Dr. Amy Bingaman knows there may come a time in the near future when she might have to choose between her Iowa medical license or the life of a pregnant person she is treating.
“I could never imagine letting a woman die on my watch when I could intervene,” Bingaman said. “The problem is to do the right thing for a patient and then have to worry about someone taking my medical license. It’s not the way anyone wants to practice medicine.”
Bingaman is an OB-GYN at Broadlawns Medical Center in Des Moines. Like many in her profession, she’s concerned that the exceptions in Iowa’s newest six-week abortion ban, currently blocked from taking effect until the Iowa Supreme Court weighs in, don’t adequately protect the lives of women.
“I think all of it is very blurry and I think that was the intention of the bill language,” said Dr. Emily Boevers, an OB-GYN at the Waverly Health Center.
That confusion could easily get women killed, she said.
What the law says
The text of Iowa’s six-week abortion ban says abortions are allowed for medical emergencies. Those are defined as situations where abortion is performed to save the life of a pregnant woman if her life is endangered by a physical disorder, illness, or injury. That includes a life-endangering physical condition that is caused by the pregnancy.
However, pregnancy is complicated, even without emergency complications.
Bodies go through a lot of changes, pre-existing conditions such as asthma, diabetes, depression and anxiety often get worse, and small things can become major very quickly.
Abortion can also be performed if continuing the pregnancy will create a “serious risk of substantial and irreversible impairment of a major bodily function.”
But the law doesn’t say when doctors are allowed to act, and it generally prohibits abortion if electrical impulses—inaccurately called “fetal heartbeats” by anti-abortion lawmakers because there is no physical heart—can be detected. The exceptions are: medical emergencies, the pregnancy being the result of a reported rape or incest, a fatal fetal abnormality or the patient has miscarried but hasn’t expelled all fetal tissue.
“That decision [when to act] will fall to the patient’s physician ultimately to have enough information to justify performing an abortion for a patient whose life is at risk,” Boevers said, and she added there’s never a clear-cut moment when the scale has tipped toward a woman’s life being in danger.
Abortion bans cause harm
Across the country, abortion bans—even those with life-of-the-mother exceptions—have led many doctors and hospitals to wait until the last minute to provide abortion care because the woman’s death wasn’t close enough and they tried to avoid breaking the law.
In Texas, a group of 15 women successfully sued the state in July because the state’s ban—which has a medical emergency exception—damaged or endangered their health in various ways when they were forced to carry nonviable pregnancies. However, an appeals court has blocked the initial injunction.
To add more complications, Iowa has the lowest number of OB-GYNs in the country, per capita.
“People need to be prepared to watch women die in early pregnancy because Iowa does not have the medical personnel across the state to deal with emergencies in early pregnancy for everyone,” Boevers said.
Bingaman said emergencies can develop rapidly and intervening sooner rather than later is always the best move.
“Say somebody comes in and they’re hemorrhaging, but the baby has a heartbeat. Now, women who are pregnant tend to be young and healthy, so they have a lot of reserve. So if you’re going to wait for them to have changes in their vital signs until they’re on death’s doorstep, usually they’ve lost at least 1500 milliliters of blood,” she said.
Bingaman and Boevers both said allowing patients to get close to the point of death is not why they became doctors.
“When I’m taking care of a patient, my aim is always to avoid that moment in time where if you don’t do something right now, this patient will die,” Boevers said.
She has experience working in hospitals with hospital lawyers and ethics committees weighing in on some emergencies, and she said the process is rarely rapid.
“The practice of medicine already requires a lot of really difficult decisions about when and whether somebody is improving or decompensating,” Boevers continued. “You’re watching them closely, and it’s uncertain if people are getting better or getting worse, and by the time somebody starts to get worse, sometimes it’s too late.”
What is “reasonable medical judgment?’
Bingaman also has concerns about people with pregnancies where a baby won’t survive long after birth. Iowa’s ban allows for abortions if there’s a fetal abnormality that a physician certifies, using “reasonable medical judgment,” is incompatible with life.
Reasonable medical judgment is also defined in the bill, but it’s vague and doctors will have to wait for the Iowa Board of Medicine to issue guidelines to know how to navigate it.
The text says: “a medical judgment made by a reasonably prudent physician who is knowledgeable about the case and the treatment possibilities with respect to the medical conditions involved.”
In other states, women have been made to carry those pregnancies, often because physicians can’t guarantee the pregnancy will result in death. Those women have had to try to get abortions out of state or deliver babies and watch them die.
“The risk of postpartum depression is quite high in that scenario,” Bingaman said, adding that the delivery and pregnancy would likely also be traumatic.
“People want to feel empowered in that situation,” she continued. “I think taking away their choices also takes away any empowerment that they have in a situation that they have no control over.”
Boevers said she hasn’t been surprised by any of the stories coming out of other states. She advised Iowans to pay close attention to them and know what to expect if Iowa’s six-week ban goes into effect.
“I don’t think that the exceptions are meant to be easy to navigate,” Boevers continued. “I think the exceptions are meant to buy goodwill from people who think that abortion should be highly regulated. But in reality, you know, abortion already is very highly regulated.”
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