Could Michigan’s abortion ban affect miscarriage management, IVF and emergency contraception?

Michigan’s 1931 abortion ban has not been enforced for nearly five decades.

Much has changed since the 1970s, and some doctors have questions about the implications for some routine or proven treatments.

The law prohibits the intentional administration to a pregnant woman “any medicine, drug, remedy or thing whatsoever” to “cause a miscarriage.” Anyone who does so, other than saving a mother’s life, is guilty of an offense, the statute reads.

It is now being blocked by a court order of May 17 while a case was filed against the Attorney General and by Planned Parenthood.

A monumental U.S. Supreme Court ruling on June 24 to Roe v. Wade overthrew made way for the application of the law, depending on the outcome of the ongoing Court of Claims case.

Two provincial prosecutors – Jerard Jarzynka in Jackson County and Christopher Becker in Kent County, who said they would prosecute on the basis of the ban if given the chance – and two pro-life groups have asked the Michigan Court of Appeal to take control of the case. to take.

RELATED: Abortion is still legal in Michigan. It may not stay that way.

What is going to happen is unclear. The law can be called completely unconstitutional. Or it can be partially maintained. The court may, for example, say the ban only applies to abortions in the first trimester, says Maureen Carroll, a professor at the University of Michigan Law School. Before it was set aside, Roe v. Wade said states cannot ban abortion before the point of fetal viability. After the second trimester, the fetus became viable, and the state could regulate or prohibit abortions, except when necessary to preserve the life or health of the mother, it held.

If the law is enforced in its current form, here are five questions that will be answered:

How will this affect miscarriage management?

Most seriously, doctors may be reluctant to intervene when someone is bleeding or has an infection, says Dr. Lisa Harris, a professor of reproductive health, obstetrics and gynecology, and women’s and gender studies at the University of Michigan, where she also leads the fellowship. program in family planning.

“So, people who are relatively stable but experience infection or bleeding are likely to get sick until it feels inevitable that they will die, and then doctors will feel that they can intervene without running the risk of criminal justice themselves,” said Harris, who ‘s published article on navigating loss of abortion services was quoted by the three conflicting judges in Dobbs v. Jackson Women’s Health Organization.

If it is pushed too far and people bleed enough or have a serious infection, then it becomes impossible to treat it and people can suffer irreparable organ failure or die, she said and mentioned Savita Halappanavar (31) from Ireland, who in 2012 died of septicemia, an infection she contracted after being denied an abortion during a miscarriage.

In its lawsuit, Planned Parenthood states that every pregnancy carries the risk of miscarriage and premature rupture of membranes. Complications can lead to infection, bleeding and death. The risk of death from miscarriage is about twice the risk of death after an abortion, the organization reports.

Harris said mifepristone and misoprostol, the same medications used in preferred abortions, are the best evidence-based treatment for a pregnancy that has stopped progressing but remains in the womb.

Dr Lauren Owens, an obstetrician, gynecologist and specialist in family planning in the Northville, Ann Arbor and Kalamazoo areas, said misoprostol is also helpful in causing labor for a term pregnancy, and for postpartum hemorrhage.

Both mifepristone and misoprostol are on the World Health Organization’s list of essential medicines, but pharmacies may be reluctant to keep it in stock and doctors may worry about using it for fear that they will appear to be giving abortions.

Carroll said defining the point at which someone had a miscarriage can be difficult. Was the person pregnant when, for example, a doctor performed a dilation and curettage, often referred to as D&C, to remove tissue from within a woman’s uterus?

“How do you know for sure that that miscarriage is going to be a complete miscarriage or a looming miscarriage?”

Diane Trombley, a retired nurse who heads Michigan Nurses for Life, said in the case of miscarriage, the baby is already dead. No one kills the baby. Intention is important, she said. “I do not mean any of this is really rocket science. It’s actually very simple.”

What about an ectopic pregnancy?

It occurs when a fertilized egg grows outside the uterine cavity, usually in a fallopian tube, but sometimes in the stomach, cervix, ovary and cesarean section scar, according to the American College of Obstetricians and Gynecologists.

Ectopic pregnancies are never viable. They cannot move or be moved to the uterus. As the pregnancy grows, it can cause the structure where it was implanted to burst or tear, causing major internal bleeding.

Harris said doctors may not want to treat an ectopic pregnancy if there is evidence of fetal heart activity.

The weekend after Roe v. Wade was overthrown, one of Harris’ colleagues was consulted because a patient in a neighboring state where abortion is now illegal could not have her ectopic pregnancy treated.

In the event of an ectopic pregnancy, the woman’s life is definitely in danger, Trombley said. “The treatment for the ectopic pregnancy is to remove what has essentially become a diseased organ.”

About 90% of these occur in the fallopian tube. In surgery for a tubal ectopic pregnancy, the entire pregnancy is removed from a tube or the tube is removed with the pregnancy.

“Any application of an abortion ban that affects those who need treatment for ectopic pregnancies is inappropriate and will definitely cost lives,” reports the College of Obstetricians and Gynecologists.

Would IVF be criminalized?

“I would not think so,” Carroll said. But that will have to be determined by courts, she said.

In her paper, Harris wrote that infertility practices may need to stop providing selective reduction for multifetal pregnancies due to “superovulation or in vitro fertilization.”

“Without multifetal reduction, loss of the entire pregnancy, premature delivery with associated risks of neonatal complications or death, and clinically significant maternal complications are likely,” she continued.

In practice, Dr. Owens performs abortion, labor and childbirth, and antenatal care. She does not do in vitro fertilization (IVF), but said an abortion ban could certainly raise questions about the legality of the procedure in which multiple fertilized eggs are stored and possibly discarded later.

“I think one of the hardest things about these laws is all the ripple effects and implications are not entirely clear,” Owens said. “There can certainly be problems with that.”

The American Society for Reproductive Medicine concluded: “While the overthrow of Roe v. Wade does not necessarily restrict access to assisted reproductive technology (ART) procedures, including in vitro fertilization, the details of state legislation are critical to understand as they are too broadly statutory. language and definitions may, intentionally or not, imply and even prohibit such procedures. This decision and related state action in its aftermath have the potential to severely limit the ability to provide high-quality, patient-centered maternal health care. ”

It examined “trigger laws,” laws designed to take effect with the overthrow of Roe v. Wade, in 13 other states and found that most of them are likely to affect IVF or other ART services.

Like some of the laws analyzed, the first part of Michigan’s statute prohibits the acquisition of a miscarriage for a “pregnant woman,” which is generally defined as a developing embryo or fetus in the body.

Is emergency contraception prohibited by law?

Emergency contraception, often referred to as the Plan B brand, is a medication that women take when they have had unprotected sex and it works by slowing down ovulation. “If you ask, does emergency contraception disrupt an established pregnancy? The answer is no, “Harris said.

Abortion pills, mifepristone and misoprostol work alternately. They have no impact on ovulation, but will disrupt a pregnancy implanted in the uterus, Harris said. To undergo a medication abortion, people first take mifepristone, which blocks progesterone, and prevents the pregnancy from developing. They then take the second medicine, misoprostol, which causes the uterus to contract, bleed and expel the embryo.

“To prevent fertilization, to prevent implantation, even that will not be a miscarriage. But the medication abortion pills will do that, ”Harris said.

Carroll clearly said before conception there is no miscarriage. It becomes difficult when considering the prevention of implantation, but not fertilization. The law requires that the patient be pregnant. “At what stage is it considered a pregnancy?”

There have been arguments, for example, that intrauterine devices, often called IUDs, are abortion drugs, a substance that causes an abortion, in part because they prevent the implantation of a fertilized egg, Carroll said. “And it’s even more complicated here. Because it’s not just about how something could act theoretically, but to prosecute under (Michigan’s ban), you’ll have to say it was meant to act that way. filthy.”

Would it be a crime to advise someone about an abortion or refer someone from the state for an abortion?

Michigan’s Abortion Act of 1931 does not explicitly state that it would be illegal for a physician to refer a patient out of state for an abortion.

It prevents any person from using “any instrument or other remedy whatsoever, for the purpose of thereby obtaining the miscarriage.”

“I think it’s hard to read it to refer to kind of helping someone go somewhere to do something,” Carroll said.

“It is therefore unlikely, but it is difficult to say with certainty.”

Owens referred to other states asking the same question. In Montana, for example, Planned Parenthood allegedly requires proof of residency for medication abortions, although they will continue to perform surgical abortions for patients who are out of state.

Even if Michigan does not immediately ban the referral of patients outside the state for abortion care, Owens said confusion about what is allowed where and fear about the perception of legal consequences could prevent clinicians from providing adequate care.

“When you scare people into providing optimal medical care, how much harm to patients are you willing to accept? And I think that conversation is not happening enough, ”Owens said. “By 02:00 in the emergency room, someone will be worried that they will be charged with a crime because they did the right thing and that is really worrying.”

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