They call me “The Baby Maker.”
I am a fertility doctor in Dallas, Texas, and I practice at the opposite spectrum of the abortion debate, I help people become parents. My patients, staff, and colleagues could not be more pro-family, pro-pregnancy, pro-life. That is all we do!
Let me welcome you into a day in my life.
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I started the day returning a phone call to a local OB-GYN as I drove to a surgical center to perform a few procedures. She volunteers full-time as director of a conglomerate of clinics that serve indigent patients, and are funded by Christian groups. She wanted me to help her create a protocol to prevent miscarriages in women at risk. She then went on to tell me that their biggest challenge now is caring for women who are getting clandestine abortions or going to other states to have an abortion.
They are returning with infections, bleeding, and pieces of placenta left behind and they are having great difficulty finding practitioners in the Dallas-Fort Worth area to care for these ladies after so much loss and heartache.
I arrived at the surgical center and my first case was a 46-year-old lady desperately trying to conceive via egg donation. She has abnormalities in the uterine cavity, and to correct them I must go through her cervical canal, which was stenosed. To overcome the stricture, we routinely use misoprostol, given in pill form. This medication is also used for gastric ulcers, constipation, and induction of labor. My patient could not use the medication preoperatively, as the pharmacist refused to fill the prescription—something we’re seeing with greater frequency—due to fears that the medication would be used to terminate a pregnancy.
Later, I met with my second surgical patient, who was lucky enough to get her misoprostol filled. However, she shared with me the unfortunate case of her cousin, who was pregnant with a child that did not have a cranium—and the brain was exposed to the outside world.
This tragic situation is one of many that are discovered between 18-21 weeks of pregnancy. But this case was worsened by her inability to care for herself locally, forcing her to travel to New Mexico to end the pregnancy. Texas law gave her no other option.
Then I worked with a young couple that has been trying to conceive for two years through in vitro fertilization (IVF). In “normal” times they would start treatment with simple office-based fertility treatments. However, they were fearful that IVF, the most powerful treatment in our fertility armamentarium, may not be accessible to them if “personhood” laws take effect—which would consider the millions of laboratory-created embryos in this country as “persons,” and thus directly jeopardize access to many of our technological advances, the disposition of embryos, and the ability of embryologists to safely work in this state.
My last patient of the day was pregnant after years trying to conceive. However, the embryo was implanted in the fallopian tube, which cannot sustain the fetus to reach viability. The patient was facing the loss of this pregnancy and possible tubal rupture—which often leads to exsanguination into the abdomen, and if left untreated, even maternal death.
This is an ectopic pregnancy, and when caught early, it can be successfully treated with an injection of methotrexate, minimizing visits to the emergency room, bleeding, loss of a fallopian tube, surgery, and further morbidity.
A major national pharmacy refused to fill the prescription—even though it was sent with a diagnostic code (CPT) for ectopic pregnancy (something we never had to do in the past). The pharmacy’s computer system flagged this CPT code, and the pharmacist said, “no.”
I politely explained to the pharmacist that Texas law specifically allows for the treatment of the mother if her life is in danger, or if it is an ectopic pregnancy, as it was in this case. I was unsuccessful in convincing the pharmacist of the necessity.
I got more frustrated and explicitly asked the pharmacist under what circumstance could the script be filled: When the CPT is for hemoperitoneum (a belly full of blood) is used, or when the patient is unconscious?
Methotrexate is used for many other conditions such as cancers and arthritis. A man with arthritis or lymphoma would not have an issue filling this medication. But how much does a woman have to suffer or be close to death so that we can properly care for them?
Even though all we do is grow families, the new wave of pro-life anti-abortion laws is directly jeopardizing the lives of women, and their ability to become mothers.
This may seem paradoxical, but poorly written pro-life legislation is doing exactly the opposite!
There are now delays in the diagnoses and treatment of women, as the access to common medications that we have used for decades in gynecological and obstetrical care is being significantly limited by fear and misunderstanding of the law. Attorneys are making medical decisions for patients, and healthcare staff are being asked to become attorneys and interpret the law.
The result of this obscene mess is a lack of resources and options for our patients, suboptimal treatment approaches, limitations in their counseling, and a constant fear that a link in the treatment chain will break—such as the dispensing of medications, the ability to perform a procedure, use a surgical facility, or rely on our medical support staff to care for the patient.
In short, women no longer have the full access to modern American medical care they once had. We have accepted in this society a paternalistic approach to female healthcare, limiting their resources to what was available decades ago, or occurs in third world countries.
This is the new America, the land where politicians and attorneys get to practice medicine, dictating who gets to be a parent, avert catastrophic bleeding or organ loss, the epidemiology of a virus and immunogenicity of a vaccine.
