Media coverage about serious consequences of CO usually only happens when a woman dies or a woman sues. Here are their stories, but there must be many more we never hear about:
Miscarrying woman refused termination, forced to get very sick and suffer through prolonged labour
In early 2017, a woman arrived at Wheaton Franciscan-St. Joseph hospital in Milwaukee, Wisconsin, in labour. She was 18 weeks pregnant with twins. She miscarried one fetus within hours of admission, but the second still had a heartbeat. Because the hospital followed Catholic directives that prohibited termination until the patient hemorrhaged or showed at least two signs of infection (fever of 100.4 or higher, uterine tenderness, rapid heart rate, or rapid fetal heart rate), the woman’s pro-choice doctor, Jessika Ralph, could do little except watch her patient sicken.
After about 10 hours, the patient’s temperature soared to 102 or 103 degrees. Ralph and her team gave the patient medication to induce labour. But Ralph could not administer mifepristone, the most effective drug for such cases. The Catholic hospital didn’t carry the drug due to religious motivations, which needlessly prolonged the woman’s labour.
Although the patient wanted to continue her pregnancy if there was any chance it could be saved, she rapidly sickened. She and her family then pleaded with Dr. Ralph to speed up the process of ending her pregnancy, but Ralph felt powerless. The safest procedure for terminating a second-trimester pregnancy (D&E) was not offered at St. Joseph and no doctor there know how to perform it. For over 24 hours, the patient laboured through painful contractions. She bled heavily, requiring at least one blood transfusion. Her lips and face lost their colour. Finally, she delivered a fetus that had no hope of survival. The patient survived the ordeal.
Read full article: Catholic Rules Forced This Doctor to Watch Her Patient Sicken—Now, She’s Speaking Out. Rewire.
Young incest victim forced to give birth to her father’s child
Andrea was a pregnant victim of incest at 12 years old. In February 2017, her mother went public about the sexual violence Andrea had suffered from her father. “After she told me about what happened with her father, she became extremely anxious and told me she didn’t want to exist in this world any longer because of everything that had happened.” Andrea is depressed, says her mother, barely eating, suffering extreme nausea from the pregnancy and says she does not want to have the baby.
In Costa Rica, it’s legal to terminate pregnancy when the life or health of the woman is at risk, but the lack of a technical protocol that provides legal protection to doctors who perform abortions meant that the medical procedure was never offered. Rather than call for Costa Rican law to be enforced, the media offered a platform for religious figures to voice their opinions. Churches and anti-choice organisations contacted the girl and her mother, trying to convince them not to pursue the idea of terminating the pregnancy. Andrea is being forced to become a mother at 13, giving birth to her father’s child.
Read full article: Incest Case Attests That, In Costa Rica, Abortion Is Legal In Name Only. Huffington Post.
Fact Sheet on Valentina Milluzzo’s Death
November 15, 2016
Information in this fact sheet was compiled from publicly available sources like media reports, statements from the family, and the preliminary official report.
Read the fact sheet: [pdf]
When a Fetal Heartbeat Is More Important, Sometimes Women Die
Oct. 30, 2016, by Silvana Agathon and Lisa Canitano
Read the article: [pdf]
Preliminary Report from the Board of Health, and Critiques
October 24, 2016 (revised Nov 24), by Joyce Arthur
This document contains the preliminary report from the Board of Health in Catania regarding the death of Valentina Miluzzo on Oct 16, in both Italian and English. Following the report are three instructive criticisms that were posted in response to the report, also in Italian and English. Then a critique of the report by Joyce Arthur, showing that the timeline in the report demonstrates medical negligence.
Read the article: [pdf]
Police launch inquiry into death of woman ‘refused’ an abortion by Sicilian doctors
The Guardian, 23, Oct 2016 by Stephanie Kirchgaessner
Valentina’s father: “My daughter screamed in pain, the doctor said he couldn’t intervene.”
Oct. 20, 2016, Catania Italy: Video of interview with Valentina’s father
Source (translated from Italian): [valentinas-father-interview pdf]
Abortion laws under fire in Italy after death of Valentina Milluzzo
dw.com, 20.10.2016 by Elizabeth Schumacher
Italy abortion row as woman dies after hospital miscarriage
Woman suffers serious harm after being denied right to information on serious condition affecting her fetus
Ana (not her real name) was denied information on the serious condition affecting her fetus for almost six weeks. Due to this violation of her right to information, as well as the discrimination she faced in the Santa Lucía de Cartagena Public Hospital in Murcia, she was not able to access abortion services in a dignified way, and as a result suffered serious physical and psychological harm. After the public hospitals in Murcia refused to perform a termination, Ana was forced to travel to Madrid at her own expense to undergo an abortion.
Unfortunately, cases such as Ana’s have been seen across Spain (also see the stories of Paula and Irena). According to data from the Ministry of Health, there are four regions in Spain, including Murcia, whose public health systems did not perform a single abortion in 2014. Women’s Link is suing the health department of the Region of Murcia, Spain, for violating Ana’s rights.
Read full article: Women’s Link Worldwide, March 7, 2017
The Guardian, August 2014, by Henry McDonald
Woman denied abortion in Ireland ‘became pregnant after rape’
A recent immigrant to Ireland (unnamed) was raped in her country before coming to Ireland and became pregnant. She requested an abortion at 8 weeks because she was suicidal, but was refused by a panel even though the new Irish law allowed abortion when there is a risk of suicide. After further denied requests to obtain an abortion and being unable to travel to England, she threatened a hunger strike and was hospitalized at 24 weeks and forcibly hydrated. After a further wait of 1 or 2 weeks to ensure the survival of the fetus, she was subjected to a forced Caesarean section.
Read full article: www.theguardian.com
Miscarrying woman with sepsis refused treatment by Irish hospital, suffers trauma and risk of life
An anonymous Irish woman reported in May 2018 that she had to travel to England for a termination of a miscarrying pregnancy with the same circumstances as that of Savita Halappanavar. She was almost 20 weeks pregnant (when the fetus cannot survive) and said “I had been refused care by my hospital because my baby still had a heartbeat, even though it had no chance of survival.” She continued: “My Irish consultant didn’t seem to fully understand what was wrong with me and my baby. For the previous three weeks what she told me changed each time I saw her. I was first told I was likely to miscarry in the next week. Then I was told the baby would probably have severe brain damage and be physically disabled. The third week I was told the baby would die at birth, as it didn’t have any lungs, and my life was in danger. I was one of the first cases under the new law, and my hospital didn’t want to be the first to do a termination.”
She began to develop painful symptoms of septicemia, and even though abortion is legal in Ireland when a woman’s life is at imminent risk, the hospital refused to treat her. She had to travel to England for a termination with her husband. When examined by a British consultant: “He put the jelly on my stomach for the scan. He was pretty angry when he examined me. He turned and said, ‘Your waters are completely gone. How have the Irish sent you over to us in this state?’ I spent months and months after I returned from Liverpool trying to piece my life back together. I was severely traumatised and was in a constant state of panic. There was a time when I thought I would never get back to feeling normal again.”
‘My circumstances were the same as Savita Halappanavar’s’ – Irish Times, May 16, 2018
A death that shocked a family, a hospital, and a country
Savita Halappanavar, a 31-year-old dentist, died on October 28, 2012 at University Hospital Galway in Ireland of sepsis after she miscarried at 17 weeks. She was denied a termination due to Irish law giving “equal” rights to fetuses and pregnant women, but inadequate care and comments by the health professionals indicate that religious beliefs against abortion may have also been a factor.
Savita went to the hospital with her husband Praveen on Oct 21 complaining about back pain. Her water broke early on the morning of Oct 22 and Savita asked if anything could be done to save the baby. She was told that miscarriage was inevitable. On Oct 23, knowing the baby would not survive, she asked for a termination, and was told it was not legally possible in Ireland while there is a fetal heartbeat. A midwife manager attempted to calm Savita and said the termination could not be carried out because it’s a “Catholic thing”. Over the next day, despite repeated requests for a termination by Savita and her husband – to which her doctor responded by saying the law forbids it and they don’t do terminations because it’s a “Catholic country” (which the doctor later denied saying) – Savita’s condition deteriorated while medical staff failed to properly monitor her while waiting the fetus to die. She had clear signs of infection and sepsis, which her doctor ignored. Finally, the fetal heartbeat stopped and Savita was transferred to the delivery room where she spontaneously delivered a dead baby on Oct 24. By then it was too late – Savita died four days later due to complications of sepsis that had already ravaged her system prior to the delivery.
Savita’s husband Praveen went to the media to protest his wife’s death. He said: “We were always kept in the dark. If Savita would [have] known her life was at risk, she would have jumped off the bed to seek another hospital. We were never told about it. It is horrendous, it is barbaric and inhumane the way Savita was treated in that hospital.” His complaints triggered an inquest, which in 2013 found that “medical misadventure” and mismanagement of Savita’s treatment led to her death. Irish medical staff failed to recognize “increasing risk to the life of the mother”. Irish law was also called into question, as there were no guidelines for doctors to follow as to when an abortion could be done to save a woman’s life. Regardless, medical staff prioritized the fetus over care of Savita, and could have done an earlier termination to save her life without breaking the law.
Abortion in Ireland: The Injustice and Day-to-Day Terror Faced by Countless Women, by Sarah Fisher, Rewire, Nov 28, 2012
Timeline: a death that shocked a family, a hospital and a country, The Journal, Apr 20, 2013
Final Report of Health Service Executive, June 2013
Praveen Halappanavar: ‘Savita’s treatment was horrendous, barbaric and inhumane’, The Journal, April 19, 2013
You Can’t Have it Both Ways: The Interpretation of Catholic Health Policy and the Consequences for Pregnant Women, by Marge Berer, Rewire,
“The doctors’ right to object nearly cost me my life”
El Pais, Nov 9, 2016, Cristina Huete
The Galician public health service in Spain was ordered to compensate a woman €270,000 for her suffering and permanent injuries after a hospital refused to perform an abortion because of “conscientious objection”, even though the fetus was incompatible with life.
“Paula” learned that the fetus she was carrying had a fatal anomaly only seven months into her pregnancy, due to errors during antenatal diagnosis. She was unable to find anyone who would terminate the pregnancy, either in her own town in Galicia or in any other nearby public hospital. Eventually, the Galician public health service, SERGAS, declared that “in order to respect the professionals’ right to objection on moral grounds”, the authorities would pay for termination of the pregnancy in a private clinic in Madrid, by which time she was into her 32nd week of pregnancy.
She had to make the 570km trip to Madrid by by car with her partner. She had been having vaginal pains for some days but was told by the hospital it was just wind. In fact, the pain was due to an irregularity in her uterus, affected by the pregnancy. By the time she arrived at the clinic in Madrid, she was bleeding heavily and had to be transferred to a hospital for an emergency caesarean section to remove the fetus, which died soon after. Her uterus had to be removed to stop the bleeding, so now she is unable to have any more children.
In July 2017, the Galician Health Service was found guilty of intentionally concealing from Paula the fact that her fetus was suffering from severe life-limiting anomalies that included “cri du chat” syndrome, a rare genetic disorder that causes serious mental disability. During the High Court proceedings, it also emerged that her doctors had deliberately delayed the required prenatal diagnostic testing. When she finally got the correct diagnosis, a gynaecologist then delayed authorization for an abortion, claiming that further diagnostic tests were necessary, when in fact they were not. The High Court’s ruling made it clear that what had occurred was a “severe failure of the health system.” The president of the regional government, Albert Nuñez Feijoo, resolved not to appeal the initial decision of the county court and apologized for what had happened, attributing blame to the fact that a very high proportion of doctors in the region are “conscientious objectors” to medical abortions.
“The doctors’ right to object nearly cost me my life”: elpais.com
Read also: www.safeabortionwomensright.org
Compensation was granted but nothing has changed in Galicia, Aug 11, 2017: www.safeabortionwomensright.org
Spain: Health Service held accountable for objectors’ abortion delays and loss of uterus, Oct 31, 2017: ReproHealthLaw Blog
Woman not informed of serious fetal defects at 12-week ultrasound
Nicola (not her real name) went for an ultrasound on 23 October 2012 at 12 weeks of pregnancy. The doctor noticed a lump on the head of the fetus, and didn’t know what it was. She was given an appointment for 2 weeks later (6 November) for another ultrasound. The two doctors said they were following the problem and had a clinical session the next day to evaluate the case and decide on possible actions. On November 7, the doctor told her she had to get an amniocentesis and an early echo-cardiogram. Nobody in the obstetrics service informed her that at the 12-week ultrasound a severe malformation of the fetus was clearly observed. This malformation was diagnosed by a gynecologist as an occipital meningocele, after observing a defect of the cranial occipital skull cap covered by skin and meninges, with observations of arachnoid strips inside the hernial sac and through the spine (and other problems). This was corroborated by 2 other gynecologists and two family doctors when they looked at the 12th week ultrasound. Nicola stated: “I believe that they are not served by this service and that they are negligent because they do not know how to diagnose or because they hide information.”
Source: Claim from Nicola to the Hospital da Costa Burela, 28 December 2012 (translated and summarized from Galician)
Woman denied abortion for fatal fetal abnormality forced to carry to term and suffer multiple rights violations
32-year old Aurora became pregnant in June 2012, after several attempts. In August, she attended a prenatal checkup at the hospital, where her pregnancy was diagnosed with “possible abdominal wall syndrome”. The doctor said they had to wait until the 12th week of pregnancy to be sure, but that if confirmed, the fetus would not survive at birth. The diagnosis was confirmed in the 11th week. The situation plunged Aurora into a state of acute depression accompanied by explosive vomiting that lasted throughout the pregnancy. Aurora requested that a therapeutic abortion be performed (as the law allowed), but her request was denied. Aurora told La Nación newspaper: “He was drowning in my stomach for weeks, with his lungs outside his body, ripped open by my own organs.”
On Dec 17, 2012, Aurora filed a petition with the Supreme Court of Justice of Costa Rica to request an “advancement of her birth” so as not to prolong suffering. Aurora reported multiple violations of her rights when she sought advice on the condition of her pregnancy and the implications for her health. Nevertheless, her appeal was rejected on Feb 22, 2013. Meanwhile, Aurora was hospitalized on Dec 30, 2012 for severe pain and premature rupture of membranes. She gave birth to a fetus that died immediately after a Caesarean section. After this trauma, Aurora suffered from social inhibition, anxiety, and severe emotional detachment.
Read full article: Incest Case Attests That, In Costa Rica, Abortion Is Legal In Name Only. Huffington Post.
Read Spanish source from Center for Reproductive Rights – Aurora Fact Sheet
Ms. Magazine, Spring 2011, by Molly M. Ginty
Kathleen Prieskorn of New Hampshire was three months pregnant when her amniotic sac ruptured. The nearest hospital had recently merged with a Catholic hospital, and because her doctor could still detect a fetal heartbeat, he wasn’t allowed to perform a uterine evacuation. Instead, she had to travel 80 miles in a taxi to the nearest hospital that would perform the procedure. Her doctor paid the $400 cab fare. “During that trip, which seemed endless, I was not only devastated, but terrified,” Prieskorn remembers. “I knew that if there were complications I could lose my uterus—and maybe even my life.”
The Ms. Magazine story also briefly describes two other incidents involving Catholic hospitals in Arizona and New York, which risked two women’s lives by refusing care. One was suffering a miscarriage and the other an ectopic pregnancy.
Read full article: Ms. Magazine
Vita Donna, April 2013
Objecting physician sentenced to one year in prison for denying care
In the province of Pordenone, a woman became very ill after a voluntary surgical abortion. A midwife on duty feared hemorrhage and called for the intervention of the gynecologist on duty. But the doctor appealed to conscientious objection and refused to help, even after repeated orders given by telephone from the primary physician, who finally had to go to the hospital to take urgent action to save the patient.
The objecting gynecologist was denounced and sentenced by the Sixth Criminal Section of the Court of Cassation to a year in prison, for failure to treat the patient and leaving her at risk of bleeding. The Supreme Court held that conscientious objection relates only to the actual performance of an abortion, not for care before or after. The gynecologist lost her licence and can no longer practice medicine.
April 2013 sources in Italian:
Law 194, the Supreme Court: “Objecting doctor cannot refuse care after abortion” (Legge 194, Cassazione: “Medico obiettore non può rifiutare cure dopo aborto”)
Abortion: One year in prison for objecting physician who denied care (Aborto, un anno di carcere al medico obiettore che ha negato le cure)
The Guardian, Feb 2016, by Molly Redden
Abortion ban linked to dangerous miscarriages at Catholic hospital, report claims
Tamesha was 18 weeks pregnant with her third child when her water broke. She rushed to the nearest hospital, which is operated by Mercy Health Partners in Muskegon, Michigan. Because she was only 18 weeks along, the pregnancy was not viable. Ending the pregnancy would have been the safest course of action, but the hospital’s religious policies forbade it—so they gave Tamesha two Tylenol and sent her home without telling her that there was virtually no way she could give birth to a healthy baby. When Tamesha returned the next morning, she was bleeding, in severe pain, and showing signs of an infection; again, she was turned away. Even after she returned a third time, in excruciating pain, the hospital staff began filling out the discharge paperwork. It was only when Tamesha began to deliver that the hospital provided care. The baby died within hours.
Tamesha later sued the hospital but has lost at 2 levels so far, because courts said they couldn’t interfere with religious practice.
FIVE other women had similar experiences at the same hospital between 2009 and 2010. They all suffered prolonged miscarriages, severe infections, and emotional trauma. Staff had compromised their lives and health in order to uphold religious directives against inducing delivery when a fetal heartbeat is present. None of the women were more than 24 weeks pregnant and all showed signs of life-threatening sepsis. One of the women was given Tylenol for her infection and sent home – twice – where she miscarried by herself on the toilet. Another woman spent three days in the hospital and eventually required additional surgery.
Read full article: www.theguardian.com
Tamesha’s own story: www.theguardian.com
Tamesha’s case is also discussed in the 2016 ACLU report (page 9): Health Care Denied: Patients and Physicians Speak Out About Catholic Hospitals and the Threat to Women’s Health and Lives, as well as the 2018 report Bearing Faith: The Limits of Catholic Health Care for Women of Color (pg 27/28).
Broadly, April 18, 2016, Matteo Congregalli
Abortion Is Legal in Italy, But It’s Almost Impossible to Get One
Valentina Magnanti was admitted to a hospital in the Lazio region of Italy for an abortion in the 5th month of pregnancy because her fetus was non-viable. But she was left alone in pain for 16 hours and forced to deliver in a bathroom without any medical aid because the doctor on duty was a conscientious objector. Valentina’s problems with refusal to treat began before she even got pregnant. She said: “I have a rare and terrible transmissible genetic disease, but in theory I can have children, so for me there was no access to assisted fertilization, pre-implantation diagnosis. This unjust law only allows me to get pregnant and find out later if the child I’m expecting is sick, doomed. Leaving me free to choose to have an abortion in the fifth month, almost a birth”.
She and her husband decided to terminate, but her gynecologist refused to hospitalize her, and it took several attempts to find a willing doctor who could admit her. Then she had to wait two days until the doctor was on duty, as all other doctors at that hospital were objectors. The doctor started the abortion and treated her well, but then left when her shift was over. The doctor who was supposed to continue the care never came to see her on the basis of conscientious objection. Valentina was left in excruciating pain for 16 hours and no doctor or nurses would help, even with repeated requests from her husband. Also, when Valentina was in the early stages of her abortion, a small group of people entered her hospital room holding copies of the Bible. They accused her of being a sinner and a murderer.
Read the article (in English): broadly.vice.com
Article in Italian: «Costretta ad abortire in bagno perché era cambiato il turno»: www.corriere.it
Illinois Woman Denied Emergency Abortion at Two Hospitals that Adhere to Catholic Directives
Mindy Swank and her husband were looking forward to the birth of a much-wanted second child. At 17 weeks, hydrocephaly was discovered, but they still wanted to continue and provide their baby with the best medical care. However, Mindy’s water broke prematurely at 20 weeks and they learned through testing that the fetus would not survive. Waiting for a natural miscarriage would put her at risk of infection and hemorrhaging, but the Catholic hospital in Illinois where Mindy had received the genetic testing would not perform an abortion while there was still a fetal heartbeat.
For nearly two weeks, Mindy struggled with the emotional strain of continuing a doomed pregnancy. She woke up bleeding one morning, rushed to her local hospital with her husband to complete the miscarriage, but that hospital refused to induce labor, saying she wasn’t sick enough for them to end her pregnancy, but to come back if she was bleeding more or had a fever. Mindy returned five times over the next five weeks, bleeding and in discomfort, but was repeatedly turned away. The entire time, Mindy was unaware that this secular hospital also adhered to Catholic Directives. They never told her about other options or where she could go for an abortion. Finally, when she was 27 weeks pregnant and severely hemorrhaging, they induced labor. The baby died shortly after delivery.
American Civil Liberties Union. Health Care Denied: Patients and Physicians Speak Out About Catholic Hospitals and the Threat to Women’s Health and Lives. May 2016.
The State Journal-Register. Mindy Swank: SB 1564 is reasonable compromise between patients’ rights, providers’ faith. July 26, 2016.
Full Frontal with Samantha Bee: Extended Interview: Mindy Swank. 7:11 minutes. Oct 27, 2016.
CHOICE/LESS – Mindy Swank: How Could You Treat Women So Poorly in the Name of God? – Podcast with Mindy, 16 minutes.
Aborto Inchiesta, Reviewed by EC, 5 March 2015
Abortion among the objectors: the Modern Inquisition (Abortire tra gli obiettori. La moderna inquisizione)
In the fifth month of pregnancy, Laura Fiore of Naples discovered she was pregnant with a child with Down syndrome. Aged 39, unemployed, and a mother of a 10-year old, she decided to have an abortion as allowed by Law 194. But at the Polyclinic II in Naples, after a shift change, doctors and medical staff claimed conscientious objection and refused to assist Laura as required by law. Instead, she was put on a path of “torture” and ill-treatment, including psychological mistreatment. She was left to deliver alone, with the fetus still alive attached to the umbilical cord. Only after screaming did Laura receive care.
Even though there was no chance of life, doctors decided to resuscitate the fetus, which survived four days. Then they decided to bury him in a cemetery. They put heavy pressure on both parents, both in a state of shock, to acknowledge the birth and provide a name. Laura was plunged into serious psychological trauma by the health professionals, who inflicted great guilt onto her. It took three years of psychoanalysis for her to get out of it, as well as writing a book “Abortion between objectors”, to expose what was happening in Italy – the indifference and political ferocity (usually male) against women’s freedom as permitted by law.
Watch Laura’s story: (video in Italian): L’aborto come tortura nell’Italia medievale: la testimonianza di Laura Fiore
Read Laura’s book: “Abortire Tra Gli Obbiettori: the Modern Inquisition”:
Woman was refused tests and information on the serious conditions of her fetus
Irena (not her real name), a Brazilian citizen living in Spain, became pregnant in 2007 but suffered numerous bleeding episodes. She was followed at the Hospital de Burela, but doctors did not investigate the cause or take any action beyond recommending rest. At her consultation at week 20 and again at week 30: “I asked my doctor what the bleeding meant, and she assumed I was a prostitute, and that what happened to me was a result of ‘my job’, without asking me if I was a prostitute. I told her that I did not work as a prostitute, but in the domestic service and that I had a stable relationship … without ever having relations that could give rise, as she insinuated, to this bleeding.”
The doctor’s treatment of her was always disrespectful, and the doctor refused to do the test to listen to the fetal heartbeat, or give her any information on the condition of the fetus. When questioned, the doctor would say, “Don’t teach me my job, I know it very well,” or tell her to be quiet so she could do her work. When Irena asked the doctor whether she had done the analysis for fetal anomalies, the doctor answered yes, but claimed to have found nothing, and advised Irena to fly back to Brazil.
Irena’s son was born at 8 months’ gestation with heart disease and he needed an immediate operation. He was diagnosed with Tetralogy of Fallot and Goldenhar Syndrome (respectively, a congenital heart defect; and a rare congenital defect characterized by incomplete development of the ear, nose, soft palate, lip, and mandible). The doctors asked Irena if anyone had told her during the pregnancy that her fetus had heart disease, and if they had done all the tests. She was told that both heart disease and Tetralogy of Fallot were detectable through prenatal tests, including the test of the fetal heart, which she had requested in vain from her doctor. Irena’s son also has a mental capacity of 40%, needs another operation on his heart when he’s older, and will need surgical corrections for life. His life is and will be full of limitations due to heart and bone problems, among many others.
Source: Irena’s Claim to the Galician Health Service, 2013 (translated, summarized, paraphrased from Spanish)
Woman repeatedly denied termination despite health issues and fatal fetal abnormality; forced to suffer
Ana, a 26-year old Costa Rican woman, found out in Feb. 2007 that her 6-week pregnancy was at risk, and she was diagnosed with a fetal pathology incompatible with life. Despite being plunged into a deep depression, doctors refused to terminate her pregnancy even though it’s legal in Costa Rica to terminate pregnancy when the life or health of the woman is at risk. She became suicidal in the months that followed, and her health deteriorated. In her fifth month of pregnancy, she had to be hospitalized again and was referred to a psychiatrist, who determined that the pregnancy exposed her to a risk of death by suicide, and recommended that health authorities terminate the pregnancy.
Ana repeatedly requested termination of the pregnancy, but her requests were denied and ignored, despite knowledge of her health issues. She was subjected to mistreatment by staff, who even made fun of her situation. Her fetal pregnancy was diagnosed with occipital encephalocele, but the medical staff of the public hospital where she was treated (with the exception of the clinic director, who recommended termination of pregnancy), ignored the danger that the pregnancy posed to her life and health.
In June 2007, Ana’s mother filed an action before the Constitutional Chamber of the Supreme Court of Justice of Costa Rica, invoking the rights to life and health of her daughter, but the court rejected her petition. On June 30, 2007, Ana endured 7 hours of labour for a baby girl that was already dead. To this day, Ana suffers from depression, anxiety attacks, chronic diarrhea, and social inhibition. She also had a tubal ligation in 2013 just to avoid any possibility of a future experience like this.
Raped Peruvian Teen Jumps Out of Window, Then Denied Abortion
L.C. was 13 years old and living in an impoverished region near Peru’s capital city of Lima. Starting in 2006, she was raped repeatedly by a 34-year-old man. When she discovered she was pregnant, he denied that the child could be his, so in desperation, she tried to commit suicide by jumping from a window. But she didn’t die. Instead, she lay on the ground for hours, paralyzed. When she was finally found and taken to the hospital, doctors refused to operate because she was pregnant, but also refused her family’s petition for a therapeutic abortion.
Abortion in Peru is legal when the woman’s life is at risk, or to “prevent grave and permanent damage to a woman’s health,” which was clearly the case with L.C. Because of the severity of her injuries, L.C. eventually suffered a miscarriage, but it wasn’t until several weeks later, and four months after she was told that she needed surgery, that she finally received the spinal procedure she needed. It was too late – the surgery had little to no effect and she remains paralyzed to this day.
In 2011, L.C. won a case brought by the Center for Reproductive Rights. The United Nations Committee on the Elimination of Discrimination against Women (CEDAW) ruled that Peru must amend its law to allow women to obtain an abortion in cases of rape and sexual assault; establish a mechanism to ensure the availability of those abortion services; and guarantee access to abortion services when a woman’s life or health is in danger.
Read more: Raped Peruvian Teen Jumps Out of Window, Then Denied Abortion
L.C.’s story (video, 5 min): LC: I Have To Tell What Happened To Me, by Center for Reproductive Rights
2011 Decision: L.C. v. Peru
Thirteen-year-old rape victim refused legal abortion, forced to give birth and suffer complications
As a consequence of rape, X, a thirteen-year-old child, became pregnant. She was refused a legal abortion by health service providers and subsequently by the justice system, which refused to recognize her right to access a legal abortion despite her compliance with the legal requirement to file a criminal complaint. X gave birth via an emergency caesarean section with complications. She was not treated for an STI (gonorrhea), which she caught from the man who attacked her, and she suffered from psychological trauma from the sexual violence and the mistreatment she was subjected to by the health system. During this time, she attempted to commit suicide on three occasions. The girl and her mother (XX) were subjected to harassment and attacked on a number of occasions due to the criminal charges made against the aggressor, which only intensified when the baby was put up for adoption.
Women’s Link Worldwide requested precautionary measures before the Inter-American Commission of Human Rights to protect the girl and her mother from the risk of immediate and irreparable damage and violation of the rights to life, right to personal liberty, honor and dignity, right to equality, rights of the child and furthermore, the violation of a State’s due diligence rights to prevent, investigate and prosecute violence against women. The IACHR granted the precautionary measures requested and recommended that her right to mental and physical well-being be guaranteed and that protection be provided as required. It is the first time in which the Inter-American Commission granted precautionary measures in a case related to the denial of a legal abortion.
Women’s Link Worldwide: “Colombia, 2011-08-17, X and XX v. Colombia, precautionary measures”
Rape victim with cognitive disability denied legal abortion, forced to have clandestine abortion
LMR attended a special school in Buenos Aires because she had the cognitive functioning of an 8-to 10-year-old. At nineteen, LMR was raped, allegedly by her uncle, and became pregnant. She qualified for a legal abortion under Argentina’s exception for victims of rape who have a mental disability. But as a result of the obstinacy of hospital officials and interference by religious groups, LMR was denied an abortion at a public hospital and ultimately resorted to a clandestine termination.
LMR’s mother filed a communication against Argentina before the U.N. Human Rights Committee. In 2011, the Committee held that Argentina had violated LMR’s rights to equality and non-discrimination, to privacy, and to be free from cruel, in human, and degrading treatment. Crucially, the Committee found that Argentina’s failure “to guarantee LMR’s right to a termination of pregnancy … when her family so requested, caused LMR physical and mental suffering, constituting a violation of article 7 of the Covenant. The Committee was persuaded that the state’s denial of abortion, as distinct from the rape and pregnancy itself, caused sufficient psychic suffering to constitute cruel, inhuman, and degrading treatment. The Committee deemed the rights violations particularly serious given “the victim’s status as a young girl with a disability.”
Source: Reckoning with Narratives of Innocent Suffering in Transnational Abortion Litigation, by Lisa M. Kelly, Chapter 14 of the book Abortion Law in Transnational Perspective (2014), pg 303-326.
Dying mum begged docs to abort baby
Ms B died of catastrophic heart failure because of a high-risk pregnancy that should have been aborted. In 2005, her sister filed a complaint with the New Zealand Health and Disability Commissioner, alleging negligent care by the hospital. Ms B had requested a termination after being told her heart condition could compromise the pregnancy and her life, but she had been either persuaded by staff that the risks were small, or that it was (by 21 weeks) too late for the termination to be legally performed. Her sister stated that Ms B “did not want to be an incubator” and had wanted the baby to take his own chances. She added that Ms B did not believe that she would survive the pregnancy and wanted it terminated to give her the opportunity to live.
Yet, both Ms B and her fetus died. Apparently, on the basis that her pregnancy had been wanted, her doctors never discussed the option of termination with her. They downplayed her deteriorating condition and ignored her request for an abortion, intent on trying to save her and the pregnancy instead. The Commissioner’s report on the death does not mention “conscientious objection” or whether the doctors were objectors, but the report shows the same suspicious pattern found in the cases of Savita (Ireland) and the two Valentina cases from Italy. Doctors failed to offer or discuss termination, did not pay attention to her stated wishes/concerns and emotional state, and her family complained that her wishes for a termination were disregarded.
Doctors Let Woman Die Rather Than Harm Her Fetus
Jezebel, 10/08/10 by Anna North
A Polish woman (known as “Edyta” or “Y”) died because doctors repeatedly refused to provide adequate treatment for her colon condition, with some citing CO and claiming that the treatments might harm the fetus. Her condition deteriorated and four months later, Edyta died of sepsis after miscarrying a dead fetus. Edyta’s mother filed a case at the European Court of Human Rights, but lost in 2012. The court claimed a lack of direct evidence linking Edyta’s death with the negligent care.
However, the court completely overlooked these facts:
Woman forced to carry doomed pregnancy to near-term because of CO and legal restrictions
Severina is a farmer from the small city of Chã Grande in Brazil, married with a 4-year old son, with few resources. On October 20, 2004, she was four months pregnant with an anencephalic fetus, and had just been admitted to the hospital to undergo a legal abortion. But that very day, the Supreme Court cancelled a 4-month old court injunction that had authorized terminations of anencephalic pregnancies. Severina was sent home, unable to get her abortion. She spent the next three months going from courts to hospitals and back to courts, trying to find someone to help her. But many doctors in Brazil refuse to perform abortions because they are afraid to be known as abortionists, believe they could be sued, or have a moral or religious conscientious objection.
Finally, Severina obtained authorization from a judge, but the anesthetists at the hospital where she was referred for an abortion refused to assist her on religious grounds. Severina waited again, and trekked from one hospital to another. Finally, she was assisted by a volunteer anesthetist from a private clinic who agreed to help perform the abortion in a public hospital. Since she was near-term at that point (Jan 2005), labour was induced and she gave birth to a stillborn baby. The entire ordeal was tortuous for Severina and her family.
Cadernos de Saúde Pública, Secular state, conscientious objection and public health policies, by Débora Diniz, Sept 2013.
Severina’s Story, Documentary film, 22 mins (Uma História Severina)
Ciência & Saúde Coletiva, Legal Abortion Services in Brazil – a National Study, by Alberto Pereira Madeiro and Débora Diniz, , Feb 2016
9 Year-Old Rape Victim Denied Legal Abortion for Weeks
Rosa was 8 when she was raped in November 2002 by a neighbour. She was living with her parents in a farming town in the central highlands of Costa Rica because her parents had illegally crossed the border to harvest sugarcane and coffee. She became pregnant, but even though abortion to protect a woman’s health is legal in Costa Rica, social workers persuaded the family that Rosa should carry the child to term, failing to inform them about the serious risks to their child if she brought a pregnancy to term.
It took a week to convince Costa Rica to issue a passport allowing the family to go back to Nicaragua – where at the time, abortion was legal to protect a woman’s life. But Nicaragua’s ministers of health and family services urged the family to let Rosa give birth, and the Catholic Church promised to provide full care and housing for the infant. The family was worried that nine months of pregnancy would kill their only daughter, and requested a medical consultation to comply with Nicaraguan law. The state-sponsored panel of doctors decided that either an abortion or a continued pregnancy carried severe risks. (In fact, full-term pregnancy is far riskier.) The family was given a choice, and Rosa and her parents opted for an abortion. The family went to a private hospital, where Rosa was turned away, crying, after doctors refused to treat her. Meanwhile, the government threatened to prosecute anyone who helped her. Three private doctors separately contacted the women’s group and offered to provide the abortion on condition of anonymity. The next day, Feb. 20, the women’s group took Rosa and her parents to a private clinic where she took the pill that induced the abortion. There were no medical complications.
Source: Girl, 9, in Abortion Rights Furor, March 23, 2003, Los Angeles Times
Woman with likely fetal anomaly denied prenatal examination and abortion
Center for Reproductive Rights, 2008
A pregnant woman (“R.R.”) was repeatedly refused diagnostic care after a routine sonogram detected a cyst on the fetus’s neck. Genetic tests were repeatedly stalled, preventing her from obtaining timely information on the health of the fetus and hindering her from seeking a legal abortion within the time limit. The child was subsequently born with Turner syndrome. (Poland has a restrictive law, but abortion is legal in cases of fetal abnormality.) The case “R.R. v Poland” went to the European Court of Human Rights, which ruled in 2011 that Poland violated Article 3 (the right to be free from inhuman and degrading treatment) and Article 8 (the right to respect for private life) of the European Convention on Human Rights.
Source: Center for Reproductive Rights
Teenager with anencephalic fetus denied abortion, forced to give birth and suffer
K.L., a 17-year-old, was pregnant with an anencephalic fetus, which severely compromised her life by endangering her physical and psychological health. Although Peruvian abortion law permits abortion when the life or health of the woman is in danger, K.L. was denied an abortion by hospital staff and had to deliver the baby and breastfeed her for the four days she survived. K.L. said that the experience of being forced to carry the fetus to term and seeing “her daughter’s marked deformities and knowing that her life expectancy was short” as akin to an “extended funeral.”
The Center for Reproductive Rights filed a complaint with the UN Human Rights Committee, arguing that what K.L. endured was a clear violation of international standards prohibiting violence against women, and constituted cruel, inhuman and degrading treatment by state officials. On November 17, 2005, the UN Human Rights Committee rendered its decision, establishing that denying access to a legal abortion in the case of K.L. v. Peru constituted a violation of the International Covenant on Civil and Political Rights. The ruling specifically establishes violations to the right to be free from cruel, inhumane, and degrading treatment (Art. 7), privacy (Art. 17), and special protection of the rights of a minor (Art. 24), among other things.
KL v. Peru (United Nations Human Rights Committee) Center for Reproductive Rights
United Nations Human Rights Committee decision, Nov 22, 2005.
Polish women denied a legal abortion for health reasons went nearly blind as result
Alicja Tysiac was repeatedly refused an abortion despite suffering from myopia. The pregnancy created a serious risk that she would lose her eyesight. But she was refused again, despite finally getting the required permission under law. Unable to afford an illegal abortion, she was forced to carry to term, resulting in a serious deterioration of her eyesight and a risk of eventual complete blindness.
Alicja took her case to the European Court of Human Rights. In 2007, the court held in a 6 to 1 vote that there was a violation of Article 8, Right to private life. She was awarded 25,000 euros for non-pecuniary damage and 14,000 euros for costs and expenses.
13-year old Mexican Rape Victim Denied Abortion Due to CO
Paulina Ramírez Jacinta was 13 years old when she was raped in 1999 and subsequently denied a legal abortion. She was subjected to repeated interference by state officials, doctors, and priests, who all tried to persuade her out of having an abortion. Paulina finally got authorization for an abortion, but just minutes before the procedure, a doctor warned Paulina’s mother that her daughter could suffer a fatal hemorrhage or be left sterile – even though Paulina was still in the first trimester. Overcome with fear, including the fear that the doctors “would do it badly on purpose”, Paulina’s mother refused to sign the authorization and the abortion was canceled. At age 14, Paulina gave birth to a son in April 2000.
In 2002, the Center for Reproductive Rights and two Mexican human rights groups filed a petition with the Inter-American Commission on Human Rights, alleging violations of Paulina’s guaranteed rights under Mexican law, as well as her rights to physical and psychological integrity and health. In 2006, a landmark settlement was reached with the Mexican government, which agreed to pay reparations to Paulina, provide her and her son significant compensation for health care and education, and issue a decree regulating guidelines for access to abortion for rape victims.
New York Times – Rape of Mexican Teenager Stirs Abortion Outcry
Women’s News – Rape of Mexican Teenager Stirs Abortion Controversy
Global Human Rights Watch: Paulina: Violation of Abortion Rights in Mexico
Center for Reproductive Rights: Paulina Ramírez v. Mexico (Inter-American Commission on Human Rights)
From Bearing Faith: The Limits of Catholic Health Care for Women of Color
Miscarrying woman almost dies after being denied termination at Catholic hospital
Laurie Bertram Roberts was twelve weeks pregnant when, fearing that she was experiencing a miscarriage, she rushed to the only hospital in her community, a Catholic facility. After examining her, the doctors told her to go home, rest, and return if she started to bleed. When she began bleeding heavily the next day she returned to the hospital. This time, providers performed an ultrasound and told Roberts that she was, in fact, having a miscarriage and that the fetus would not survive. Despite this, her attending doctors told her that they could not do anything to help her because the fetus still had a heartbeat. Laurie was sent home once again.
At home, Laurie continued to experience heavy bleeding and eventually lost consciousness. “I was on the phone with my mother when I passed out at my husband’s feet,” Laurie recalled. “All I can remember is honestly thinking this can’t be how I die.” Laurie was transported back to the same hospital a third time by ambulance. Finally, unable to detect a fetal heartbeat, the hospital provided Laurie with treatment for her miscarriage. At the time, Roberts was 18 years old, uninsured, and a low wage worker, so each visit imposed a significant financial burden. The experience nearly cost Laurie her life.
She only learned later that the hospital was subject to the “Ethical and Religious Directives for Catholic Health Care Services”, promulgated by the U.S. Conference of Catholic Bishops. Catholic hospitals generally do not inform patients they are receiving sub-standard care and that better options are available.
Read about Laurie on pg 6-7 in the report: Bearing Faith: The Limits of Catholic Health Care for Women of Color, by Kira Shepherd et al., 2018, Public Health Solutions.
More info at Jackson Free Press (2012)
Women’s health and lives are frequently put at risk in American Catholic hospitals, but only a few cases are publicized. (We count 24 so far). In addition to the U.S. cases of Mindy, Tamesha, Kathleen, Lauren, and Dr. Ralph’s patient on our list:
- Four cases (beiside Tamesha’s) are described in the The Guardian article (2016): Abortion ban linked to dangerous miscarriages at Catholic hospital.
- Six cases are described in the American Civil Liberties Association report (2016): Health Care Denied: Patients and Physicians Speak Out About Catholic Hospitals and the Threat to Women’s Health and Lives.
- One case is described in the American Civil Liberties Association report (2013, page 14): Miscarriage of Medicine: The Growth of Catholic Hospitals and the Threat to Reproductive Health Care.
- One case is described in AJOB Primary Research (2013): Conflicts in Care for Obstetric Complications in Catholic Hospitals.
- Three cases are described by the National Health Law Program (2010): Health Care Refusals: Undermining Quality Care for Women.
- Four cases are described in the American Journal of Public Health (2008): When There’s a Heartbeat: Miscarriage Management in Catholic-Owned Hospitals.
Excerpts are below (names and dates are mostly unknown).
2016 Guardian excerpts:
The woman inside the ambulance was miscarrying. That was clear from the foul-smelling fluid leaving her body. As the vehicle wailed toward the hospital, a doctor waiting for her arrival phoned a specialist, who was unequivocal: the baby would die. The woman might follow. Induce labor immediately.
But staff at the Mercy Health Partners hospital in Muskegon, Michigan would not induce labor for another 10 hours. Instead, they followed a set of directives written by the United States Conference of Catholic Bishops that forbid terminating a pregnancy unless the mother is in grave condition. Doctors decided they would delay until the woman showed signs of sepsis – a life-threatening response to an advanced infection – or the fetal heart stopped on its own.
In the end, it was sepsis. When the woman delivered, at 1.41am, doctors had been watching her temperature climb for more than eight hours. Her infant lived for 65 minutes.
This story is just one example of how a single Catholic hospital risked the health of five different women [including Tamesha] in a span of 17 months, according to a new report leaked to the Guardian.
The women were all experiencing a rare pregnancy complication in which the membranes surrounding the fetus rupture too early. When that happens before the fetus is viable, the rupture leads to a miscarriage.
All five women, the report says, had symptoms indicating that it would be safest for them to deliver immediately. But instead of informing the women of their options, the report says, or offering to transfer them to a different hospital, doctors – apparently out of deference to the Mercy Health Partners’ strict ban on abortion – unilaterally decided to subject the women to prolonged miscarriages.
As a result, the report claims, several of the women suffered infection or emotional trauma, or had to undergo unnecessary surgery.
None of the women in the report were more than 20 weeks pregnant – which is several weeks before the fetus can survive outside the womb. And all five women showed signs of infection, the report says, such as an elevated temperature or heart rate.
One of the women described in the complaint was given Tylenol for a potentially deadly infection and sent home – twice – where she miscarried by herself on the toilet. Another woman, the report says, spent three days in the hospital and eventually required additional surgery.
Yet staff never informed any of the women that there was an alternative to natural miscarriage – immediate delivery – or that immediate delivery is a safer option for women showing signs of infection, the report says. One woman told Groesbeck that even when she asked medical staff to deliver her infant, they refused.
One woman arrived at the hospital after seeing a fetal limb in her toilet. Staff dilated her, causing “a bulging bag of waters”, but refused her request to break her water and begin delivery, the report says.
“The patient was forced to wait over eighteen hours, while dilated, to complete the miscarriage naturally, resulting in retention of the placenta (a leading cause of maternal hemorrhaging and death) and additional, and potentially unnecessary, surgical intervention to remove it,” the report says. Later, a test of the placenta was positive for infection.
Another woman arrived in the early stages of miscarriage with an elevated temperature and heart rate, the report says. After a natural miscarriage, that woman also required surgery to remove the placenta – which also tested positive for acute infection.
2016 ACLU excerpts:
1. Maria (a pseudonym), a health care professional and mother of two in Washington State, was six to seven weeks along in her second pregnancy when she began experiencing heavy vaginal bleeding. She knew she was miscarrying and sought emergency care at the Catholic hospital where she was then working. Although she was aware of the hospital’s religious affiliation, her insurance coverage extended only to that hospital, and she could not afford thousands of dollars in costs to go elsewhere. Maria’s physician explained that the pregnancy was no longer viable and that her uterus needed to be evacuated in order to stop the bleeding. But, because the Directives prohibit an abortion if the fetus still has cardiac activity, her physician advised “expectant management,” i.e., waiting to see if Maria’s body would complete the miscarriage on its own.
The hospital staff delayed performing an abortion for hours while they attempted to verify through ultrasound that the fetus did not have a heartbeat, as required by the Directives. Finally, after seven hours, the hospital completed the miscarriage. By then, Maria’s iron levels were so low that she needed a blood transfusion. It was not without consequence. All blood transfusions carry risks, such as blood-borne infections and allergic reactions. But what happened to Maria was particularly dangerous. She was transfused with blood carrying Kell antigens and developed anti-Kell antibodies. Because her husband was Kell positive, this meant that their next pregnancy would be at risk for sudden fetal demise. When Maria became pregnant again several years later, she and her husband were terrified throughout that she would suddenly lose the pregnancy. Thankfully, their baby survived. But Maria and her family could have avoided significant emotional trauma if the Catholic hospital had provided her with the care she needed without hours of needless delay.
2. Dr. Rupa Natarajan was working in a Catholic hospital in New England when she encountered a 19-year-old pregnant woman experiencing preterm premature rupture of membranes at 17 weeks. The pregnancy was doomed, and the patient was getting very sick, so Dr. Natarajan determined that the best course would be to perform an abortion. But the hospital prohibited her from doing so. The patient was admitted but not treated, and over the next day, her temperature and heart rate climbed. By the time Dr. Natarajan could arrange to have her transferred to another hospital to save her life, the patient’s fever had reached 104 degrees. (5-minute video of Dr. Natarajan discussing the case)
3. Another OB-GYN on the East Coast recalled, “We had a woman experiencing preterm premature rupture of membranes at 16 weeks, but there was still a fetal heartbeat. The patient had to look into going elsewhere to get care because we weren’t permitted to deliver her. This puts a burden on the patient to go to a new doctor and have to relive everything [all] over again. Because of the delay in getting to another provider, the patient ended up delivering the [umbilical] cord at home—when the membranes rupture so early in pregnancy, sometimes the cord can be delivered first.
4. Dr. David Eisenberg recalled that “the sickest patient I ever cared for during my residency” was a young woman denied care at a Catholic hospital outside of Chicago, Illinois. Her water had broken well before the fetus was viable, but the hospital refused to take steps to hasten delivery even though everyone knew the fetus could never survive. By the time she was transferred to Dr. Eisenberg’s hospital 10 days later, she had a fever of 106 degrees and was dying of sepsis. She survived, but she suffered an acute kidney injury requiring dialysis and a cognitive injury due to the severity of her sepsis. She spent nearly two weeks in the hospital before being transferred to a long-term care facility. “I clearly remember sitting in her ICU room after her [uterine] evacuation, wondering if she would make it through the night,” Dr. Eisenberg recalled. “To this day, I have never seen someone so sick—because we would never wait that long before evacuating the uterus. Expediting the delivery is the right thing to do in such situations, always regardless of the religious affiliation of the hospital.”
5. Another OB-GYN told the ACLU about a patient she treated at a secular hospital in New England. The patient had previously been evaluated at a local Catholic hospital after she started bleeding around 12 weeks into her pregnancy. The Catholic hospital performed an ultrasound and found that the patient had an abnormal pregnancy “with placenta coming out of her cervix,” but because there was a fetal heartbeat, they told her she would have to wait. When the patient presented at this doctor’s hospital a week later, she was hemorrhaging and severely anemic from her blood loss over the past week. The medical team at the secular hospital performed emergency surgery and was just barely able to avoid the need for a hysterectomy—but the patient had to stay in the intensive care unit and needed transfusion of seven units of blood during her hospital stay. None of this would have been necessary had the Catholic hospital provided appropriate care when the patient first presented.
6. Dr. Colleen Krajewski, an OB-GYN in Pennsylvania, recalled a patient whose water had broken at the very beginning of her second trimester. She went to the hospital closest to her, which happened to be Catholic. Although it was apparent to all that the (much desired) pregnancy had no chance of survival, the patient was left in a hospital bed for two days to passively wait for a spontaneous miscarriage. The patient was devastated that she was losing the pregnancy, and her trauma was compounded each time the hospital staff came to check if there was still a fetal heartbeat. The treating physicians petitioned the hospital’s ethics committee to intervene, but the request was denied. The patient was eventually transferred to Dr. Krajewski’s hospital, which provided the appropriate care. Dr. Krajewski observed, “the hours-long, middle-of-the-night transfer added to the patient’s experience of fear and abandonment.”
2013 ACLU excerpt:
In 2010, a woman who was 15-weeks pregnant with twins arrived at the Sierra Vista (Arizona) emergency department after miscarrying one of the twins at home. The remaining fetus had a heartbeat. The doctor who examined her recommended that the pregnancy be terminated, given the low chances of a successful pregnancy and the risks of attempting to continue the pregnancy, including severe hemorrhaging and infection. The physician recalled, “The patient and her husband were, of course, upset by the situation, but decided to proceed with the treatment.”
The physician and staff then began routine preparations to complete the miscarriage. But the hospital was subject to Catholic Directives. A hospital administrator intervened and ordered the physician to transfer the patient to avoid violating the Directive against abortion. The patient was sent by ambulance to another hospital 80 miles away where she received the care she needed.
“It was a very gut-wrenching thing to put the staff through [and to] put the patient through, obviously,” recalled the attending physician. Another obstetrician felt misled by the hospital administration. “We were told that we wouldn’t have a problem with dealing with miscarriages … and it turned out not to be true.”
2013 AJOB excerpt:
A patient presented to the emergency room at a Catholic hospital with a molar pregnancy, for which the standard care is evacuation of the uterus. It was a twin pregnancy, with one healthy-appearing baby and the other a typical mole. Dr. P told the patient what her risks were. “She didn’t want to carry the pregnancy further but by the time she reached that decision, she was about 16 weeks gestation. And she had vaginal bleeding so of course she now goes to the hospital … And then you can’t do anything while she’s there [in the Catholic hospital], you can’t help her end the pregnancy in a hospital setting that’s safer.”
The ethics committee refused permission to end the pregnancy. Another doctor, Dr. L., said: “The clergy who made the decision Googled molar pregnancy.” Based upon this search, ethics committee members ruled, “There’s a possibility that she could actually have a viable pregnancy [because] there have been cases where a child was born.” Thus, the ethics committee identified treatment of this molar pregnancy as equivalent to abortion. Dr. L. said: “They called it a termination, which is a bogus term because you’re not terminating anything but a horrible situation.”
The patient was transferred out for care, despite her bleeding, and despite the fact that terminating a bleeding molar pregnancy is safer in the hospital setting due to a high risk of hemorrhage.
2010 National Health Law Program excerpts:
1. Carla, who lives in eastern Oklahoma, thought she had the flu. Her family doctor referred her to an Obstetrician/Gynecologist (OB/GYN) who discovered she was pregnant and that she had a large mass growing on her uterus. Carla’s youngest child was already 16, and she decided to have an abortion, but when she went to the abortion clinic she was told that she needed to have the mass removed before she could have the abortion. Then her encounter with health care refusals began. The OB/GYN refused to remove the mass because it would endanger the pregnancy. The anesthesiologist in the practice group refused to give her any drugs that would harm the pregnancy. At this point the mass was shutting off her colon and bladder. Eventually Carla found a doctor an hour and a half away in another city, but due to the substantial delay, he had to remove her uterus, a procedure that would have been unnecessary if the abortion had been performed earlier in her pregnancy. Carla and her family were left with $40,000 in medical bills.
(NHLP reference: Story collected as part of the Heartland Abortion Regulation Project; PI Weitz, approved by the Institutional Review Board of the University of California, San Francisco, #H11760-29203, data on file)
2. Dr. Smits was a physician at St. Mary’s hospital in a large Eastern city. The patient was 19 weeks pregnant and her membranes had ruptured. The fetus was not yet viable and the patient was septic as a result of PROM. Dr. Smits and the patient wanted to end the pregnancy to save the woman’s health, but the hospital ethics committee refused to approve the termination because the fetus still had a heartbeat. Dr. Smits was giving the woman medications to keep her blood pressure up and using a cooling blanket to keep her temperature down. As Dr. Smits said, “this woman was dying before our eyes.” And still the ethics committee refused to approve the termination. The patient was in ICU for ten days, and nearly died. The fetus died in utero. The woman had substantial internal bleeding, and developed pulmonary disease, resulting in lifetime oxygen dependency.
(NHLP reference: Freedman L. Willing and unable: doctors’ constraints in abortion care: University of California, Davis, Retrieved October 12, 2009 from Dissertations & Theses @ University of California. Publication No. AAT 3329612; 2009)
3. Dr. Brill described another doctor at the hospital at which he worked. The patient had placental abruption, where the placenta separates from the uterus and puts the patient at extreme risk for internal bleeding. If left untreated, the patient may need transfusions or even bleed to death. The treating physician was a “fundamental Christian.” The patient was 20 weeks pregnant. The physician refused to terminate the pregnancy. Instead he tried to stop the bleeding and to stop the labor. She continued to bleed. A week or two later, she spontaneously aborted, but not until she required several blood transfusions.
(NHLP reference: Freedman L. Willing and unable: doctors’ constraints in abortion care: University of California, Davis, Retrieved
October 12, 2009 from Dissertations & Theses @ University of California. Publication No. AAT 3329612; 2009.)
2008 American Journal of Public Health excerpts:
Intro: Obstetrician–gynecologists working in Catholic-owned hospitals described cases in which abortion was medically indicated according to their medical judgment but, because of the ethics committee’s ruling, it was delayed until either fetal heartbeats ceased or the patient could be transported to another facility. Dr P, from a midwestern, mid-sized city, said that at her Catholic-owned hospital, approval for termination of pregnancy was rare if a fetal heartbeat was present (even in “people who are bleeding, they’re all the way dilated, and they’re only 17 weeks”) unless “it looks like she’s going to die if we don’t do it.”
1. In another case, Dr H, from the same Catholic-owned hospital in the Midwest, sent her patient by ambulance 90 miles to the nearest institution where the patient could have an abortion because the ethics committee refused to approve her case.
“She was very early, 14 weeks. She came in … and there was a hand sticking out of the cervix. Clearly the membranes had ruptured and she was trying to deliver… . There was a heart rate, and [we called] the ethics committee, and they [said], “Nope, can’t do anything.” So we had to send her to [the university hospital]… . You know, these things don’t happen that often, but from what I understand it, it’s pretty clear. Even if mom is very sick, you know, potentially life threatening, can’t do anything.”
2. Dr B, an obstetrician–gynecologist working in an academic medical center, described how a Catholic-owned hospital in her western urban area asked her to accept a patient who was already septic. When she received the request, she recommended that the physician from the Catholic-owned hospital perform a uterine aspiration there and not further risk the health of the woman by delaying her care with the transport.
Because the fetus was still alive, they wouldn’t intervene. And she was hemorrhaging, and they called me and wanted to transport her, and I said, “It sounds like she’s unstable, and it sounds like you need to take care of her there.” And I was on a recorded line, I reported them as an EMTALA [Emergency Medical Treatment and Active Labor Act] violation. And the physician [said], “This isn’t something that we can take care of.” And I [said], “Well, if I don’t accept her, what are you going to do with her?” [He answered], “We’ll put her on a floor [i.e., admit her to a bed in the hospital instead of keeping her in the emergency room]; we’ll transfuse her as much as we can, and we’ll just wait till the fetus dies.”
Ultimately, Dr B chose to accept the patient to spare her unnecessary suffering and harm, but she saw this case as a form of “patient dumping,” because the patient was denied treatment and transported while unstable.
3. Some doctors have decided to take matters into their own hands. In the following case, the refusal of the hospital ethics committee to approve uterine evacuation not only caused significant harm to the patient but compelled a perinatologist, Dr S, now practicing in a nonsectarian academic medical center, to violate protocol and resign from his position in an urban northeastern Catholic-owned hospital.
“I’ll never forget this; it was awful—I had one of my partners accept this patient at 19 weeks. The pregnancy was in the vagina. It was over… . And so he takes this patient and transferred her to [our] tertiary medical center, which I was just livid about, and, you know, “we’re going to save the pregnancy.” So of course, I’m on call when she gets septic, and she’s septic to the point that I’m pushing pressors on labor and delivery trying to keep her blood pressure up, and I have her on a cooling blanket because she’s 106 degrees. And I needed to get everything out. And so I put the ultrasound machine on and there was still a heartbeat, and [the ethics committee] wouldn’t let me because there was still a heartbeat. This woman is dying before our eyes. I went in to examine her, and I was able to find the umbilical cord through the membranes and just snapped the umbilical cord and so that I could put the ultrasound—“Oh look. No heartbeat. Let’s go.” She was so sick she was in the [intensive care unit] for about 10 days and very nearly died… . She was in DIC [disseminated intravascular coagulopathy]… . Her bleeding was so bad that the sclera, the white of her eyes, were red, filled with blood… . And I said, “I just can’t do this. I can’t put myself behind this. This is not worth it to me.” That’s why I left.”
From Dr S’s perspective, the chances for fetal life were nonexistent given the septic maternal environment. For the ethics committee, however, the present yet waning fetal heart tones were evidence of fetal life that precluded intervention. Rather than struggle longer to convince his committee to make an exception and grant approval for termination of pregnancy, Dr S chose to covertly sever the patient’s umbilical cord so that the fetal heartbeat would cease and evacuation of the uterus could “legitimately” proceed.
4. Dr. G also circumvented the ethics committee in her southern Catholic-owned hospital. She opted not to check fetal heart tones or seek ethics committee approval when caring for a miscarrying woman for fear that documentation of fetal heart tones would have caused unnecessary delays. This led to conflict with the nurse assisting her.
“She was 14 weeks and the membranes were literally out of the cervix and hanging in the vagina. And so with her I could just take care of it in the [emergency room] but her cervix wasn’t open enough … so we went to the operating room and the nurse kept asking me, “Was there heart tones, was there heart tones?” I said “I don’t know. I don’t know.” Which I kind of knew there would be. But she said, “Well, did you check?” … I said, “I don’t need an ultrasound to tell me that it’s inevitable … you can just put, ‘The heart tones weren’t documented,’ and then they can interpret that however they want to interpret that.” … I said, “Throw it back at me … I’m not going to order an ultrasound. It’s silly.” Because then that’s the thing; it would have muddied the water in this case.”
Dr G’s main concern was sparing the patient extended suffering during loss of pregnancy. She disregarded the authority and protocol of the hospital ethics committee by not checking for fetal heart tones, which, she believed, would have led to significant delay in the inevitable treatment.