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By Rose Hoban
Since legislators returned to Raleigh in late January, physicians opposed to any new restrictions on abortion in North Carolina have been making themselves visible at the General Assembly.
Leading the opposition to any new legislation are obstetrician-gynecologists (known as OB-GYNs), who have the closest contact with people who face the decisions about whether to continue a pregnancy.
“I have a patient in the hospital right now in renal failure, who was advised not to be pregnant because of the seriousness of her renal failure and the threat to her life that a pregnancy causes,” said OB-GYN Lisa Carroll, who specializes in maternal-fetal medicine — treating pregnancies that are complicated and potentially life-threatening for mother and fetus alike.
Carroll’s patient had tried multiple long-acting, reversible contraceptives such as intrauterine devices and hormone implants. The mother of four children still got pregnant again.
Carroll described her patient with kidney disease as someone who is “tormented” by the looming decision about whether to continue with a pregnancy that could kill her. Currently in her fifteenth week, the woman knows that her time for making the choice is running short. North Carolina bans any abortions after 20 weeks.
“People, even when they’re faced with these decisions of ‘protect my health, protect my family or continue this pregnancy,’ they struggle,” Carroll said.
Carroll, who practices in the western part of the state, says the time she spends with her patients — listening to them, describing their options and the possible consequences of any choice they make — is valuable.
If lawmakers were to impose a ban on abortion at six, 13 or 15 weeks, that vital medical give-and-take would be derailed.
That’s why OB-GYNs are traveling to Raleigh, making appointments to speak to their legislators back home, writing letters and organizing to avert what they contend is intrusion on their ability to practice good medicine.
Abortion statistics for 2020 (latest year for state data)
- 25,058 abortions were provided to NC residents, with 98.5 percent obtained in-state.
- Two-thirds of people seeking an abortion were already parents to one or more children.
- More than half — 56.6 percent — of abortion seekers were 20 to 29 years old.
- 49.3 percent of abortion seekers were African American, 27.9 percent were white and 13.1 percent Hispanic.
- More than half — 58.7 percent — of people seeking an abortion had more than a high school education.
- 48 NC residents obtained abortions after 21 weeks. 30 of those procedures were performed in-state and 18 took place out of state.
Making themselves seen
North Carolina’s medical organizations and individual health care providers have come out forcefully this year against any further restrictions on abortion by the General Assembly.
In February, the powerful North Carolina Medical Society released a new policy on reproductive health care, stating that the organization “opposes government, institutional, or corporate interference in individuals’ ability or right to access reproductive health and support services.”
Later in February, a group of physicians rallied in front of the legislative building to oppose any further abortion restrictions and to present a letter signed by more than 1,200 providers opposing interference in their practices.
And on “White Coat Wednesdays” each week, the building fills with doctors in their formal white coats walking the halls and sitting down with lawmakers.
At least 10 physicians joined Democratic lawmakers for a news conference on Wednesday — the third one this year — asking lawmakers to overturn restrictions on abortion and return decision-making about the procedure to physicians and their patients. Democratic lawmakers introduced a bill that would repeal measures that have been added over the past decade — while Republicans have had majorities in both legislative chambers — such as a 72-hour waiting period, a requirement that physicians read a script to people considering a pregnancy termination and the mandate for an ultrasound before an abortion procedure can be done.
Rep. Julie von Haefen (D-Apex) acknowledged that she doubted the RBG Act — named for late Supreme Court Justice Ruth Bader Ginsberg — would go anywhere in the Republican-dominated legislature. Nonetheless, she and her Democratic Senate colleagues thought they needed to signal their opposition.
Only Democratic lawmakers have filed bills related to the abortion debate this session. No Republicans have filed any bills to further restrict the procedure — yet.
“There’s been no determination on timeline” for an abortion bill, House Speaker Tim Moore (R-Kings Mountain) told reporters on Wednesday afternoon. “As you can tell, we’re moving very slowly.
“We’re trying to get input from all sorts of perspectives on this. We’re looking for input from folks from the medical perspective, to make sure that what we do is something that makes sense — and that will save lives and is consistent with best practices.”
Moore said that opinions in the House range across a wide spectrum, and he’s asked members to hold off on filing anything on their own before the caucus reaches some consensus. Any bill that gets filed by House Republicans, according to Moore, would be negotiated ahead of time with the Senate.
“There’s a lot of detailed conversation — sometimes some heated conversations,” Moore said.
Creating exceptions is problematic
Nicole Teal is wrapping up a fellowship in maternal-fetal medicine at one of the academic medical centers in the state. When the federal court reinstated a state ban on abortions past 20 weeks in August 2022, after the U.S. Supreme Court overturned Roe v. Wade, it complicated Teal’s care for her patients. The federal court had earlier put a halt to the 20-week ban while a lawsuit challenging the restriction was adjudicated.
Teal said she’d had about 15 instances since August where “a patient has a desired pregnancy and has a bad outcome or a medical condition that comes up, either with their fetus or with themselves, after that 20-week mark.”
Teal described one patient whose amniotic sac broke at 21 weeks. It was almost certain the fetus would die without amniotic fluid, and the woman could develop a systemic infection. But because of the timing, Teal could not offer the woman an abortion.
“She is at risk of sepsis, hemorrhage, losing her uterus, all of these things,” Teal said. “But in the state of North Carolina, now, when someone walks in at 21 weeks for that problem, I have to wait until they’re sick enough to provide them an abortion, something that I’m very well trained to do. And who defines what’s sick enough? I can’t define it.”
It took a week — and an ICU admission — for that patient to become “sick enough” for Teal to proceed.
Teal and Carroll explained that for many pregnancies, catastrophic abnormalities only become apparent close to the 20-week mark.
“I can’t do any genetic testing on a fetus until 10 weeks. I can’t do a meaningful ultrasound of the fetus’ anatomy until at least 13 weeks — even that is limited,” Carroll explained. “You maybe can detect 50 percent of anatomic differences in the baby’s body at that point.”
It’s between 18 and 22 weeks when an ultrasound can pick up something truly catastrophic in fetal anatomy, they said.
“Some women are coming in for their routine anatomy scan, thinking they have a low-risk pregnancy. They’re 21 weeks along, they get their routine anatomy scan and we find a devastating lethal diagnosis: The fetus doesn’t have a brain. The fetus doesn’t have a skull. The fetus doesn’t have kidneys,” Carroll said. “There’s so many different ways that the development can be disrupted.”
The choices for such patients, Carroll said, are to go to another state with fewer restrictions on abortion or to continue the pregnancy, “deliver their baby and then watch the baby die after birth. And that’s a stark choice for a lot of people.”
There’s so much variability in anatomy and human development that it would be impossible for lawmakers to include a list of allowable exceptions in a statute, both women said.
“Pregnancy is unpredictable,” Carroll said. “And I feel like I’ve learned that every day in my job.”