ATLANTA — Some doctors say they struggled to navigate medical exceptions to Georgia abortion restrictions that were in place until last week, sometimes delaying treatment and increasing risks to pregnant patients.
The stricter law, which went into effect July 20, prohibited abortions after fetal cardiac activity is detected, usually about six weeks into a pregnancy. It contained exceptions in cases of rape, incest or complications that threaten the life of the pregnant person or render the pregnancy futile.
A Fulton Superior Court judge struck the law down Tuesday, but the state has appealed the ruling.
Four doctors who work at various hospitals and clinics in the metro area that provide abortions told The Atlanta Journal-Constitution they dealt with medical complications that presented legal gray areas, most commonly women whose water broke before fetuses were likely viable.
“There’s not this line in the sand where people go from totally fine to actively dying,” said Dr. Nisha Verma. “It’s a continuum.”
A fetus is generally considered to be viable outside the womb, with major medical intervention, after around 24 weeks of pregnancy. In fewer than 1% of pregnancies, a patient’s water breaks before that point, although a fetal heartbeat continues.
The doctors interviewed by the AJC said they were not sure whether they could terminate those pregnancies under the fetal viability exception because of patients who manage in rare cases to delay labor for weeks after their water breaks and deliver babies that survive.
All four said they were not aware of any deaths in metro Atlanta as a result of denied abortions while the law was in effect.
The Georgia Obstetrical and Gynecological Society and the Medical Association of Georgia did not respond to requests for comment for this article.
The day after the state law took effect in July, Cary Perry, then-president of Georgia’s OBGYN association, told the AJC, “People are in a state of grayness. People don’t know how to make a move.”
Most women, when their water breaks before the fetus is likely viable, want abortions to head off the infection or hemorrhage likely to follow, and a surgical abortion is the fastest way to empty the uterus for patients who risk infection, said Dr. Megan Cohen, medical director of Planned Parenthood Southeast, and an abortion provider at other metro Atlanta facilities.
When Georgia’s “heartbeat law” was in effect, she said doctors were not able to perform abortions while the fetus had a heartbeat until patients showed signs of those complications, and even then, doctors were not sure how early they could intervene.
Cohen and Verma said they were called to deal with those complications, sometimes known as “incomplete miscarriages,” about once a week. Two other metro Atlanta doctors, who did not want to be named, said they faced similar situations.
It is unclear how often Georgia patients with medical complications bypassed local doctors to travel to states with looser restrictions.
Verma and Cohen are both vocal opponents of the state’s abortion law. Verma criticized it in September testimony to the U.S. House Oversight and Reform Committee, while Cohen slammed it in August at a state Democratic Party event. The two other doctors requested anonymity to avoid identifying their employers or patients.
Cohen said her incomplete miscarriage cases were most commonly resolved when patients developed infections and went into labor. Infections left untreated too long can lead to sepsis and death, and doctors said they aren’t trained to wait for sick people to get sicker before intervening.
The doctors said they also were unable to intervene quickly for a handful of pregnant patients with heart conditions that become life threatening later in pregnancy but were not posing an immediate risk at the time. A couple of patients were able to get abortions after waiting at least a week for additional documentation from obstetricians, Cohen said.
Cohen said she had to refuse abortions to about two patients every month who said they were raped but did not want to file police reports as the law requires.
Cohen and Verma said they also know of two patients whose fetuses had lethal genetic conditions but were denied abortions until the genetic anomalies could be seen on an ultrasound. Cohen said that was not reliably possible until about 18 to 20 weeks of pregnancy.
Doctors unsure of how to interpret the exceptions could seek an opinion from the state attorney general, said Emily Matson, a Rome-based attorney who chairs the board of the Georgia Life Alliance, an anti-abortion group.
“I think the overall effect of this law is, there’s a second consideration about this decision that’s being made, and our hope is that children’s lives are being saved,” said Matson, speaking before the law was overturned last week.
Doctors did not request interpretations from Attorney General Chris Carr while the law was in force, said spokeswoman Kara Richardson, noting that is not the role of the state AG office.
“Our office serves as legal counsel to the executive branch of state government,” Richardson said. “Doctors would reach out to their hospital or practice’s legal counsel for interpretations, if needed.”
Since the U.S. Supreme Court overturned constitutional protections for abortion in June, state laws concerning the procedure have fluctuated around the country.
Georgia’s “heartbeat law” placed it in a unique position, with other states permitting the procedure until later stages of pregnancy or banning it at conception.
It is unclear how many Georgians took advantage of rapidly growing networks that provide abortion pills, without prescriptions, from distributors in other countries. Two of the most popular shippers, Austria-based Aid Access and Mexico-based Las Libres, did not return emails from the AJC seeking comment.