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In early October, Avery Davis Bell learned she and her husband were about to lose the baby they so desperately wanted.
A 34-year-old geneticist in Georgia was hospitalized after repeated bleeding, and she and her doctors know exactly what it takes to manage a miscarriage and prevent a life-threatening infection. They also knew why she didn't receive that care right away.
In an instant, the impact of her state's restrictive laws on abortion care became clear: If Bell had been bleeding from a car accident or a ruptured appendix, doctors could have helped her immediately. If she suffers a miscarriage in Boston, where she will live until 2020, doctors may be called into action. But she had a miscarriage in a hospital in Georgia and had to wait for an operation.
The US Supreme Court in
Most miscarriages happen at home without medical intervention, but cases like Bell's can be treated with the same medications or surgical procedures used to induce abortions.
Thirteen US states They have general or general abortion bans. Many others limit certain points in pregnancy, including Georgia, which limits abortion to the first six weeks of pregnancy. Bell's pregnancy was 18 weeks — too early for her fetus to survive outside the womb — but Georgia passed the cutoff.
Unless her condition worsened, doctors told Bell she would have to wait. Georgia It allows people to wait 24 hours before having an abortion, except for emergency treatment.
Bell turned into a crisis situation.
“I was breathing, recording everything that was going on in my mind, and thinking, 'I just need to get through this,'” Bell said. “I even told my husband, who was very sad when we got this news, 'I love you. We're sorry, but right now I have to go through this medical emergency, and I'm sorry to ask you, but I need you to pull it together until he goes through this surgery.' ”
Bell said. She doesn't blame her doctors at Emory University Hospital in Atlanta. Instead, she blames the law itself.
When Georgia's six-week abortion ban takes effect in 2022, Republican Gov. Brian Kemp He promised pregnant women The state is “ready to provide the resources they need to stay safe, healthy and informed,” he said. But Georgia, which has been around for a long time One of the worst Maternal mortality rates were the lowest in the country Two deaths Pregnant women who cannot access timely medical care or legal abortion.
This state is not the only one facing such issues. Texas passed an abortion ban in 2021, and the maternal mortality rate increased 56 percent from 2019 to 2022, according to an analysis of data from the U.S. Centers for Disease Control and Prevention by the Gender Equity Policy Institute. this year, A woman died at a Texas hospital after being told it was a “felony” to interfere with her abortion, and a pregnant teenager died after visiting Texas to seek care for complications during her third pregnancy. Emergency rooms.
Maternal mortality rates in states with abortion restrictions Between 2018 and 2020, it doubled from states without such restrictions, the 2022 report shows. Commonwealth Fund. The inequities have widened racial and ethnic gaps in health outcomes, as women of color — especially black and Hispanic women — have higher maternal mortality rates overall.
Bell and her husband, Julian, were able to stay in Boston, where she earned a doctorate in genetics and genomics from Harvard University and a bachelor's degree from MIT. But Bell grew up in Georgia, and they wanted to be closer to family when they expanded their own.
They were overjoyed to welcome their first child, a boy, in 2021.
This July, she found out she was pregnant again. When she was 12 weeks old, she told her son that he would soon have a sibling. He was very happy.
“Talk to the baby and hold the baby in my belly every day,” she said.
By September, Bell was having trouble with her pregnancy. Her condition was stable but she was bleeding. Doctors diagnosed a subchorionic hematoma, a condition that causes bleeding between the uterine wall and the amniotic sac. He It usually clears up on its own. But Bell said she has one of those rare cases where she continues to bleed.
Doctors finally advised Bell to rest in bed. She said she only left the house to pick up early and make a routine trip to the doctor.
But in early October, Bell's bleeding worsened and she had to go to the hospital three times in two weeks.
At first, doctors told Bell that the baby was still doing well. At her second visit, they warned that if the bleeding did not stop, it could be too much for the fetus and dangerous for her health.
At one point she passed a blood clot the size of a dinner plate. She took him out of the toilet and put him in a takeout container to show the doctors.
“It was scary,” Bell said.
On October 17, on her third trip to Emory, the doctor was on duty as she delivered her first child. She runs tests and tells Bell that her water has broken and her pregnancy must be over.
“She was with us for a long time, and we hugged,” Bell said. “You know it's hard when you get a hug from your doctor.”
Waiting times and paperwork
Bell was crushed. At 18 weeks of pregnancy, she knew that the fetus could not survive outside the womb.
Her doctor called in a sophisticated family planning specialist to help. Dilation and evacuation are important to control bleeding and to clean the uterus and prevent infection.
But since the fetus still had a heartbeat, the procedure would be an abortion. Georgia law It criminalizes abortion past six weeks unless it is “necessary to prevent the death of the pregnant woman or significant and irreversible damage to a major bodily function.”
“He was telling me, 'Because we're in Georgia, we can't go into surgery right away,'” Bell recalled.
Georgia's 24-hour wait time scared and frustrated her.
“It's really hard because it's an on-demand pregnancy, it's really inevitable and the waiting period that I'm in makes it even harder,” Bell said. “We have not been able to move from crisis to action. We just had to sit in limbo. My fetus is dying, and I'm relieved this second that I think about it, but it might not be in 10 minutes, and that's a time no one should prolong, that limbo.
The law also forced Bell to fill out paperwork, much to her chagrin. It detailed the medical risks of abortion, the viability of the fetus, whether a human has a heartbeat, and financial support if she were to give birth.
“I had to sign a consent form for an abortion that had some dirty language about heartbeats and fetal pain and things that were clearly laid out for scientific reasons,” Bell said.
The hospital moved Bell — still bleeding and in pain — to another facility better equipped to perform the operation, but she will have to wait again until doctors know when to schedule the procedure.
Later that day, tests revealed that the level of hemoglobin, the oxygen carrier in her blood, had reached a critical level, putting her life in further danger. This new sign means that doctors can finally help her.
Bell was grateful that she finally got the care she needed, but she was angry on behalf of her doctors, who were not allowed to use their best judgment.
“My doctor took more than a decade of education after college to be able to navigate those situations, but the law knocked her out,” she said. “Doctors are made to jump through hoops written by old people with no medical knowledge and ideological positions that don't match how biology works.”
Emory University declined 's interview request, but said in a statement: “Emory Healthcare uses consensus medical literature and legal guidelines from clinicians to support our providers in making individualized treatment recommendations consistent with Georgia's abortion laws.” Let the patients we serve be safe and secure, no matter where the patients or physicians live.
Dr. Sarah Prager, from American College of Obstetricians and GynecologistsA professional organization representing more than 26,000 physicians says abortion laws like Georgia's are inhumane.
“You have people with non-clinical weight on medical decisions, which is asinine,” said Prager, who is not involved in Bell's care. “The whole purpose of modern medicine is to prevent disease, so it is wrong to push people to the brink of death and pull them back because of some laws, and if nothing else, we are not always successful.
“It is cruel, and it devalues human life and health,” she added.
There is also the trauma that comes with prolonging the situation. Bell, who had to get another iron injection after the surgery and is now walking again, said it will take some time to heal physically and emotionally.
Eventually, she hopes to create a diary of her ultrasound scans, notes from friends and family, and microprints from the hospital. She couldn't see those yet.
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What's left is a mix of emotions. The whole family is saddened by the loss of the pregnancy. Bell and her husband still hope to have another child. And there is outrage that Georgia's laws extended her painful experience.
“Even if everything goes well, this is still one of the worst times of my life and the hardest time for my whole family,” she said. “Then we will add insult to this law.”
Having family around her and having a background in science made it easier to advocate for her care, she said. Her doctors assured her that they would not allow her to die the entire time she was in the hospital. Treat her like a peer by talking openly and encouraging them to help her. But not everyone has the same situation, and she worries about other people…