Categories

Tag: Dobbs v. Jackson

Miscarriage or Abortion? The Crisis in 14 States Post Dobbs.

By MIKE MAGEE

“What did they know, and when did they know it?”

These are the questions Americans have become accustomed to asking of their leaders, dating back to Nixon and extending to Trump, and all Presidents in between. But now the same questions have surfaced, to the extreme discomfort of conservative Justices, as death and destruction of lives begins to mount in the wake of the Dobbs decision.

As predicted, graphic cases of young women bleeding out in parking lots after being refused life-saving acute care for miscarriage in 14 states across the nation are being documented and described. These stories are not only affecting the lives of couples across the land, but also threatening the “political lives” of downstream Republicans facing an upcoming election.

The responsible Supreme Court Justices (Alito, Thomas, Gorsuch, Kavanaugh, and Barrett) and their legions of Ivy League clerks had scoured the literature far and wide before making the decision to eliminate women’s reproductive freedom in the U.S. and inflict lasting harm to their life-saving relationships with their local doctors.

Their review had to include Blue Cross & Blue Shield’s timely publication, “Trends in Pregnancy and Childbirth Complications in the U.S.” That report, surveying over 1000 pregnant women ages 18 to 44 in April, 2020, was, in part, designed to understand the impact the Covid epidemic had had on prenatal care nationwide. But what it revealed was that pregnancy complications were up 16% over prior years, in part due to “social barriers such as availability of appointments, lack of transportation or nearby providers.”

A comparison of 1.8 million pregnancies in 2014 versus 2018 demonstrated a severely compromised women’s health support system. 14% did not receive prenatal care in their first trimester, and 34% missed scheduled prenatal visits with 1 in 4 of these suffering complications in pregnancy. The BC/BS summary “underscores the importance of focusing on the health of pregnant women in America, especially as health conditions increase in this population…”

The Conservative Justices were forewarned. Yet they still elected to throw fuel on a maternal health system which was already in flames. They were also aware of a 2021 study that confirmed that miscarriage was 43% more likely in Black women than in their white counterparts.

On May 2, 2022, Justice Alito and his allies engineered the release of a draft of a majority opinion in part to freeze attempts by Chief Justice Roberts to secure a compromise. The leaked document labeled Roe v. Wade “egregiously wrong from the start.”  As predicted, the ruling spawned chaos.  When 14 Red states established total bans on all abortions, miscarrying women seeking help in ER’s literally had to fight for their lives. Their doctors were criminalized. Was this an abortion gone bad?

A miscarriage, or pregnancy loss before 20 completed weeks, is not an uncommon affair. Approximately 15% of pregnancies end in miscarriage, mainly the result of chromosomal or genetic abnormalities. That amounts to some 540,000 women in crisis, which most believe is under-counted. 80% of miscarriages occur in the first 13 weeks of pregnancy.

25% of pregnant women experience some vaginal bleeding in the first trimester. For most (6 in 10) this is self-limiting and they go on to deliver a healthy baby. But for 4 in 10 (or 10% who present with bleeding) they go on to miscarry. All pregnant women who experience vaginal bleeding in early pregnancy need to have a medical examination. Doctors and midwifes check blood work, perform a physical examination, and do an ultrasound examination.

Most pregnancy loss (95%+) occurs before 20 weeks gestation. If miscarriage occurs before 13 weeks, there is a good chance of clearing the blood clots and uterine tissue with medication and no surgical intervention. But if bleeding is severe, or the loss is occurring beyond 13 weeks, dilation and curettage (D&C) is both necessary and at times life-saving. Under anesthesia, the cervix is dilated and any remaining pregnancy-related tissue is gently scraped and suctioned from inside the uterus. Patients are then closely monitored for several weeks for any evidence of continued bleeding or infection.

What did the Justices know, and when did they know it?

  1. They knew that Miscarriages were a medical emergency and exceedingly common.
  2. They knew that 80% occur during the first trimester, and that existing state abortion laws on the books would restrict access to acute life-saving treatments in 14 states.
  3. They knew that pregnancy loss was far more common in non-whites and in rural underserved communities.
  4. They knew that the medical community opposed overturning Roe v. Wade in overwhelming majorities, and predicted maternal loss of life if the Justices proceeded.
  5. They read, two years after their deadly decision, the Commonwealth Report which stated that “The United States continues to have the highest rate of maternal deaths of any high-income nation, despite a decline since the COVID-19 pandemic. And within the U.S., the rate is by far the highest for Black women. Most of these deaths — over 80 percent — are likely preventable.”

They knew all this, and they did it anyway.

Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex. (Grove/2020)

“All Men Would Be Tyrants.” History Reverberates!

By MIKE MAGEE

“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

This striking and sweeping statement of values, the Preamble to our Constitution, was anything but reassuring to the wives, mothers, sisters and daughters of the Founding Fathers. Abigail Adams well represented many of them in her letter to John Adams in March, 1776, when she wrote:

Remember the Ladies, and be more generous and favorable to them than your ancestors. Do not put such unlimited power into the hands of the Husbands. Remember all Men would be tyrants if they could. If particular care and attention is not paid to the Ladies we are determined to foment a Rebellion and will not hold ourselves bound by any Laws in which we have no voice or Representation.”

Her concern and advocacy for “particular care and attention” reflected a sense of urgency and vulnerability that women faced, and in many respects continue to face until today, as a result of financial dependency, physical and mental abuse, and the complex health needs that accompany pregnancy, birth, and care of small infants.

The U.S. Constitution is anything but static. In some cases, the establishment of justice, or the unraveling of injustice may take more than a century. And as we learned in the recent Dobbs case, if the Supreme Court chooses, it may reverse long-standing precedents, and dial the legal clock back a century overnight.

Roe v. Wade was a judicious and medically sound solution to a complex problem. Perfection was not the goal. But in the end, most agreed that allowing women and their physicians to negotiate these highly personalized and individualized decisions by adjusting the state’s role to the reality of the 1st, 2nd, and 3rd trimester made good sense. But getting physicians to step forward and engage the issue was neither simple nor swift.

In July, 1933, McCall’s magazine published one of hundreds of ads that year for contraceptive products. This one was paid for by Lysol feminine hygiene. It pulled punches, using coded messages, and suggesting that the very next pregnancy might finally push a women over the edge, and that would indeed be a “travesty.”

Continue reading…

When Push Comes to Shove: The AMA v. Dobbs. Part 1.

BY MIKE MAGEE

Should anyone present know of any reason that this couple should not be joined in holy matrimony, speak now or forever hold your peace.”     Book of Common Prayer, Church of England, 1549

Last evening Trump rose from the ashes and declared it was time to “Make America Great and Glorious Again” (MAGAGA).

This past week, five days after the Midterm elections, AMA President, Jack Resnick, Jr., MD, raised his voice from the podium at the AMA Interim Meeting in Hawaii with the AMA’s own version of a call to action:

But make no mistake, when politicians insert themselves in our exam rooms to interfere with the patient-physician relationship, when they politicize deeply personal health decisions, or criminalize evidence-based care, we will not back down…I never imagined colleagues would find themselves tracking down hospital attorneys before performing urgent abortions, when minutes count … asking if a 30% chance of maternal death, or impending renal failure, meet the criteria for the states exemptions … or whether they must wait a while longer, until their pregnant patient gets even sicker…Enough is enough. We cannot allow physicians or our patients to become pawns in these lies.”

Continue reading…
assetto corsa mods