After three years and two rounds of in-vitro fertilization, things were finally looking up.
Robin, a 37-year-old project manager who lives in St. Louis County, went in for a routine 21-week ultrasound with her husband this past November. The couple had no idea that something was wrong.
“[The baby] was measuring one day ahead. I had a friend that had a home Doppler that she gave me, and I would listen to the baby’s heartbeat, just to hear it,” she recalled.
As the appointment dragged on, the nurse fell silent, and said she needed to bring in the doctor. Robin’s daughter had developed polycystic kidney disease in the womb. She had to make a heart-wrenching choice, one she hopes remains open to other women, even if state legislators disagree.
“Her kidneys weren’t working, and there was therefore no amniotic fluid and without amniotic fluid she would never develop lungs,” Robin said. “I asked what her chances were, and they said there weren’t any.”
St. Louis Public Radio is only using Robin’s first name to protect her privacy. She and her husband only had a few hours to make a decision: terminate the pregnancy, or wait until she gave birth. Most likely, doctors said, her baby would be stillborn.
“We just felt so strongly that allowing her to be born, to immediately suffer, and to go through the trauma of childbirth… to go into a NICU and be held alive just to die was so inhumane,” Robin said tearfully.
Robin was booked for an appointment to terminate her pregnancy at Barnes Jewish Hospital in St. Louis. Her care was paid for by her health insurance. Providing abortions will put Barnes and other hospitals on the list of providers that may lose a portion of their Medicaid funding for women’s health services, due to a budget amendment passed last year by the Missouri legislature.
Like a bill under consideration in Congress, Missouri’s measure was written with Planned Parenthood in mind. Last spring, after the release of videos purporting to show the sale of fetal tissue by Planned Parenthood, the Missouri legislature moved to eliminate all public funding to the organization. The videos were later discredited.
Rep. Robert Ross, R-Yukon, sponsored a budget amendment to stop the state’s Medicaid waiver program for women’s health services from covering care at any organization that also provides abortions.
“Simple amendment, this stops your tax dollars from being used to fund abortions,” he said on the House floor last spring. Ross did not return requests for further comment.
Under state law, no insurance plans based in Missouri can cover abortions, including Medicaid. The only exception is if the procedure is to save the life of the mother. But pro-life groups argue that any public money that goes to an organization may indirectly subsidize the practice.
“It is a myth that Planned Parenthood provides women’s healthcare services. It is a myth!” said Rep. Diane Franklin, R-Camden, during debate on Ross’ amendment.
Several House Democrats unsuccessfully tried to challenge the amendment.
“Your amendment is taking funds, not from abortions, but from organizations that you think perform abortion,” argued Rep. Michael Butler, D-St. Louis. “If women have complications through pregnancy, and they don’t have a primary doctor, where do they go?”
By kicking Planned Parenthood and other organizations that provide abortions off of the Medicaid program, legislators could have run up against a federal law that gives patients the right to choose their own provider. So Missouri legislators voted to reject $8.3 million in federal funding, and replace it with state money. The program provides pelvic exams, contraception, and other women’s health services to about 100,000 patients who may have to switch their doctor when the rule is implemented.
Last summer, at the start of the fiscal year, state health officials began submitting information to the federal Centers for Medicare and Medicaid Services so they can go forward with these cuts.
Language in a public notice to suspend federal expenditures makes the effect of the legislation clear.
“The Missouri Women’s State-Funded Health Services Program will not cover or pay for services provided by an organization that also provides abortion services,” wrote officials from the Missouri Department of Social Services, before specifying that independent affiliates of organizations that provide abortions would not be disqualified.
Hospitals and clinics will be required to provide a letter of attestation that certifies they do not provide abortions.
“Most abortions in the United States do not need to be done in a hospital. The ones that need to be done in a hospital are the ones where the mother’s medical condition requires that higher level of care,” said Dr. David Eisenberg, an OB-GYN for Washington University in St. Louis.
Eisenberg is one of the doctors who can terminate pregnancies at Barnes Jewish Hospital, where about 150 abortions are performed every year. Generally, Eisenberg said, they’re done because the mother’s life is in serious danger, or the fetus has a severe fetal anomaly and won’t survive. He has seen women in heart failure, or with a condition called pre-eclampsia that can cause heart attacks or stroke.
About four percent of abortions in the United States are done in a hospital, according to the Guttmacher Institute, a research group previously affiliated with Planned Parenthood.
It’s unclear if all hospitals will be included in the cuts. Catholic hospitals, for example, are governed by directives issued by the U.S. Conference of Catholic Bishops.
Doctors in those facilities avoid abortions except in dire circumstances, said the Rev. Charles Bouchard, the senior director of theology and ethics for the Catholic Health Association, based in St. Louis.
“Our position is based on two things; the first one is that even though you can’t prove it scientifically, the embryo is a person from the moment of conception. And that as a person, the embryo’s life is equal in value to the mother’s,” Bouchard said.
Because of that, Bouchard explains, doctors in Catholic hospitals cannot terminate a pregnancy unless it’s the indirect consequence of a different procedure to save the mother’s life — such as a hysterectomy if she’s being treated for uterine cancer.
“Obviously there are crisis cases, when you’re balancing the life of the mother against the life of the child. We do everything we possibly can to protect the life of the mother and not endanger them,” Bouchard said.
Eisenberg, the OB-GYN, worries such patients aren’t given all the information about their risks if they continue a pregnancy.
“Without a doubt, I have taken care of patients who have not been told what their options are,” Eisenberg said. "It bothers me on many levels, because I do think women suffer physically and emotionally. And I worry about the profession of medicine when we allow our own, personal beliefs to cloud our counseling for patients."
Like all women who have an abortion in the state of Missouri, Robin signed paperwork saying she had heard her baby’s heartbeat, seen an ultrasound. She had to wait 72 hours.
At home, she and her husband pulled together a playlist of music they loved, and said goodbye to their daughter, who they named Grace Pearl. The next day, Robin brought the playlist with her to the procedure.
“They promised me they would use an ultrasound to cut her umbilical cord before they did anything else,” Robin said. “So I like think of her as her heart stopped beating, hearing the music that her father and I liked so much.”
Today, Robin is still recovering. She shared her story in a public post on Facebook that was shared more than five thousand times.
“I was just like I have to say something. So people understand that this is something that exists. And that funding is really important,” Robin said. “It needs to be a safe procedure. It needs to be a legal, routine, safe procedure.”
Planned Parenthood is not pursing legal action against this rule in Missouri. According to a timeline set by the Missouri Department of Social Services, the measure could go into effect as soon as March 30.
Follow Durrie on Twitter: @durrieB.
Editor's note: An earlier version of this story misstated the Rev. Charles Bouchard's title.