comment

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