SIOUX FALLS, S.D. (KELO) — In the five weeks since the Supreme Court overturned Roe v. Wade, some Sioux Falls doctors have already started to notice changes in care.
The number of requests for tubal ligations and contraceptives has increased according to two Sioux Falls doctors. One Sioux Falls OB/GYN, who wished to remain anonymous, said that in the time since the Supreme Court decision leaked in May, they and their colleagues have seen an uptick in young women seeking tubal ligations, when fallopian tubes are cut, tied or blocked to prevent pregnancy along with more men seeking vasectomies.
The OB/GYN has also seen an increase in patients interested in long-term birth control options like IUDs rather than daily birth control pills.
“And so, they didn’t, weren’t even scheduled to come in for that necessarily, but because of the overturning of Roe, I’ve had a lot more people who are interested in what you call ‘long acting, reversible contraception,’” the OB/GYN said.
Another Sioux Falls physician, who also wished to remain anonymous, has seen an increase in patients looking for referrals for tubal ligations and birth control.
“I’m going through my schedule for today and I actually have three patients who want referrals for tubal ligations,” the physician told KELOLAND News last week.
But the overturning of Roe isn’t just affecting patient concerns. Both the OB/GYN and physician said they are worried about how the current abortion ban in place in South Dakota will affect those providing reproductive care.
Even before the abortion ban took effect, doctors in South Dakota health systems did not provide elective abortion care for patients. Instead, those patients would have to visit Planned Parenthood in Sioux Falls to willingly terminate a pregnancy. But that doesn’t mean abortions didn’t happen in hospitals.
“But abortion care is honestly a part of reproductive care, because pregnancies go wrong, sometimes,” the OB/GYN explained. “Some examples of some we’ve seen in the past are moms with significant cardiac issues, where pregnancy is dangerous.”
The OB/GYN provided examples such as a pregnant woman who might have cardiac anomalies where the risk of death is close to 50/50 or cancer patients who are unable to continue full treatment while pregnant who might have pregnancies terminated to continue care to treat their cancer.
“So, if there’s a patient on dialysis that accidentally gets pregnant, one of the things that we would do to help preserve their renal function, and then potentially their life would be to offer an abortion for that reason, too,” the OB/GYN said.
Before the Supreme Court decision, the OB/GYN said doctors would have performed those procedures without hesitation if that was what the mother wanted. But now, they’re hesitating.
“So, if you have a significant pregnancy complication before a baby can be resuscitated at about, it used to be 24 weeks; now, we actually will resuscitate babies at 22 and 23 weeks, depending on their size. But if you’re 17 weeks and you have a major complication that puts your life at risk, like your water breaks early, or you have hemorrhaging, you know, the standard of care is to offer to end your pregnancy to help save your life,” the OB/GYN explained. “And those are things that right now, we’ve had a few cases already since Roe was overturned, of things like really early preterm labor, or really early rupture of membranes. And now it’s kind of like, okay, can we actually do this?”
Abortion ban impacting care, doctors say
While the law states that abortions can be performed to save the life of the mother, the OB/GYN said at their health system in Sioux Falls, doctors still have questions of what they are legally allowed to do due to what they view as a “vague” law.
“It has kind of a chilling effect, like, you know, I think we can, legally because the mom’s life is at risk,” the OB/GYN said. “But it kind of doesn’t matter what the law actually says. The only thing that actually matters is what OBGYNs across the state think it says, because if you’re not sure, and it’s two in the morning, you’re going to do the thing that’s going to not get you into trouble, you know?”
The OB/GYN said that may leave some doctors waiting until business hours when they can consult with the hospital’s legal team or text colleagues, which has already happened to the OB/GYN several times.
The Sioux Falls physician we spoke to said they personally did not find themselves hesitating to provide contraceptive care or consulting with the hospital’s lawyers more post-Roe. But they worry about how it could impact other physicians who deal with reproductive health and pregnancies more frequently.
“I absolutely think that the abortion ban impacts physicians’ ability to care for patients within that direct physician-to-patient relationship and medical-decision making,” the Sioux Falls physician said.
One thing that has been clear for the doctors at the health system has been messaging around miscarriages, the OB/GYN said. Dilation and curettage procedures (D&C’s) are performed to remove tissue from the uterus following a miscarriage. The doctor said their health system has been clear that miscarriage care should not be impacted post-Roe.
That being said, the OB/GYN added that miscarriages are not always “clear cut.”
“Sometimes the cervix is dilated but there’s still a heartbeat. We consider that an inevitable miscarriage in the first trimester, so we treated it like a miscarriage in the past,” the OB/GYN explained. “This is the area that, especially the ER, had lots of questions about. And it’s still a smidge fuzzy so we have been told it needs to be carefully documented that this is an incomplete miscarriage.”
Governor Kristi Noem’s office has told KELOLAND News that miscarriages will not be impacted by current South Dakota law. She, and other lawmakers, have also been clear that in the case of elective abortions performed in the state, the punishment will fall on the doctors, not the patient.
For the Sioux Falls OB/GYN that causes some concern.
“And it’s terrible that potentially we can be in a position where we’re trying to choose, do we do the standard of care? And what’s right for our patient? Or do we take the risk that we could end up with a felony on our record, and the end of our career,” the OB/GYN asked.
Another area of concern for the OB/GYN is lethal anomalies in fetuses. Often, the OB/GYN explained, those anomalies can’t be detected until 20 weeks.
“In the past, before Roe v. Wade was overturned, some women did choose to continue their pregnancy until the baby died on their own time, or until they delivered and the baby died after birth. But I would say the majority of women don’t want to do that,” the OB/GYN said.
The alternative would be carrying the pregnancy to term knowing that the baby will or has already died, the OB/GYN said. They went on to explain that one patient they had was carrying a baby with a lethal anomaly and wished to end the pregnancy. Due to an issue with insurance, they were unable to do so.
“And so after a month, her insurance covered it because she tried to kill herself,” the OB/GYN recalled. “And you know, it never had to get to that point, you know, it– it was because she didn’t have the option. And I think about her now all the time, because I think now all these patients won’t have this option. There’s gonna be so many patients that won’t have that option.”