WASHINGTON — The Supreme Court’s decision to overturn Roe v. Wade will have a wide-ranging effect on the treatment of numerous medical conditions and diseases, including care for cancers that occur during pregnancy as well as miscarriages.
Restrictive abortion laws will likely make it more difficult for women to get appropriate miscarriage treatments, doctors say, because the procedures used to treat it can be exactly the same as those used to terminate an otherwise viable pregnancy.
Abortion advocates and doctors’ groups have warned about the havoc that a ban could cause for pregnant patients with a wide range of illnesses and ailments. Now that the court has delivered its decision against abortion rights, patients are going to feel the effects, doctors said.
“There is a lot of overlap between abortion care and miscarriage management,” said Holli Jakalow, an obstetrician/gynecologist at Columbia University in New York. Some miscarriages develop slowly and doctors may remove fetal tissue early to reduce risk of complications such as bleeding. But now “until there is no absolute heartbeat we are not going to be be able to intervene in some states.”
Doctors in states with abortion bans or severe restrictions will have to worry about “the legal small print” instead of doing what think they is best for a patient, Jakalow said.
The fast-shifting patchwork of state abortion laws and policies, now subject to change at any time, pose more challenges, as doctors will have to weigh potential and changing legal consequences against their medical judgment.
“If a doctor can’t tell what the law is at the time they are trying to provide care, it has a terribly chilling effect on the medical care that is provided,” said Molly Meegan, chief legal officer for the American College of Obstetricians and Gynecologists, said during a briefing with media.
Doctors in states with abortion restrictions may not receive as much training in procedures that are used in abortions as well as in miscarriage management. A study published in the Obstetrics & Gynecology journal earlier this year found that medical residents who received instruction in abortion care were more likely to feel confident providing treatments for miscarriage.
Cancer care during pregnancy is another area likely to be affected by the Supreme Court ruling. The condition occurs during roughly 1 in 1,000 pregnancies, according to a 2020 review by doctors at the University of California at San Francisco.
Harold Burstein, a breast cancer specialist at the Dana-Farber Cancer Institute in Boston, said that most patients who are pregnant and have cancer can receive the proper treatment while maintaining their pregnancies. But in certain circumstances, the cancer care might cause harm to the pregnancy.
“Sometimes, that involves discussion of abortion, to enable certain kinds of cancer treatment,” Burstein said. “Every busy cancer center will see patients like this every year.”
Katherine Van Loon, a specialist in gastrointestinal cancers at UCSF who helped write the 2020 review, said that pelvic radiation for rectal cancer is one such treatment that can’t safely be done on pregnant women because it would damage the fetus.
“It puts us in a situation of withholding necessary treatments to preserve a mother’s health if we can’t terminate a pregnancy that is interfering with our ability to deliver curative therapy,” she said.
Ideally, doctors treating pregnant cancer patients in situations like these would be able to discuss the risks and benefits of all medical options — terminating the pregnancy and starting treatment, or waiting to treat the cancer until later in the pregnancy or until the baby is born — and let the mother choose. But abortion restrictions curtail that choice.
“This takes mom out of the scenario,” Van Loon said.
