Will abortion bans prevent the essential training of the next generation of obstetricians? | Roe vs. Wade

IIt was the moment Dani Mathisen had been looking forward to for weeks. She and her husband watched the ultrasound screen as the wand cut through the jelly on her stomach. As a doctor, Dani was able to interpret the images of the 20-week anatomical scan herself – and immediately she began to see the problems in her pregnancy.

Her daughter’s feet weren’t forming quite properly. Bone surgery can solve this problemshe thought.

There was only one kidney. But you only need one kidney.

A small bulla at the base of the spine indicated neural tube defects. A neurosurgeon could fix that. Scoliosis has curved the spine itself. An orthopedic surgeon could fix it.

And then they got to the brain. It had never developed; there were no identifiable structures.

A surgeon can’t fix thisshe thought, soaked in grief. No one can fix this.

Dani always wanted to be two things in life: a good doctor and a good mother. Both goals appeared to be on target. She was finishing medical school and she and her husband bought a house with an extra bedroom that would be perfect for the nursery. They named their growing fetus Mini.

But looking at the ultrasound images, she knew that being a good doctor and a good mother meant ending the pregnancy.

Dani, however, lived in Texas, where abortions were banned after six weeks from September – the same month she had her ultrasound. She was finally able to make an appointment in another state, with a doctor she had never met before. Her husband was not allowed into the clinic with her due to Covid restrictions, and she could not keep her phone with her. The procedure lasted 14 hours.

After her experience, Dani, a lifelong Texan, moved away from home to do her medical residency in a state where the right to abortion is protected – in part in case she needed care like this again. but mostly so she can become a “full, rounded ob-gyn who has every tool in her arsenal,” she said. in June only reinforced the decision.

Abortion bans primarily affect pregnant women who need care. But the bans proliferating in US states will also ripple through an entire generation of medical professionals.

“It’s going to change the way medicine is practiced,” said Kavita Vinekar, assistant clinical professor at UCLA’s David Geffen School of Medicine and co-author of a study on how abortion restriction affects medical training. Instead of providing care based on “clinical decision-making, solid evidence, and the body of knowledge we have in medicine, we’re going to be forced to operate in a truly confusing and fearful environment.”

Abortion care learning is not required in US medical schools, but some programs offer lectures or opportunities to shadow clinicians. Obstetrics and gynecology residency programs are the only ones required, by a national credentialing board, to train physicians in abortion care – including procedures, counseling and management of complications – although residents can choose not to perform the procedures if they wish. Obstetrics and gynecology residency programs in abortion-banning states may need to offer out-of-state training options or alternative training in order to maintain their accredited status, per guidelines that are updated below. the decision of the Supreme Court.

“You’re going to be raising a generation of obstetricians who have never been exposed to these kinds of procedures,” said Danielle Jones, an obstetrician and science communicator who trained and lived most of her life in Texas before leaving. the state about six months ago.

Physicians who do not feel capable or confident in their ability to provide abortion care may also find their skills limited in other areas of care. “A lot of what we learn in abortion care extends far beyond abortion care,” Vinekar said. Many procedures are the same for other reproductive health complications, such as managing miscarriages or uterine evacuations. “These are all situations that arise whether or not you have legal abortion in your state, and physicians need to be well trained and able to deal with these sometimes emerging scenarios.”

In states that prohibit abortion, the American College of Obstetricians and Gynecologists (ACOG) “will work specifically with those states to address and ensure proper training,” co-executive director Dr. Maureen Phipps said during an interview. a press briefing on the Dobbs. decision. But, she warned, “it’s not simple. We are going to have to do a lot of work to provide this training. The organization will also offer resources and answer individual questions from members about the patchwork of state laws, she said.

The Biden administration recently promised protect the right to abortion when a patient’s life is in danger. But pregnancy, especially in the United States, is already extremely dangerous. Doctors fear an environment where they have to wait until patients are near death before providing them with the treatment they need – especially if they have to seek authorization in situations where a few minutes can be the difference between Life and death.

IIn Texas, Dani saw how close pregnant patients had to be to death before a doctor could intervene. During her medical school rotations, she saw patients with dangerous high blood pressure — putting them at risk of stroke and neurological damage — or who clearly developed sepsis, a life-threatening infection, but whose doctors had to wait until their condition worsened. before terminating the pregnancy.

“You know the bad things that can happen, and you just have to sit back and wait until it’s bad enough?” It’s awful,” Dani said. “To me, that goes against ‘do no harm’ because it happens – harm happens. It’s just not harmful sufficient.”

Staying pregnant herself would have opened Dani up to potential danger, while the outcome for Mini would have been the same no matter what. All Dani could do was ease the pain.

An undeveloped brain meant that the baby would die before delivery or soon after birth, as there would be no respiratory impulse prompting it to breathe. If Mini survived childbirth, she would slowly suffocate to death – and there was no way to save her.

“It wasn’t really a decision because no one would choose for their child to live and die like this. It would have been a very painful death where she would end up running out of oxygen,” Dani said.

And seeing Mini die would have made it difficult or impossible for Dani to work as a doctor. “I don’t think I could have gone back to medical school after watching my child die,” she said. “I couldn’t relive that every time.”

Doctors forced to monitor patients enduring such danger and trauma will struggle with falling morale and burnout, Vinekar said.

“I can’t think of anything more likely to drive people out of health care because of this powerlessness,” Vinekar said. “The reason we’re in this business is to help people.” But “forcing people to run the risk of pregnancy against their will is perhaps one of the most inhumane things you can do.”

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