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.

What you should know about Catholic health care:

  • 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

Learn more about Catholic hospitals

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

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  • I conduct public health surveillance in a community with a sole Catholic healthcare provider. One justification for compliance with the Directives in cases of miscarriage management prior to viability is that there haven’t been any documented deaths. However, a lot of morbidity can occur prior to death, which is the most extreme outcome measure. None of the studies done on expectant management or expectant management at home in cases of pPROM measure mental health outcomes. That being said, in all of these studies the women were given a choice of intervention and declined intervention after consent was obtained, which cannot occur when intervention is not an option at a facility. So, this is the first research that I have seen that suggests that a woman’s mental health can be negatively impacted by adherence to the Directives.

  • Darrell:

    @Faith Groesbeck
    Let’s see your sources. I want to see valid links to these “studies” you speak of which have been done on expectant management.

    Feel free to read about a few of the “ethical” handlings of miscarriages by Catholic owned hospitals here:
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636458/

    The way Catholic hospitals avoid taking any blame for these situations is they transfer the patients elsewhere. Can’t even care for their own patients because they can’t handle abortions. Kind of seems like they shouldn’t be in the hospital business AT ALL.

  • Sara:

    The mental health of a patient is most definitely impacted while waiting for an approval from an ethics committee when making the difficult decision to terminate a VERY MUCH wanted pregnancy. I know this because I was one of those patients. I suffered pprom at 19 weeks with fraternal twins. After making the heart wrenching decision to induce labor I was made to wait for an ethics committee to review my decision. Even though I now know that there was no way my babies would have made it, I still feel and will forever feel horrible about that choice. The metal anguish I felt that day was amplified by waiting for someone to approve my decision. Did these people really think that I wanted to go through with this?! I had no choice. Think about what you’re putting people through. If there was a reasonable chance that my outcome could have been different, then by all means debate away. Trust me, my mental anguish is great. Putting people through anymore mental torture is just cruel. All for religion? I believe in God and consider myself a religious person. But something tells me this has nothing to do with God. I think it’s to make sure the hospital is not blamed for making unethical decisions. Ultimately the ethics committee approved my decision. Heres an idea: decide what it ethical BEFORE, instead of putting a patient through any more pain than they are already in.

  • Monika Myers:

    I really appreciate this article. I am also reminded of women who experience ectopic pregnancies which, like molar pregnancies, are not viable. My understanding is that Catholic doctrine only allows removal of the entire tube in the case of an ectopic pregnancy, rather than allowing the use of a medicine that would terminate the pregnancy while preserving the tube for future fertility. I imagine that many Catholic doctors at Catholic hospitals also struggle with this issue, since there is no medical reason for most women with ectopic pregnancies to lose their fallopian tube. Thank you for bringing this important issue to light.

  • Here is a bibliography I compiled on this topic. It includes the article you suggested: http://www.muskegonhealth.net/programs/health/pprom.pdf. When these cases were first brought to my attention, I went to the literature to find our what the established clinical guidelines were. Many show expectant management at home to be safe. My point was that in the research, unlike the cases that we are seeing in our local Catholic hospital, the women are all given a choice between expectant management and induction. In practice her, if it wasn’t for heavy doses of antibiotics, which is inadvisable in the literature for pPROM, and in some cases blood transfusions, more deaths would occur. For some of the women who’ve been denied care and understand why, the worst outcome is the psychological trauma they endure and Lori Freedman’s latest article is the first I’ve seen that suggests that mental health outcomes need to be considered.

    Locally, I rarely see transfer of care. Our tertiary hospital only accepts transfers after viability. In the majority of cases, expectant management at home after a round of multiple antibiotic treatment with instructions for temperature checks every 4 hours is the norm. Unfortunately, the literature shows that only 12% of women in this situation are candidates for expectant management at home. Our local hospital does not have screening criteria in place.

    In terms of Catholic hospitals getting out of the business, that becomes more complicated in a county in which 60% of births of covered by Medicaid. Competitors have already gotten out of the business and no one is stepping up to offer services to our poor, unhealthy population.

  • Ex-Catholic:

    “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” — um, no, it doesn’t. If some Catholics are making that claim, they don’t know what they’re talking about.

  • Dear Ex-Catholic,
    Thanks for pointing out that the language in that sentence isn’t quite precise. Evidence of hemorrhage, pre-eclampsia, or other serious life-threatening problems in addition to infection should also suffice to get the Catholic hospital ethics committee to approve an abortion procedure. This is interpreted from Directive 47 (not by individual or lay Catholics, but by hospital authorities and clergy who control these aspects of care). Read the article for more details: http://www.ansirh.org/_documents/library/freedman_ajob2013.pdf
    Thanks for your comment,
    Lori Freedman

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