OT Roe V Wade In Trouble

As Abortion Laws Drive Obstetricians From Red States, Maternity Care Suffers
Some doctors who handle high-risk pregnancies are fleeing restrictive abortion laws. Idaho has been particularly hard hit.

One by one, doctors who handle high-risk pregnancies are disappearing from Idaho — part of a wave of obstetricians fleeing restrictive abortion laws and a hostile state legislature. Dr. Caitlin Gustafson, a family doctor who also delivers babies in the tiny mountain town of McCall, is among those left behind, facing a lonely and uncertain future.

When caring for patients with pregnancy complications, Dr. Gustafson seeks counsel from maternal-fetal medicine specialists in Boise, the state capital two hours away. But two of the experts she relied on as backup have packed up their young families and moved away, one to Minnesota and the other to Colorado.

All told, more than a dozen labor and delivery doctors — including five of Idaho’s nine longtime maternal-fetal experts — will have either left or retired by the end of this year. Dr. Gustafson says the departures have made a bad situation worse, depriving both patients and doctors of moral support and medical advice.

Texas, Oklahoma and Tennessee, obstetricians — including highly skilled doctors who specialize in handling complex and risky pregnancies — are leaving their practices. Some newly minted doctors are avoiding states like Idaho.

The departures may result in new maternity care deserts, or areas that lack any maternity care, and they are placing strains on physicians like Dr. Gustafson who are left behind. The effects are particularly pronounced in rural areas, where many hospitals are shuttering obstetrics units for economic reasons. Restrictive abortion laws, experts say, are making that problem much worse.

“This isn’t an issue about abortion,” said Dr. Stella Dantas, the president-elect of the American College of Obstetricians and Gynecologists. “This is an issue about access to comprehensive obstetric and gynecologic care. When you restrict access to care that is based in science, that everybody should have access to — that has a ripple effect.”

Idaho doctors operate under a web of abortion laws, including a 2020 “trigger law” that went into effect after the Supreme Court eliminated the constitutional right to abortion by overturning Roe v. Wade last year. Together, they create one of the strictest abortion bans in the nation. Doctors who primarily provide abortion care are not the only medical professionals affected; the laws are also impinging on doctors whose primary work is to care for expectant mothers and babies, and who may be called upon to terminate a pregnancy for complications or other reasons.

Idaho bars abortion at any point in a pregnancy with just two exceptions: when it is necessary to save the life of the mother and in certain cases of rape or incest, though the victim must provide a police report. A temporary order issued by a federal judge also permits abortion in some circumstances when a woman’s health is at risk. Doctors convicted of violating the ban face two to five years in prison.

Dr. Gustafson, 51, has so far decided to stick it out in Idaho. She has been practicing in the state for 20 years, 17 of them in McCall, a stunning lakeside town of about 3,700 people.

She sees patients at the Payette Lakes Medical Clinic, a low-slung building that evokes the feeling of a mountain lodge, tucked into a grove of tall spruces and pines. It is affiliated with St. Luke’s Health System, the largest health system in the state.

On a recent morning, she was awakened at 5 a.m. by a call from a hospital nurse. A pregnant woman, two months shy of her due date, had a ruptured membrane. In common parlance, the patient’s water had broken, putting the mother and baby at risk for preterm delivery and other complications.


Dr. Gustafson threw on her light blue scrubs and her pink Crocs and rushed to the hospital to arrange for a helicopter to take the woman to Boise. She called the maternal-fetal specialty practice at St. Luke’s Boise Medical Center, the group she has worked with for years. She did not know the doctor who was to receive the patient. He had been in Idaho for only one week.


“Welcome to Idaho,” she told him.

In rural states, strong medical networks are critical to patients’ well-being. Doctors are not interchangeable widgets; they build up experience and a comfort level in working with one another and within their health care systems. Ordinarily, Dr. Gustafson might have found herself talking to Dr. Kylie Cooper or Dr. Lauren Miller on that day.

But Dr. Cooper left St. Luke’s in April for Minnesota. After “many agonizing months of discussion,” she said, she concluded that “the risk was too big for me and my family.”

Dr. Miller, who had founded the Idaho Coalition for Safe Reproductive Health Care, an advocacy group, moved to Colorado. It is one thing to pay for medical malpractice insurance, she said, but quite another to worry about criminal prosecution.

“I was always one of those people who had been super calm in emergencies,” Dr. Miller said. “But I was finding that I felt very anxious being on the labor unit, just not knowing if somebody else was going to second-guess my decision. That’s not how you want to go to work every day.”


The vacancies have been tough to fill. Dr. James Souza, the chief physician executive for St. Luke’s Health System, said the state’s laws had “had a profound chilling effect on recruitment and retention.” He is relying in part on temporary, roving doctors known as locums — short for the Latin phrase locum tenens, which means to stand in place of.

He likens labor and delivery care to a pyramid, supported by nurses, midwives and doctors, with maternal-fetal specialists at its apex. He worries the system will collapse.

“The loss of the top of a clinical pyramid means the pyramid falls apart,” Dr. Souza said.

Some smaller hospitals in Idaho have been unable to withstand the strain. Two closed their labor and delivery units this year; one of them, Bonner General Health, a 25-bed hospital in Sandpoint, in northern Idaho, cited the state’s “legal and political climate” and the departure of “highly respected, talented physicians” as factors that contributed to its decision.

Other states are also seeing obstetricians leave. In Oklahoma, where more than half of the state’s counties are considered maternity care deserts, three-quarters of obstetrician-gynecologists who responded to a recent survey said they were either planning to leave, considering leaving or would leave if they could, said Dr. Angela Hawkins, the chair of the Oklahoma section of the American College of Obstetricians and Gynecologists.


The previous chair, Dr. Kate Arnold, and her wife, also an obstetrician, moved to Washington, D.C., after the Supreme Court overturned Roe in Dobbs v. Jackson Women’s Health Organization. “Before the change in political climate, we had no plans on leaving,” Dr. Arnold said.

In Tennessee, where one-third of counties are considered maternity care deserts, Dr. Leilah Zahedi-Spung, a maternal-fetal specialist, decided to move to Colorado not long after the Dobbs ruling. She grew up in the South and felt guilty about leaving, she said.

Tennessee’s abortion ban, which was softened slightly this year, initially required an “affirmative defense,” meaning that doctors faced the burden of proving that an abortion they had performed was medically necessary — akin to the way a defendant in a homicide case might have to prove he or she acted in self-defense. Dr. Zahedi-Spung felt as if she had “quite the target on my back,” she said — so much so that she hired her own criminal defense lawyer.

“The majority of patients who came to me had highly wanted, highly desired pregnancies,” she said. “They had names, they had baby showers, they had nurseries. And I told them something awful about their pregnancy that made sure they were never going to take home that child — or that they would be sacrificing their lives to do that. I sent everybody out of state. I was unwilling to put myself at risk.”

Perhaps nowhere has the departure of obstetricians been as pronounced as in Idaho, where Dr. Gustafson has been helping to lead an organized — but only minimally successful — effort to change the state’s abortion laws, which have convinced her that state legislators do not care what doctors think. “Many of us feel like our opinion is being discounted,” she said.

Dr. Gustafson worked one day a month at a Planned Parenthood clinic in a Boise suburb until Idaho imposed its near-total abortion ban; she now has a similar arrangement with Planned Parenthood in Oregon, where some Idahoans travel for abortion care. She has been a plaintiff in several lawsuits challenging Idaho’s abortion policies. Earlier this year, she spoke at an abortion rights rally in front of the State Capitol.

In interviews, two Republican state lawmakers — Representatives Megan Blanksma, the House majority leader, and John Vander Woude, the chair of the House Health and Welfare Committee — said they were trying to address doctors’ concerns. Mr. Vander Woude acknowledged that Idaho’s trigger law, written before Roe fell, had affected everyday medical practice in a way that lawmakers had not anticipated.

“We never looked that close, and what exactly that bill said and how it was written and language that was in it,” he said. “We did that thinking Roe v. Wade was never going to get overturned. And then when it got overturned, we said, ‘OK, now we have to take a really close look at the definitions.’”

Mr. Vander Woude also dismissed doctors’ fears that they would be prosecuted, and he expressed doubt that obstetricians were really leaving the state. “I don’t see any doctor ever getting prosecuted,” he said, adding, “Show me the doctors that have left.”

But lawmakers refused to extend the tenure of the state’s Maternal Mortality Review Committee, an expert panel on which Dr. Gustafson served that investigated pregnancy-related deaths. The Idaho Freedom Foundation, a conservative group, testified against it and later called it an “unnecessary waste of tax dollars” — even though the annual cost, about $15,000, was picked up by the federal government.

That was a bridge too far for Dr. Amelia Huntsberger, the Idaho obstetrician who helped lead a push to create the panel in 2019. She recently moved to Oregon. “Idaho calls itself a quote ‘pro-life state,’ but the Idaho Legislature doesn’t care about the death of moms,” she said.

Most significantly, the Legislature rejected a top priority of Dr. Gustafson and others in her field: amending state law so that doctors would be able to perform abortions when the health — not just the life — of the mother is at risk. It was almost too much for Dr. Gustafson. She loves living in Idaho, she said. But when asked if she had thought about leaving, her answer was quick: “Every day.”

 

House bill criminalizing common STIs, could turn thousands of Oklahomans into felons

If signed into law, House Bill 3098 would criminalize the intentional or reckless spread of STIs.

Violators could face between 2 to 5 years in prison.

However reckless is not defined in the bill, which experts in the field say leaves an open door to potential unnecessary lawsuits and prosecutions.

https://ktul.com/news/local/house-b...3098-state-department-of-health-hpv-infection

 

LOLZ!

 

Registering guns... bad.

Registering pregnant women... good.

 

Tennessee woman denied abortion after fetus’ ‘brain not attached’ slams state’s ban

A Tennessee woman who was denied an abortion despite a fatal abnormality says the state’s anti-abortion laws resulted in her losing an ovary, a fallopian tube and her hopes for a large family.

“The state of Tennessee took my fertility from me,” Breanna Cecil, 34, told The Independent. She added that state lawmakers “took away my opportunity to have a family like my own biological family because of these horrible laws that they put in place.”

The mother-of-one said she has not felt the same since her doctor told her in January 2023 that her fetus was diagnosed with acrania, a fatal condition where the fetus has no skull bones.

Then, 12 weeks pregnant, Ms Cecil was getting her first ultrasound. She attended the appointment alone, so when the doctor told her the fetus was not viable outside the womb, she was left with only asking the doctor what she should do.

However, she was left with few options. The state’s near-total abortion ban prevents anyone from getting an abortion if there is still a heartbeat - which her fetus still had.

The law makes no exceptions for fatal conditions and also criminalizes physicians who perform the procedure outside of the allowed exceptions.

Ms Cecil recalled the doctor not knowing how to respond to her question about her options.

“That’s something that no one should ever hear,” she noted.

The doctor set her up with a specialist, where another ultrasound was conducted. That scan was more difficult, she says, because she could see the severity of the fetus’ condition. “I could see the brain not attached,” Ms Cecil said.

The only advice doctors could give offer was that if she had her second child it would “most likely die inside of me before 20 weeks” and she would be forced to deliver a stillborn.

The news was crushing as Ms Cecil said her pregnancy was starting to show. Not only could she not “mentally handle” the well-intentioned questions about the baby’s due date and sex, she said she could not be a “good mom to [her] little boy” if she was forced to go through with her pregnancy, and deliver the stillborn.

She decided to get an abortion.

After “sobbing to receptionists” at roughly 20 clinics and hospitals in a desperate attempt to get an appointment, she finally had success. A hospital in Chicago had an opening. On 3 February, doctors performed a dilation and curettage procedure.

Just six days after returning to Tennessee, thinking the worst was behind her, Ms Cecil started experiencing a fever and back pain. Her doctor gave her antibiotics, but something still wasn’t right.

She went for another ultrasound and the physician found retained tissue leftover from the fetus, which can have serious consequences. Doctors performed another procedure on Ms Cecil hoping it would be the end.

Her fever persisted and two days later, she returned to the hospital, where doctors discovered she had a nine-centimeter-sized abscess in her abdomen that encompassed some of her reproductive organs.

Doctors had to perform emergency surgery on her, and removed her right ovary and fallopian tube.

Ms Cecil returned home after a grueling 10 days in the hospital.

Ms Cecil and her husband had spent nearly a year trying to conceive that pregnancy. “Fertility and infertility is really hard to go through in itself,” she said, noting the couple thought they’d finally gotten through the difficult stage.

So when news of the fetus’ condition hit, she blamed herself and asked the nurses: “Did I do something wrong?”

Since her third procedure, she and her husband have not been able to become pregnant. Ms Cecil doesn’t think it’s a coincidence and wonders if not for Tennessee law, would she still have her fertility?

“Right now I feel like they took that away from me,” the 34-year-old said of state lawmakers.

Ms Cecil said she wanted to make clear to legislators that “abortion is not black and white,” explaining that every situation is different.

Like Texas woman Kate Cox, who was also denied the procedure in her home state, Ms Cecil wants a large family; neither woman falls within the stereotype that many on the right are portraying as abortion candidates.

The young mother added pregnant people who need an abortion shouldn’t feel like they need to beg for permission from lawmakers who do not have medical backgrounds.

Often, women in these situation are “deciding if we want our child to suffer” after being born or are “waiting until they die inside of us,” Ms Cecil said.

She added she still doesn’t feel normal more than a year after the pregnancy. Physically, she has a scar that stretches from her belly button down to her pelvic bone that has caused her fat to become displaced. Emotionally, she said, “I think about that baby all the time.”

While she and her husband have been trying for another baby, she often breaks down and thinks, “I just want that baby. Why didn’t that work out?”

Ms Cecil contemplated joining a group of women, represented by the Center for Reproductive Rights, who were denied abortions and are now fighting the state’s prohibition, asking for “clarity” on the ban’s medical exceptions.

The state of Tennessee took my fertility from me

Breanna Cecil

She decided not to become a plaintiff in the case because she feared others’ opinions of her decisions.

On 4 April, a three-judge panel listened to arguments from lawyers from the center and the state about a temporary block of the abortion ban. The center’s attorneys mentioned a series of heartbreaking stories from the plaintiff — as well as a woman whose baby was diagnosed with acrania.

They were referring to Ms Cecil.

The three-judge panel has yet to rule on the temporary injunction in a state that is one of 14 across the nation that made abortion illegal since the end of Roe v Wade in June 2022.

After hearing the oral arguments, Ms Cecil now wants to join the case. “If someone doesn’t ever want to hire me again because of what happened to me, I just don’t care. I’m not gonna let that bother me anymore,” she said.

She’s lived in Tennessee since she was seven years old, and while she has been tempted to leave, she refuses to let the anti-abortion crowd force her from her home.

“I can’t back down and let them win this battle,” Ms Cecil said.

https://www.independent.co.uk/news/...see-denied-abortion-ban-lawsuit-b2529144.html

 

Texas professors sue to fail students who seek abortions

A pair of Texas professors figured out that their female students have sex and, boy, they do not like it. So now the philosophy professor and finance professor are suing for the right to punish their students who, outside of class, have abortions.

"Pregnancy is not a disease, and elective abortions are not 'health care,'" University of Texas at Austin professor Daniel Bonevac sneers in a federal court filing with professor John Hatfield. Instead, Bonevac writes, because pregnancy is the result of "voluntary and consensual sexual intercourse," students should not be allowed time off to get abortions. If the students disobey and miss class for abortion care, the filing continues, the professors should be allowed to flunk students. Additionally, Bonevac asserts that he has a right to refuse to employ a teaching assistant who has had an abortion, calling such women "criminals."

The sexual hang-ups of abortion opponents are rarely far from the surface, but even by those low standards, the unjustified male grievance on display in this new Texas lawsuit is a doozy. At issue are federal regulations, called Title IX, first signed into law by President Richard Nixon in 1972. They currently bar publicly funded schools from discriminating on the basis of sex or gender. This means that schools cannot penalize students for health care based on sex. As a male student would be granted leave if he had to travel for surgery, so must a female student, the federal statute requires. The two men argue that granting students an excused absence in such cases violates their First Amendment rights.

Even though the plaintiffs suing for the right to flunk female students for abortion include boilerplate arguments in which they feign concern that abortion is "killing," the legal filing makes it clear that what really outrages Bonevac and Hatfield is that Title IX prevents them from controlling the private lives of students. Along with their anger about abortion, they grouse about not being allowed to punish students "for being homosexual or transgender." They also argue they should be able to penalize teaching assistants for "cross-dressing," by which they appear to mean allowing trans women to wear skirts.

As Jessica Valenti at Abortion, Every Day wrote, the language of the legal complaint is "downright petulant." The picture painted is of two men obsessed with controlling student lives based on what they're packing inside their underwear. It should be common sense that college students should be graded on their performance in class, not whether or not their professor resents their sex life or sexual identity. Alas, because the Supreme Court overturned Roe v. Wade and Texas banned abortion, it's created a pretext for every busybody who wants to spend less time grading papers and more time working himself into an angry froth over the imagined sexual exploits of his students.

Even though Bonevac and Hatfield work in Austin, Texas, they filed their lawsuit 486 miles away in Amarillo, Texas. The reason for this is not mysterious: Donald Trump-appointed judge Matthew Kacsmaryk. The right-wing judge has a long and frankly unhinged history of screeching at top volume about the evils of "sexual revolutionaries." (Yes, that does sound like a compliment, but he doesn't mean it as such.) It takes very little to draw Kacsmaryk's sexualized condemnation. Premarital sex, for instance, makes one a "sexual revolutionary." Using contraception within marriage also makes one an irredeemable pervert. In his legal writings, Kacsmaryk is very clear that sex is only for procreation within marriage, and anything outside of that should draw legal sanction. He has not weighed in on whether there should be restrictions on what sexual positions are legally permissible within the procreation-only marital sex, but give him time.

Unfortunately, the Dobbs decision, which ended abortion rights, didn't just empower professors who are overly preoccupied with the sex lives of undergraduates. Texas has swiftly turned into a case study in how abortion bans aren't really about "life" at all, but about giving abusive misogynists a whole new set of tools to use in controlling women. As Melissa Gira Grant at the New Republic wrote earlier this month, domestic "[a]busers have noticed and taken advantage" of how abortion bans mean the "legal system itself" is now "an instrument of abuse." Operators at domestic violence hotlines have seen a surge in calls from victims whose abusers who "use state anti-abortion laws to intimidate and threaten partners" who have had or are considering an abortion.

One would think the Republicans who wrote the abortion bans might want to distance themselves from terrible men using the laws as leverage to force women into sexual relationships. Instead, Republicans are embracing the cause of men who believe coercion is an acceptable substitute for romance. Jonathan Mitchell, the former Texas solicitor general who wrote one of the two major Texas abortion bans, has been representing men who don't even bother to hide that they are motivated by a belief that women simply don't have a right to say no to them.

We've covered the first case, of Marcus Silva, extensively at Salon. Court filings accuse Silva of extensive abuse of his ex-wife, including getting drunk at her work party and calling her misogynist names in front of colleagues. Her friends document how he reportedly knew his ex-wife was going to abort a pregnancy, but didn't try to stop her. Instead, he wanted to use her abortion as leverage. Text messages show him threatening to turn her and her friends into the law after her abortion unless she returned to do his laundry and have sex with him. Mitchell is representing Silva in a lawsuit against his ex-wife's friends for "aiding and abetting" an abortion that made it easier for her to leave him.

Turns out Mitchell is quickly creating a cottage industry of using the Texas law to help men harass ex-girlfriends. As the Texas Tribune reported earlier this month, Mitchell is representing two more men who want to use legal action to punish their ex-girlfriends for traveling out of state to get a legal abortion. In one case, the woman's lawyers argued it was part of a "scheme to harass an ex-girlfriend who has moved on from her relationship with him." Even if Mitchell never moves to sue the women, their providers, or their friends who helped, by filing legal motions, a legal expert told the Tribune, Mitchell can put "the woman in front of a court reporter and force her to answer questions." Making a woman sit through humiliating questioning at the hands of an abusive ex-boyfriend is clearly a punishment in and of itself. And, again, for using her legal and moral right to terminate an unwanted relationship.

In the decades after Roe v. Wade, the Christian right insisted stridently that their opposition to abortion was about "protecting life," and was not about restoring male dominance over women. That this was a lie was always evident to those willing to look even a centimeter below the surface. These same forces also organized against sex education and affordable contraception, both far more effective at preventing abortion than abortion bans. But in the aftermath of Dobbs, there can be no doubt. After red states started banning abortion, the abortion rate rose, fitting the pattern seen in other countries with severe abortion restrictions, because anti-abortion states also tend to be hostile to pregnancy prevention.

These series of legal maneuvers in Texas further flesh out what's really going on here. Nosy right-wing professors and angry ex-boyfriends are not, despite their feeble protestations to the contrary, just really into babies. For people who actually care about children, there are plenty of volunteer opportunities that aid real kids who need food to eat and opportunities to grow. Instead, the throughline is anger at women, whether students in their classrooms or ex-girlfriends who don't return their calls, for living their lives outside of the control of the men who feel entitled to dominate them.

https://www.salon.com/2024/06/03/texas-professors-to-fail-students-seek-abortions/