When a politician decides if the life of the mother is at risk

“I have a 20-year-old with what I can only describe as a poorly repaired heart defect and, uh, suboptimal follow-up,” the cardiologist’s voice was rushed.

“That’s no good,” I said.

“Yeah, well, it gets worse. She had baby two years ago. Went into heart failure around 36 weeks. I’ve got the records. I have no idea how she made it home.” And then he added, “She had a c-section, but no one tied her goddamn tubes.”

“That happens,” was all I could say.

Actually, failing to do a tubal for a young woman with a very serious medical condition happens a lot. Patient refusal, Medicaid issues, or an OB dissuaded by her young age and the hope that advances in medicine might make it safe for her to be pregnant sometime in the next ten years. However, it was also possible that this young woman was so critically ill during her c-section that the doctors were just desperate to close her belly and get her off the table as soon as possible. Sometimes you just don’t have the five minutes.

“She came in short of breath. Eight weeks the radiologist says.” He added.

“So, uh, we have a problem…” I started, but he interrupted.

“Yeah, the pregnancy needs to be over. Today. Before she goes into heart failure,” he pressed.

I was fully aware of the medical urgency. That the amount of extra fluid the body accumulates in the early 2nd trimester can easily cause a damaged heart to decompensate. She’d already proven her heart wasn’t up to the challenge of the third trimester.

“I have to tell you something,” I said. I’m sure I closed my eyes, because even though I had nothing to do with it, I hated myself for what I was about to say. “There’s a new law. Maybe you don’t know about it? When the hospital’s budget was submitted this year to the state there was an additional clause. No abortions in this facility unless it’s life or death. Doesn’t matter if we can get insurance to pay or even if everyone is willing to waive their fees. The hospital is owned by the state.”

The Dean and the Chief of OB said they objected vigorously, but I don’t remember it being more than a minor blip in the news at the time.

“But it is a matter of life and death.” he said. “It’s not if it’s when. Her ejection fraction sucks. Her heart is crapping out already. Oh, and she had postpartum cardiomyopathy last time.” He was yelling by this point.

No wonder he was amazed that she survived her first pregnancy. Postpartum cardiomyopathy, devastating failure of the heart after delivery, has a 50% mortality rate. Women with underlying heart disease are at increased risk of getting this condition and the lucky survivors are more likely to get it again should they chance another pregnancy.

“Look, I’m not the bad guy here. But unless you can tell me she’s going to die in the next 30 minutes, we can’t do anything. Legal was very explicit. The next step is for you to call the concerned politician who wrote the law, explain her medical condition, and then find out if she meets his criteria for life and death. Basically, you need his permission” I paused, knowing what was coming next.

“You are fucking kidding me. You are just fucking kidding me,” he shouted. Not at me. It was abject disbelief.

Her odds of dying in the pregnancy or postpartum were high, but her chance of dying that day or tomorrow were not. When the balance would tip was difficult to know. Of course, the closer she was to a politician’s definition of certain death, the more dangerous any intervention would be.

“You could also arrange to transfer her to a private hospital, but I’m guessing she somehow hasn’t qualified for Medicaid.” His silence was reply enough.

“How is this a law?” He asked.

“It’s not about medical care, that’s all I know. Anyway, get your thoughts in order. Here’s the number for the hospital lawyer. He’ll arrange a conference call between you and the politician and then he’ll contact me if you’ve made her case.”

By the end of the day I still hadn’t heard, so I went home and waited for the phone to ring.


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  1. Yes, if you could specify which state this was in and what law you are writing about then I’d greatly appreciate it.

  2. Please tell us what state this was in, what the law actually says, and which legislators sponsored it. At 8 weeks, I am curious to know which state requires a life and death determination to perform an abortion.

  3. Dr. Gunter, just for clarification, would you or the doctor quoted here advocate tying a woman’s tubes without her informed consent? When I shared this on Facebook, some of my friends got that impression.

    1. No physician should ever perform a tubal ligation (or any surgery, for that matter) without a patient’s consent and full understanding of the surgery. Written informed consent is the standard of care.

  4. Please let us know the names of the state, politicians, and whatever happens. The patient’s name must be private, but the rest needs to be broadcast far and wide. I would think there would be some protest on behalf of this unknown woman. Maybe there should be an honor guard for a “tomb of an unknown woman.”

  5. sad article. even sadder that the doctors can’t see the incredible parallel between the politician’s alleged concern and their disbelief that “no one tied her goddamn tubes.” horrifying all around.

  6. Maybe the lawyer’s conference call should have been made conferenced in to the local news outlets in said politician’s home district. I’m sure the breaking news telecasts would allow him to gauge opinions at home.

  7. How does that even *work*?! How does a politician write *themselves* into being the arbiters of life and death?! Is it a specific person? It sounds to me like the ‘mother’s life in danger’ clause was just a smoke-screen to make it seem palatable to the public while politicians with a big rubber-stamp with the word “NO” written on it sit behind a desk feeling righteous and godly!

  8. I’d be interested to know where did this happen and what’s the name of this law? I’m very surprised that permission would need to be obtained from a politician and not a court/tribunal..

  9. Yes, the United States really HAVE lost their f*$&%& minds. It’s really sad to see health care today, especially concerning women, not being based on science anymore but instead based on misogynistic religious ideology that has no concerns for the life of women, let alone their needs, desires and well-being.

    American women have dug themselves in an enormous shithole by slowly allowing such laws to be passed, without strong rebuttal. And despite all the talking and screaming, I don’t see things changing for the better. Liberals need to have their acts together and need to demand that those attacks from women STOP. Once and for all. And no apologies.

  10. What will it take? A dead woman’s family suing a politican for witholding emergency medical care? Women’s lives should not be held to ransom like this.

  11. I wouldn’t be surprised to learn that the reason her tubes were not tied in the previous procedure had something to do with mandatory discussions and release form signings to make sure she was ‘making the right decision to not have any more babies’, Being red tape, it would have definitely taken longer than 5 minutes.

  12. If this horrible law manages to save this embryo at the cost of the mother’s life, is the state going to take care of the two motherless children left behind? Somehow I doubt it.

    1. Those programs have been cut due to budget deficits caused by tax breaks for the wealthy.

  13. I am full of rage and words that should not be used “in mixed company.” Sharing this post, and my outrage with others. Thank you for sharing a real story, as opposed to the fantasy “babies” the legislators are “saving” at the price of the lives of living women.

  14. It seems as though we, as a society, have completely lost our fu@#ing minds! Unfortunately, I am a nearly 64 year old. If I were much younger, I would be packing my bags and looking for a place to go to that was not bereft of hope.

    1. My husband insists he can help do good from the inside of the system, as a preacher. He doesn’t want to deny me my rights, but he feels the need to fight for others without them. I want to get the hell out of this backwards country. He said if Romney wins, we’ll start packing.

  15. Thank you for sharing this post. While this would be fascinating case to study in a Medical Ethics class I’m thankful I don’t have to face life and death situations and face the responsibility that you and your colleagues do on a regular basis.

    I work with Highly Impacted (Work First) young women on a regular basis. While this class is designed to teach job search and job retention skills I usually find ways to weave in family planning and basic health education. I hope it helps to know that will some of us might not have official health care or health education titles we are also trying to help avoid situations like the one you so elegantly described.

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