The Hell of Providing Health Care in a Post-Dobbs America
In her 32 years as an advanced heart failure and transplant cardiologist, Mary Norine Walsh has seen very sick patients and many deaths. “We’re not like orthopedists who only see one in their entire career,” says Walsh, a physician at a Catholic hospital system in Indianapolis and the former president of the American College of Cardiology. Among those very sick patients are pregnant people. Over the decades, Walsh made caring for these types of patients her specialty. She became known for it, and began to receive referrals from other providers for whom pregnancy was too challenging a complication.
Walsh describes pregnancy as “nature’s stress test.” A person’s blood volume more than doubles, which can worsen preexisting conditions and expose countless new ones, such as heart disease. For instance: If a woman develops peripartum cardiomyopathy, a rare type of heart failure, she is in danger of her heart muscle weakening—a condition that could threaten her life, even in future pregnancies. Though cardiovascular issues affect only a small percentage of pregnancies, they are responsible for more than half of postpartum maternal deaths in the United States, making them the leading cause of death among pregnant people.
So when Walsh meets with sick women who are of reproductive age, she brings up contraception. If a patient is already pregnant, Walsh raises the idea of abortion. “The usual recommendation that we have with a very high-risk cardiac condition is a termination,” she says. Without one, says Walsh, her patients could die. Since Walsh doesn’t perform abortions herself, she refers women to a maternal-fetal medicine specialist to receive further care and discuss options, including termination. Walsh has spent years developing her expertise to save women’s lives—a specialty of extraordinary value given that most cardiology studies have been done on men. In some cases, her patients successfully go on to deliver babies, navigating complicated heart conditions with her help. In others, they come back to her pregnancy free, having avoided a possibly lethal health crisis.
But after the Supreme Court’s Dobbs ruling nullified the nearly 50-year-old Constitutional right to an abortion and handed the responsibility for its regulation back to the states, what was often a black and white decision to protect the life of the mother is now a grueling calculus of legal risk for doctors like Walsh.
https://www.motherjones.com/politics/2023/06/abortion-dobbs-health-care-doctors/
Very much worth reading all the way through.
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