My wife and I practice in medical fields — obstetrics and pediatrics — that should be filled with happiness. And often they are, though we have selected sub-specialties that are often shrouded in sadness — high-risk obstetrics for me, and pediatric oncology for my wife. We have both watched children die while held in their mother’s arms.
Often we are asked about our psychological defenses in the face of tragic outcomes: the cancer that does not have a cure, or pre-eclampsia that becomes life-threatening to the pregnant woman before viability. In my opinion, the most important defense is the voice in your head that says, “I did everything I could.” I tell myself that I used treatments supported by research and monitored pregnancies with the highest-quality technology. I performed complex procedures, listened and counseled. I did everything I could, but ultimately the preterm labor could not be stopped — or, in my wife’s case, the child’s leukemia was just too aggressive. So we provide comfort and bear witness.
On June 24, Roe v. Wade was overturned and a near-total abortion ban became law in Ohio, where my wife and I practice. There are no exceptions for rape, incest or fetal anomalies, including lethal conditions.
Diagnosing birth defects is what I do. Over the years many of my patients with lethal anomalies have elected to continue their pregnancy knowing that their child will die after delivery. These patients always have my full support. Sometimes this is in concurrence with their religious beliefs, though sometimes it’s simply meaningful for them to deliver and spend time with their child, even if only for minutes or hours. Most patients, however, elect to discontinue the pregnancy.
For these patients, abortion is now illegal in Ohio. Some people will travel out of state. However, many people will not be able to do so, particularly people of color and those living in strategically disenfranchised communities. Sometime soon, I am going to meet a patient who has no ability to leave the state, and I am going to have to tell her that her baby has a lethal condition, and she is going to have to carry a pregnancy to term against her will. It might be tomorrow. It might be weeks from now. But this is going to happen, and I cannot stop it.
This patient will go through her third trimester visibly pregnant. Strangers in the grocery store will congratulate her. She will have to explain her story over and over again to friends, neighbors and co-workers. She will be forced to experience labor and delivery, and then her child will die. The risks of term delivery are far greater than the risk of abortion, so she may also experience hemorrhage, pre-eclampsia, blood clots or other complications.
Ohio’s new law is unimaginably cruel.
What am I going to do when I meet this patient — when I am sitting in an examination room with her as a nightmare unfolds before us? I hope the voice inside my head will again say, “I did everything I could.” But this time the voice would not only be talking about my medical management. Over the years, the Ohio section of the American College of Obstetricians and Gynecologists, which I chair, has issued statements, engaged social media and organized action alerts and membership lobby days on a wide range of important issues, including abortion. We have testified publicly before Ohio House committees and made direct appeals to legislators in their offices. For instance, in 2019 we successfully fought HB 413, which would have made “abortion murder” a crime and could have required doctors to “reimplant an ectopic pregnancy into the woman’s uterus,” which is impossible. And in February we testified against HB 598, which would ban virtually all abortions in the state and could even affect fertility services.
So I will try to tell myself that this is not my fault. I will remind myself of the politicians who either did not believe me or did not care. But did I do everything? It is impossible to not worry that I have failed the physicians and patients of Ohio.
As physicians, what would we not do to save our patients from suffering and death? We have worked in hospitals through the night. We have performed surgery for hours. We have been splashed with blood, urine and amniotic fluid. We have listened to our patients’ concerns and sometimes held their hands and cried with them. The Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization, which overturned Roe, is a tragedy for our patients, many of whom will suffer and some of whom could very well die. Did we vote in every election? Did we call our legislators? Were we always brave enough to speak clearly and truthfully about abortion, especially in settings that make us uncomfortable?
When we are in the room with our patients, will the voice in our heads still say, “I did everything I could”?
David N. Hackney is a maternal-fetal medicine specialist and chair of the Ohio section of the American College of Obstetricians and Gynecologists.
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