For the "Health" of the Mother

Remember John McCain's use of air quotes in the presidential debates when he talked about abortions to preserve women's "health"? Remember how the Bush Administration is trying to push through a "conscience clause" for providers of reproductive health services that's so capacious, it would likely redefine birth control pills as abortifacients? Remember how women used to routinely die in this country during childbirth? (Okay, so you need a longer memory for that last point. A century ago, the lifetime risk of death in childbed was about 1 in 20. 'Course, that only applied to women, which might explain why McCain sees "health" as a non-issue.)

Well, as Tracy Clark-Flory reports at Broadsheet, the Bushies are making one last push during these lame duck days to put that new rule in place. The only good thing about this? The ensuing discussion is shedding light on the barriers women already face in getting decent, equitable, timely reproductive health care. From the L.A. Times:

In calling for limits on “conscientious refusals,” ACOG [American College of Obstetricians and Gynecologists] cited four recent examples. In Texas, a pharmacist rejected a rape victim's prescription for emergency contraception. In Virginia, a 42-year-old mother of two became pregnant after being refused emergency contraception. In California, a physician refused to perform artificial insemination for a lesbian couple. (In August, the California Supreme Court ruled that this refusal amounted to illegal discrimination based on sexual orientation.) And in Nebraska, a 19-year-old with a life-threatening embolism was refused an early abortion at a religiously affiliated hospital. [My emphasis.]

That last case was new to me, so I hunted it down - first via the ACOG report and then the ACLU analysis that ACOG footnoted (both are pdf files). The ACLU report had the details. Here's the story:

In the spring of 1994, a nineteen-year-old woman in Nebraska, Sophie Smith [not her real name], was admitted to the emergency room of a religiously affiliated hospital with a blood clot in her lung. Tests revealed that Smith was approximately ten weeks pregnant, and the clotting problem resulted from a rare and life-threatening condition exacerbated by the pregnancy. The hospital immediately put her on intravenous blood-thinners to eliminate the existing blood clot and to help prevent the formation of more clots that could kill Smith instantly if they lodged in her lungs, heart, or brain.

Smith’s doctors told her that she had two alternatives. She could stay in the hospital on intravenous blood-thinners for the remaining six-and-a-half months of the pregnancy. She would also need a procedure in which a doctor would insert into one of her primary veins an umbrella-like device designed to catch blood clots before they reached a vital organ. Or she could have a first-trimester abortion, switch to oral blood-thinners, and be released from the hospital.

Smith decided to have an abortion. She wanted to go home to her two-year-old child. Because she was poor, Medicaid was covering her medical expenses but would pay for an abortion only upon proof that it was necessary to save her life. Four doctors at the hospital certified that Smith needed a lifesaving abortion, and Medicaid agreed to cover it.

On the morning Smith was scheduled to have surgery, however, the hospital’s lawyer appeared in the operating room. He announced that the hospital would not permit an abortion – lifesaving or otherwise – to take place on its premises. The procedure was canceled, and Smith was wheeled back to her room.

Ten days of dangerous delay followed. Smith wanted to be transferred to a facility that would perform the abortion, but moving her increased the risk that she would throw a life-threatening blood clot. Moreover, because the blood-thinners she was taking made her prone to excessive bleeding during surgery, Smith’s doctors felt that it was in her best interest to be treated in a hospital. The hospital, however, stood by its decision not to let the abortion take place in its facilities. Notwithstanding the risks, Smith was ultimately transferred by ambulance to her doctor’s office. He performed the abortion and sent Smith back to the hospital, which provided follow-up care.

Even in a culture where a presidential candidate feels free to mock women's health, this story is shocking. It wasn't just Sophie Smith's health that hung in the balance; it was her very life.

I know someone who died in her twenties from a pulmonary embolism. One of my grandfathers died - long before I was ever born - from an embolism. If even Medicaid judged the situation to be life-threatening, you'd better believe it was. An embolism is an immediate life-or-death emergency, not some remote risk.

And yet this hospital saw fit to risk the Smith's life. Of course, if she had died, she wouldn't have been much use to her potential child, either - not to mention her actual one! But I guess that didn't occur to these morally pure hospital administrators. She did survive, but due to luck, and no thanks to the "care" she received.

Historically, of course, the woman's life was always chosen first - not because women had higher standing in the past (they didn't) but because they typically had family members who depended on their care. Even the Roman Catholic Church was on board with this policy until about 1900. After that, it began to revalue the "innocent" life of the fetus as worthier than that of the presumably sinful mother.

In Smith's case, you have to wonder if any particular "sins" exacerbated her situation. She was young. She was obviously poor enough to qualify for Medicaid. She may have been married, though given her youth, odds are that she wasn't. I'm guessing that an educated, middle-class married woman in her thirties might have had better luck. But then again, maybe not.

And remember: Smith's ordeal happened in the mid-nineties. The climate for reproductive choice has only deteriorated since then, with the emergence of new tactics such as pharmacists' concerted refusals to fill birth control prescriptions. Anyone want to imagine what new scenarios might emerge if Bush manages to ram through this new rule?

As Clark-Flory notes, Hillary Clinton and Patty Murray have vowed to fight the rule. An Obama administration won't let it stand. But repeal will take time and political capital, and it leaves women's health advocates fighting a stupid, unnecessary rear-guard battle.

Update 12/4/08: I corrected the text to keep the blame focused on the hospital administrators, where it belonged, not on the doctors. Thanks for pointing out the slippage, moioci.