The new crop of laws in the Unites States using the premise of “fetal pain” to restrict abortion can only be described as unscience (an Orwellian theme that sadly fits). The latest is the new Georgia abortion law HB 954, which the OB/GYN Society of Georgia states is “murky” and difficult to interpret. HB 954 states that an OB must aggressively institute all known medical interventions for any fetus 22 weeks or older and at 22 week a fetus must be delivered in the manner that provides the “best opportunity for the unborn child to survive.” At 22 weeks intact survival, meaning without gross neurological disability, is 1%. While there is an exception for medically futile pregnancies, this term applies only to chromosomal or birth defects.
Read any obstetrical textbook and the treatment options at 22 weeks with ruptured membranes or an impending premature delivery will include (after a full discussion of the odds of survival by a neonatologist) aggressive intervention, antibiotics but no monitoring of the baby’s heartbeat and no c-section with a reassessment of this decision at 24 weeks should the pregnancy not deliver, and hastening delivery. These are very difficult decisions with no right or wrong. The decision to proceed full court press with aggressive interventions versus minimal intervention is a hard, personal choice that shouldn’t involve the government. Doctors provide information and discuss survival statistics and the risks of intervening versus no intervention. I know this both as an OB/GYN and as a mother who woke up at 22 weeks and 3 days with ruptured membranes.
However, because a 22 week fetus in Georgia must be delivered in the manner that provides the “best opportunity for the unborn child to survive,” the state legislature is now in the delivery room and the following scenarios could easily transpire…
- Labor between 22 and 24 weeks. If stopping the labor fails, if the fetus is breech a c-section will be needed as a vaginal delivery does not provide the “best possible outcome” for an extremely premature fetus. Preterm delivery can happen very quickly so this could lead to an emergency c-section, which has a far higher risk of complications such as blood transfusions, infection, permanently damaging the uterus, and maternal death. As monitoring the fetal heart rate will now be standard of care, emergency c-sections will also happen for fetal intolerance of labor.
- Ruptured membranes between 22 and 24 weeks. Instead of antibiotics and then watching and waiting until 23 or 24 weeks to start more aggressive care (based on parental desires), fetal heart rate monitoring will be required and if labor starts and the fetus is breech or if fetal distress is encountered a c-section will be required. Again, most likely under emergency situations, although there is the added bonus of an infected uterus in this scenario. The option to end the pregnancy with ruptured membranes is off the table.
What will happen to a woman who refuses a c-section at 22 or 23 weeks for her breech fetus? Her claim of not risking anesthesia, a major surgery, and almost always a c-section for subsequent deliveries (that is if she doesn’t lose her uterus) are valid reasons in other states, never mind the obstetrical literature. Will such a woman in Georgia be charged with murder? And what kind of documentation will be required to protect the medical team from criminal prosecution when they follow their patients’ wishes and not intervene? Will there be a system of on call judges to decide who must have a c-section?
And what if the life of the mother is at risk? The most common scenario is an infection and ruptured membranes at 22 or 23 weeks, but the fetal heart beat persists. Since there is a “life of the mother” clause, women with a ruptured membranes and a severe infection will probably be allowed to have a D & E (dilation and evacuation) or induction of labor, however, what if the infection is mild? It will, of course, only get worse, but who decides how sick is sick enough? How infected will a pregnant woman in Georgia have to be for a doctor to feel safe from prosecution in performing a D and E or an induction of labor, far safer procedures, versus a c-section to end her futile pregnancy?