Unclear medical guidance compels many doctors to perform c-sections for abortions
Because traditional methods might bring a prosecution, doctors have opted for more invasive procedures that are less legally risky
Virtually no one who attended this week’s Texas Medical Board meeting about its abortion guidelines went away satisfied.
The board met on Monday to discuss proposed changes to give doctors a better idea of when and in what situations abortion would be permissible insofar as the exceptions to the state ban are concerned. Since the restrictions took effect, medical experts and practitioners have reported a chilling effect in situations where it’s still permissible because doctors fear authorities will see an abortion as being performed unnecessarily.
I spoke with Amy Bresnen, one of the leaders pushing for more straightforward guidance from the board. She told me that the biggest issue is the excessive documentation that doctors must have to perform abortions in situations called for by the exceptions.
“We all need to be careful about the way that we word that,” Bresnen said. “It is over burdensome. And it's not necessary, and it's not required under the statute.”
Among the things doctors have to document is whether there was time to transfer a patient to another facility to avoid an abortion.
Several other things emerged from my phone call with Bresnen. We spoke about how doctors are performing C-sections instead of D&E procedures to accomplish abortion. The latter method is far safer and less intrusive. Still, doctors have avoided it because it’s exclusively used and associated with abortion, and they fear it would be more likely to lead to prosecution than the c-section procedure. I intend to write about this further in a later newsletter and my book. It’s an essential point of advocacy for leaders. Women are entitled to the safest possible medical care using the simplest method called for.
The organization that is pushing for the c-section approach is the American Association of Pro-Life OBGYNs. In a policy letter sent out, the organization referred to abortion as “feticide.”
It recommends C-sections to remove stillborns because it is a morally acceptable procedure. They also recommend a salpingostomy, which is a surgical procedure that involves making an incision into a fallopian tube to remove an ectopic pregnancy while preserving the tube's patency.
“In conclusion, AAPLOG urges the profession of obstetrics and gynecology to cultivate a life-affirming way to practice the specialty, in which both the maternal and fetal patients are treated with human dignity and respect,” the letter concludes.
One of the chief proponents of the C-section method is Dr. Ingrid Skop, who testified before the Senate Committee on the Judiciary in April 2023. Skop enumerated a list of reasons for why she felt D&E procedures were dangerous.
Skop then expounded on the C-section method.
However, it is unusual for a physician to need to resort to an abortion when complications arise during pregnancy. A cesarean section or labor induction are readily available when a woman experiences a complication with her pregnancy that requires separation of mother and baby. Indeed, for nearly any serious pregnancy complication that arises after the point of viability, a cesarean section or labor induction will be the most effective remedy. If the pregnancy is causing a serious health concern for the mother, delivering the baby will address the underlying health issue, while also providing the baby with the best opportunity for survival. Delivery is also far preferable to a dilation and evacuation abortion because it is faster and more widely available and shows respect for the unborn human life. Once a physician determines that separation of mother and baby is necessary, a cesarean section can usually be performed within 30 minutes.
If the situation is less immediately urgent, labor induction is also an option. Both interventions can be performed in any hospital environment providing obstetric care, as all ob/gyns are trained to perform these procedures. In fact, cesarean sections account for nearly a third of all U.S. deliveries currently. To be sure, even in these scenarios, it may not always be possible to save the baby’s life. But taking steps like labor induction or cesarean section will give the baby the best opportunity for survival, whereas resorting to abortion eliminates any opportunity for the baby’s survival. Perinatal hospice services are also available in many hospital systems, whereby a multidisciplinary team comforts and supports the fragile child and his family, even if he is too young or sick to survive.
Consistent evidence supports improved mental health outcomes for women and families following this more caring approach. Such pre-viability deliveries are rare. Deliveries between 20 and 26 weeks, either due to spontaneous labor or medical intervention for serious maternal complications are estimated to comprise only 0.5% of all births. Moreover, often when life-threatening situations arise before the point of viability, temporary medical interventions, such as antihypertensive treatments, antibiotics, bedrest and other measures may allow delay of delivery until viability has been reached, and then delivery can occur through standard obstetric interventions as mentioned above.
Bresnen explained how doctors have used this reasoning in Texas.
“If you're looking at the coding, and you can put in C-section versus D&E, you can probably…other than the fact that you just disemboweled a woman for no reason… You don't have to go to bed at night worrying about whether prosecutors are going to come after you,” Bresnen said.
I’ll report more on Texas in the coming weeks as its supreme court considers legal questions. I also intend to explore the effects abortion bans have had on medical choices doctors make and how it’s led to riskier practices.
I understand that C sections can weaken the uterus and cause scarring that can cause complications for subsequent pregnancies. They should not be done if not necessary. They also add unnecessary expense.