When a pregnancy goes wrong in Catholic hospitals
When a woman chooses a physician for pregnancy care, she’s often visualizing her baby’s birth. Will this doctor have the best skills and bedside manner to help with the delivery? If she’s high risk, does the doctor have extra training for that as well?
Rarely do prenatal patients ask: If something goes terribly wrong, will my doctor be able to provide emergency abortion care?
But perhaps they should.
My colleague Debra Stulberg, MD, and I have conducted a study with ob-gyns working in Catholic hospitals throughout the United States to find out how religious doctrine affects emergency pregnancy care. Catholic hospitals prohibit sterilization, contraception, many infertility treatments and, of course, abortion.
- 1 out of 6 patients in the United States is treated in a Catholic hospital
- Patients are religiously diverse
- Physicians are religiously diverse
- Hospitals are financed by Medicare, Medicaid, tax breaks, and private insurance, not the church
- They are sometimes the only hospital in town
For pregnant women facing serious medical problems, these restrictions can make the experience of pregnancy complications and loss even more difficult and risky.
Our article, “Conflicts in Care for Obstetric Complications in Catholic Hospitals,” recently published in the American Journal of Bioethics Primary Research, reports on the experiences of ob-gyns providing care in Catholic hospitals.
Ob-gyns told stories of being forced by the ethics committees in their Catholic hospitals to send patients elsewhere for abortion care. This includes patients who were already admitted to the hospital such as the cancer patient of a physician we interviewed. He recalled,
“[She] didn’t want to terminate her pregnancy but [her oncologist] told her she needed quite aggressive surgery and chemo…I remember speaking to [the ethics committee], saying… ‘This poor woman is suffering. She’s got a malignancy, she doesn’t want to terminate, she realizes she has to and you’re going to make her go to a clinic?’ And they said, ‘Yes, essentially that’s the case.’”
Another patient arrived at a Catholic hospital bleeding with a twin pregnancy where one was molar and one was not. A molar pregnancy involves the growth of non-viable tissue in the uterus that can potentially become cancerous for the woman. The ethics committee refused to allow her physician to terminate the pregnancy because, according to the clergyman’s Google search, there have been rare cases where the non-molar twin survived to term. The doctor we interviewed recalled,
“They called it a termination, which is a bogus term ’cause you’re not terminating anything but a horrible situation. [They said], ‘You can’t do it here. Take her to another hospital to do it.’…A molar that bleeds, you can’t move her. You’ve got to take care of her there.”
This physician was very upset by the ruling because the standard of care for molar pregnancy is termination due to the risk of cancer, hemorrhage and other health threats.
While information about what exactly takes place in Catholic hospital ethics committee meetings is hard to find, physicians report that they are generally led by clergy without medical training. The ultimate authority on ethics committee disputes is the local bishop.
Doctors in our study also report being restricted from offering timely treatment for miscarriage if the fetus still has a heartbeat, much like the case of Savita Halappanavar, who recently died in Ireland. Even when a miscarriage is inevitable, Catholic doctrine requires that doctors wait until the patient shows signs of infection in order to offer her medication or surgery (an emergency abortion). As one doctor quoted in our article said about his hospital,
“We often tell patients that we can’t do anything in the hospital but watch you get infected, and we often ask them if they would like to be transferred to a hospital that would go ahead and get them delivered before they get infected.”
In contrast, in non-Catholic hospitals, a woman in a similar situation is offered treatment as soon as it is clear that miscarriage is inevitable, in order to prevent infection. In our paper, we call this the preventative vs. curative approach to miscarriage management.
In one story in our article, the doctors didn’t wait for a miscarrying patient to get infected before treating, but they were called before colleagues to defend their course of care. One of the doctors recalled being publicly admonished by “members of the [ethics] committee who were very vocally sort of accusing us of carrying out an elective abortion.”
These are distressing experiences for patients. And they can be distressing for physicians too, who feel their hands are tied when they are unable to care for their patients according to the safest medical practices.
These stories remind us that the hospital is a powerful third party in the physician-patient relationship. And in Catholic hospitals, religious doctrine can be more powerful than the judgments of physicians and safety and preferences of the patients.
Health care advocates are working to push back on the way hospitals use religion to restrict reproductive health care services, or at least to push them to create reasonable alternatives for patients. But given the slow pace at which these changes are made, individual women should know the risks they face when they choose a Catholic hospital for pregnancy care.
Photo of St. Mary’s Hospital in Rochester, Minnesota ©iStockphoto.com/Jodi Jacobson