After Roe, doctors grapple with limits placed on the care they can provide

CHIPPEWA FALLS, Wisc. — When Heather Martell found out she was pregnant, she was over the moon.

“It was a dream come true,” said the 35-year-old legal assistant from this city in northwestern Wisconsin. “We had been trying for so many years.”

Early genetic tests and ultrasounds showed that the pregnancy was healthy. She even picked out a name: Oliver.

But at 19 weeks, a scan found something devastating. The fetus had severe abnormalities in the head, spine and heart. Heather said she could barely feel him moving.

“He was going to die after birth,” she said. “No question about it, he was going to die.”

Doctors told her she had two choices: carry to term or terminate the pregnancy.

After getting a second opinion to confirm the diagnosis, Heather and her husband, Jason, a Roman Catholic, who Martell said was anti-abortion, decided they couldn’t bear to continue with the pregnancy, feeling like their baby was suffering.

“I couldn’t allow him to come into this world to live hours or weeks in excruciating pain,” Martell said. “That wouldn’t have been fair.”

But by that point, she was 20 weeks pregnant. The law in Wisconsin at that time banned abortions after 20 weeks.

That was last year, before the Supreme Court overturned Roe v. Wade. Now nearly all abortions in Wisconsin are illegal because of a more than 100-year-old law that was triggered after the Supreme Court decision.

It’s a similar situation in eight other states that now have near-total abortion bans. Three other states prohibit abortion after six weeks.

“This one-size-fits-all approach is truly devastating for my patients and the doctors who take care of them,” said Dr. Abigail Cutler, a practicing OB-GYN and an assistant professor at the University of Wisconsin-School of Medicine in Madison.

Right now, all states with bans make exceptions for the life of the mother, meaning doctors can legally terminate a pregnancy if the mother will die. But doctors say that what constitutes imminent death has remained vague under the laws and they now fear that the shifting legal landscape is putting pregnant patients in grave danger.

“Abortion is still life-saving care,” Cutler said. “Someone is dying in front of you and if you do not intervene, they will die. But what constitutes saving the life of the mother can be impossible to pin down. How sick does a mother need to be? How much blood would they have lost?”

Cutler said pregnancy itself can spark emergency complications in even the healthiest of women.

“Pregnancy is at baseline risky to one’s health,” she said. “It’s a little bit of a miracle when there’s no complications at all.”

Any number of conditions and emergencies could cause a doctor to terminate a pregnancy to save a woman’s life, said Dr. Carrie Cwiak, professor of gynecology and obstetrics at Emory University School of Medicine in Georgia. Conditions include infection, hemorrhaging, embolisms, stroke and even severe cases of gestational diabetes and cardiovascular disease.

“All of those things increase in likelihood as pregnancy continues,” Cwiak said.

But adding to the confusion among doctors is that many of these cases aren’t black and white.

Dr. Jordan Crow, an obstetrician in Eau Claire, Wisconsin, said one example is a woman whose water breaks well before a fetus could survive outside the womb, leaving her susceptible to infection.

“If she is not clearly infected and septic, it is not clear to me that it would be legal to end her pregnancy,” Crow said. “Instead, what I’m having to tell her is you can go to Minnesota, where they still honor her autonomy and standard of care medicine. Or call me back when you’re infected. There are going to be mothers that are going to die simply because there is no law that really wraps itself around the intricacies of medical practice.”

Another example is a pregnant woman who is diagnosed with cancer and needs to be treated with chemotherapy or radiation, which can harm the fetus. While she may not be dying at that moment, delaying treatment while she’s pregnant could lead to the cancer spreading and ultimately killing her.

“As a physician, I took an oath to provide my patients the best care and to do no harm and to respect the patient-provider relationship and respect their autonomy,” Cwiak said. “This flies in the face of all of that when it comes to the law.”

Dr. Nancy Wozniak, an OB-GYN in Indiana and a member of the American Association of Pro-Life Obstetricians and Gynecologists, agrees there are gray areas and nuance when it comes to defining life-saving care.

“Where it becomes a little bit gray is how infected does somebody have to be to make their delivery a legitimate concern,” Wozniak said. “I really believe that no matter which side of the spectrum you’re on, as far as pro-choice or pro-life, that physicians operate in good faith and try to have the interest of the mother first and foremost.”

But in cases like Martell’s, things get even more complicated. Carrying a baby with severe genetic abnormalities may not be life-threatening to the mother, but standard medical care is to counsel the patient on abortion, said Dr. Katie McHugh, an OB-GYN in Indiana.

“It’s a devastating diagnosis and devastating for patients,” McHugh said, adding that carrying these babies to term can cause not just emotional harm, but financial and physical harm as well. “This is a difficult conversation in a difficult time, and then to add burden and shame, it’s just inhumane.”

Wozniak whole-heartedly agrees these situations are devastating, but said she still wouldn’t support an abortion in such cases. “When the intent is to take the life of another human being, I can’t endorse that,” she said.

Instead, she stressed the importance of counseling patients on all of their options.

“Sometimes it almost feels like the reflex solution is termination,” Wozniak said. “Patients need time to think about their options, but they need to know what all their options are.”

Wozniak said in her experience, those who carry the babies to term are able to grieve in a different way.

“I think their grief was probably less complicated than somebody who’s gone through a termination,” she said. “A termination is a very emotionally difficult thing. For most women, even if it’s what we’ve considered an elective termination, you know, it’s a heartbreaking thing for them to go through. And to me that falls under that rubric of pregnancy loss.”

Martell ended up traveling across state lines to Minnesota to have an abortion. She said she was met by protesters outside the clinic, who shouted at her, saying there was help if she needed it.

“To have somebody who was just so ignorant of our situation, tell me that there was help,” she said. “If there had been help anywhere, I would have already found it and gotten it.”

That was one year ago this week. As she holds images of Oliver’s footprints, along with his ashes, given to her by the clinic, she said she has no regrets.

“I would do it all over again,” she said. “There wouldn’t be a thing about this that I would change, and that’s how I know that I did the right thing.

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