By Samantha DeAndrade
Last week, in response to a petition written by myself and colleagues, the American Board of Obstetricians and Gynecologists (ABOG), which is headquartered in Texas, reversed its decision to pursue in-person board certification exams.
In light of the Supreme Court’s ruling in Dobbs vs. Jackson Women’s Health, my colleagues and I held grave concerns about traveling to Dallas, Texas for this credentialing exam. We worried for our patients, our colleagues, and — though hard to admit it — ourselves.
In our petition, we cited concerns about the well-being of our pregnant colleagues who might encounter a pregnancy complication while in Texas and not have the full range of life-saving, evidence-based options available. We also expressed fear for our personal safety as abortion providers in a state where anti-abortion vigilantes are allowed to sue anyone who performs or assists in a pregnancy termination. It also felt wrong to contribute to the economy of a state that has passed the most restrictive abortion laws in recent history; a decision we know is about power and politics, not patient safety.
Within five days of writing our petition, we garnered over 450 signatures from fellow Ob/Gyns through our own informal networks. Shortly after, the ABOG announced that exams will be virtual. They acknowledged that our petition weighed heavily in their decision-making, and we appreciate them for taking a stand. This was unexpected. For many years, ABOG has been pressured to move its headquarters out of Texas, and has maintained that where it is located does not matter given the ever-changing political landscape on reproductive rights. This time, they could not argue that location doesn’t matter. They know, as do we, that where one resides during their reproductive years now matters very much. Something is distinctly different about this time.
A line was transgressed with the ruling in Dobbs vs. Jackson Women’s Health. A line between bodily autonomy and state’s rights, a line between the doctor-patient relationship and the law.
Those of us who work in women’s health know that pregnancy termination cannot be extricated from health care. Performing abortion procedures is an essential part of our training, and, in fact, is a skill that ABOG requires us to obtain in order to be fully competent Ob/Gyns. How is it that in some states I could be arrested for providing evidence-based, life-saving care, while in others I would simply be doing my job?
In a post-Roe world, we are forcing doctors to practice non-evidence based medicine without any room for recourse. Recently, an account on social media alleged that a patient with an ectopic pregnancy in a state with trigger laws experienced a nine hour delay in treatment as she bled internally because the hospital Ethics and Legal Counsel had to be consulted about whether or not the pregnancy tissue could be removed. An ectopic pregnancy occurs when a fertilized egg implants in the wrong location — usually the fallopian tube instead of within the uterus. Left unchecked, this pregnancy will grow only until it reaches the limit of its unnatural location, at which point it ruptures and can cause life-threatening bleeding. Ectopic pregnancies will never result in viable pregnancies. If this case had come up on my licensing exam, the correct answer for how to manage this patient would be to surgically remove the pregnancy, or medically terminate it as soon as possible.
One of the sickest patients I have ever taken care of was someone whose water broke at 20 weeks in her pregnancy, which is too early for a fetus to live outside of the womb. Now that the barrier between the pregnancy and the outside world had been breached, my patient was at risk of developing an infection inside her uterus. It was a truly awful situation to be in. Medically, the standard of care is to evacuate the uterus with a procedure, or to induce a vaginal delivery knowing that the fetus would not survive. The longer one delays this care, the higher the risk of infection, hemorrhage, sepsis, or even death. My team watched her progress from a healthy 20-something-year-old to someone who nearly needed life support, even though she received high-quality, evidence-based care. She would have died if we hadn’t intervened at all. Women will die in the aftermath of the Roe reversal, in the twenty-first century, in the world’s most powerful industrialized country, though we know better. The alarm bells are ringing loud and clear.
The time has passed for neutrality. From our standpoint, there is no middle ground between life and the preventable death of women. The fallout from the most recent Supreme Court ruling will be vast, and it will be destructive. We all know someone who has or will need an abortion — one in four women will in their lifetime. When the opportunity presents itself to take a stand, I hope you choose action, as we did. We may have been able to protect ourselves in this one instance, but we need to you to help us protect our patients and our ability to practice medicine the way we were trained to do.
Samantha DeAndrade, MD, MPH is a Female Pelvic Medicine & Reconstructive Surgery Fellow at Harbor UCLA.