Doctors struggled to care for some patients under Georgia’s abortion law

A fetus is generally considered viable outside the womb when major medical intervention is required 24 weeks gestation. In less than 1% of pregnancies, a patient’s waters rupture before this point, even though the fetus’ heartbeat continues.

Doctors interviewed by the AJC said they weren’t sure they could terminate these pregnancies under the fetal viability exception because, on rare occasions, patients manage to delay labor for weeks after bladder rupture and give birth to surviving babies.

All four said they were not aware of any deaths in Metro Atlanta as a result of denied abortions while the law was in effect.

The Georgia Obstetrical and Gynecological Society and the Medical Association of Georgia did not respond to requests for comment on this article.

The day after the state law went into effect in July, Cary Perry, then president of Georgia’s OBGYN association, told the AJC: “People are in a gray state. People don’t know how to move.”

Most women, if their waters rupture before the fetus is likely to be viable, want abortions to prevent the infection or bleeding likely to follow, and a surgical abortion is the quickest way to empty the uterus for patients who are at risk of infection, said Dr. Megan Cohen, medical director of Planned Parenthood Southeast and an abortion provider at other Metro Atlanta facilities.

When Georgia’s Heartbeat Law was in effect Effect, she said doctors were not able to perform abortions while the fetus had a heartbeat before the patients showed signs of these complications, and even then the doctors did not sure how soon they might intervention.

Cohen and Verma said they were called out about once a week to deal with these complications, which are sometimes referred to as “incomplete miscarriages.” Two other Metro Atlanta doctors, who asked not to be named, said they had experienced similar situations.

It’s unclear how often Georgia patients with medical complications bypassed local doctors to travel to states with looser restrictions.

Verma and Cohen are both vocal opponents of the state’s abortion law. Verma criticized it in September in testimony before the US House Oversight and Reform Committee, while Cohen criticized it at a state event hosted by the Democratic Party in August. The other two doctors asked for anonymity so as not to be able to identify their employers or patients.

Cohen said her cases of incomplete miscarriages most often resolved when patients developed infections and went into labor. Infections left untreated for too long can lead to sepsis and death, and doctors said they are not trained to wait for sick people to get sicker before intervening.

Doctors said they were also unable to intervene quickly in a handful of pregnant patients with heart conditions that become life-threatening later in the pregnancy but posed no immediate risk at the time. A few patients were able to have abortions after waiting at least a week for additional records from obstetricians, Cohen said.

Cohen said she had to refuse abortions every month to about two patients who said they had been raped but didn’t want to report it to the police, as the law requires.

Cohen and Verma said they also know of two patients whose fetuses had fatal genetic conditions but were denied abortions until the genetic abnormalities were seen on an ultrasound. Cohen said that this is only reliably possible in the 18th to 20th week of pregnancy.

Doctors are unsure how to interpret the exceptions seek an opinion from the attorney general, said Emily Matson, a Rome-based attorney who chairs the board of the Georgia Life Alliance, an anti-abortion group.

“I think the overall effect of this law is that there is a second thought to this decision that is being made and our hope is that children’s lives will be saved,” Matson said, speaking before the law passed last week was repealed.

While the law was in effect, the doctors did not request interpretations from Attorney General Chris Carr, spokeswoman Kara Richardson said, noting that that was not the role of the state AG bureau.

“Our office serves as legal counsel to the executive branch of the state government,” Richardson said. “Physicians would contact their hospital or practice legal counsel for interpretations, if necessary.”

Since the US Supreme Court overturned constitutional protections for abortion in June, state laws regarding the procedure have fluctuated across the country.

Georgia’s “Heartbeat Law” put it in a unique position, as other states allow the procedure until later stages of pregnancy or ban it at conception.

It’s unclear how many Georgians are using fast-growing networks selling abortion pills without a prescription from vendors in other countries. Two of the most popular mailers, Austria-based Aid Access and Mexico-based Las Libres, have not responded to emails from the AJC seeking comment.