In the wake of Louisiana's abortion ban, pregnant women have been given risky, unnecessary surgeries, denied swift treatment for miscarriages and ectopic pregnancies, and forced to wait until their life is at risk before getting an abortion, according to a new report first made available to NPR.
It found doctors are using extreme caution to avoid even the appearance of providing an abortion procedure.
"We were stunned by just how much regular medical practice for pregnant people has been disrupted," said Michele Heisler, the medical director of Physicians for Human Rights and one of the report's authors.
The report is titled "Criminalized Care: How Louisiana's Abortion Bans Endanger Patients and Clinicians."
It draws on interviews with 30 health care providers and 13 patients conducted in 2023, and was jointly supported by four groups that support abortion access: Physicians for Human Rights, the Center for Reproductive Rights, Lift Louisiana and Reproductive Health Impact.
It's among the most comprehensive research to date showing abortion bans are changing pregnancy care and worsening maternal health. It concludes that Louisiana's ban is impeding a federal law that regulates the provision of emergency health care, and is infringing on reproductive and human rights.
"There are going to be deaths that didn't have to happen. There are going to be severe complications that didn't have to happen," said Dr. Nicole Freehill, a New Orleans OB-GYN interviewed for the report.
Unnecessary C-sections raise alarms
In one of the most extreme examples of how pregnancy care has changed, doctors described cases of women who experienced preterm premature rupture of membranes (when the "water breaks" early in pregnancy, before the fetus is viable). Some of these women were forced to undergo Cesarean section surgeries to empty their uterus and avoid infection, instead of receiving an abortion procedure or medication.
"Which is ludicrous, absolutely ludicrous," said Freehill. "The least safe thing that we do, no matter if it's early in pregnancy or full-term at your due date, is a C-section."
Describing one of these cases, Dr. Michele Heisler with Physicians for Human Rights explained that the C-section was done "to preserve the appearance of not doing an abortion."
The patient wasn't given a choice, she added.
A C-section is major abdominal surgery. NPR consulted three OB-GYNs who were not interviewed for the report, all of whom said a C-section in a case like this is not standard care. Compared to an abortion procedure or an induction, it carries far greater risks for increased hemorrhaging, compromised future fertility, and other complications.
The doctors also added that patients undergoing a C-section in that circumstance would be told that in future pregnancies they couldn't deliver vaginally and risked a ruptured uterus.
"I want to emphasize that this is not what's in the best interest of the patient," said one New Orleans OB-GYN who didn't want her name used because she feared talking publicly could cause her trouble with her employer. "This is what's in the best interest of...the physician in protecting themselves from criminal prosecution."
Doctors face penalties under Louisiana's abortion ban of up to 15 years in prison and $200,000 in fines.
Prenatal care appointments pushed back
In what doctors described as another serious deviation from standard medical practice, OB-GYNs in Louisiana are now delaying routine prenatal care until patients reach 12 weeks of pregnancy — the point at which the risk of miscarriage drops significantly.
One patient interviewed in the report said several different doctors' offices wouldn't see her before 12 weeks. One office told her the abortion ban was "something that's new" and that doctors wanted "to eliminate some of the spontaneous abortions, or miscarriages, that may happen up until that 12-week mark," the patient recounted.
"I think physicians are scared, and so what can we do to decrease our risk that the attorney general is going to come after us?" said Dr. Neelima Sukhavasi, a Baton Rouge OB-GYN interviewed in the report. "And that is probably one of the things that they saw would be easiest."
Delaying pregnancy care into the second trimester can be dangerous for people who might have complications, such as a history of blood clots or an ectopic pregnancy that goes undiagnosed, doctors told NPR. Without treatment, some pregnancy-related problems can lead to birth defects, stroke, heart attack, or even death.
Delays, transfers, waits for illness to get worse
Physicians are also delaying treatment of miscarriage and ectopic pregnancy out of fear of breaking the law, the report found — as previously reported in news stories from states operating under abortion bans. Ectopic pregnancies — when the embryo implants outside of the uterus — are never viable, and they can even be deadly.
One patient with an ectopic pregnancy said her care was delayed so long that her fallopian tubes ruptured.
"I could have died," she said in the report. "I really could have died."
In another case, Sukhavasi had a patient in her first trimester who came to the hospital bleeding and in pain. The patient wanted an abortion procedure called dilation and curettage, or D&C, which uses suction to empty the contents of the uterus and stop the pain and bleeding.
"I know this pregnancy is not going to make it anywhere near survival. And I was stopped from taking her to the operating room," Sukhavasi said.
The woman waited for hours while hospital officials decided if her abortion was allowed. Sukahavasi said it all goes back to fear.
"Institutions don't want the government coming down on them, accusing us of doing something wrong when what we're doing is just providing essential health care that people are coming to us for," she said.
When miscarrying women arrive at ERs in rural areas, those rural hospitals are increasingly transferring patients to urban, specialty hospitals, the report found, to avoid having to treat those patients altogether. But refusing miscarriage treatment could be a violation of the Emergency Medical Treatment and Labor Act, or EMTALA — a federal law requiring emergency medical care.
The doctors described numerous cases in the report in which seriously ill patients were denied abortions until they became so sick that their lives were irrefutably at risk.
These included pregnant women with cancer; patients with heart problems and kidney failure, who were on dialysis and hospitalized; and women who'd experienced life-threatening complications from previous pregnancies and found themselves pregnant again.
In one case, an OB-GYN treating a patient with severe heart failure was first required to prescribe multiple cardiac medicines before being allowed to offer an abortion.
"And I'm thinking, but what if she doesn't want to wait that long because she could have a heart attack and die?" the OB-GYN said. "At what point can you act? How many cardiac meds have to fail?"
Another physician in the report couldn't get their colleagues to agree to an abortion for a patient with a history of multiple C-sections, hemorrhaging and infections in past pregnancies.
"It was a risk" to require the patient to stay pregnant, the physician said, but the woman wasn't yet "at the brink of death."
Some hospitals have even told physicians that they can't give patients any information on how to get an abortion outside of Louisiana — because that advice could be construed as "providing" an abortion.
Louisiana's ban allows for abortion in cases of severe fetal anomalies – but only if those anomalies are on a list of conditions published by the state's health department. Women whose fetuses are diagnosed with severe and even fatal conditions that don't appear on that list are also being told they can't get an abortion, the report found. Doctors said patients who can afford to are traveling out of state for abortions, while those who can't remain pregnant.
Louisiana's maternal health outcomes might get worse
Physicians interviewed in the report and those interviewed separately by NPR agreed that women's health and their lives were being put at risk because of the abortion ban, especially Black and low-income women.
Louisiana already suffers from some of the highest rates of maternal mortality and morbidity in the nation. Black women in the state are more than twice as likely to die as a result of their pregnancy as white women.
Nearly two-thirds of maternal deaths in Louisiana are among low-income women on Medicaid.
Some doctors in the report said they have considered leaving Louisiana. Others warned that a possible exodus of OB-GYNs would exacerbate the state's existing shortage of obstetricians.
Louisiana Right to Life, which helped author Louisiana's ban, declined to comment on the report's conclusions, without being able to read it before its public release on Tuesday afternoon
Its executive director, Benjamin Clapper, told NPR that the law clearly allows for the treatment of miscarriages and that OB-GYNs contacted by his organization have seen no change in miscarriage care as a result of the ban.
Clapper has said previously, in response to claims that the law is harming women's health, that these concerns have been "manufactured" by abortion rights supporters.
The report's authors said they have simply documented the facts on the ground.
"The anti-abortion movement in Louisiana has for decades created a culture of harassment and intimidation of people providing abortion care," said Michelle Erenberg, the executive director of Lift Louisiana. "And so for folks in that movement to now say, well, providers are just overcomplying with the law, or they're misunderstanding the law, no. They are terrified."
Beyond going to prison, she said, doctors fear being harassed or ostracized from the institutions where they work, and the communities in which they live.
"And all of that is a legitimate fear," she said.
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