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After abortion ban, Missouri doctors grapple with the meaning of a ‘medical emergency’

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Jay Fram
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“Medicine, in general, is not really black and white in many circumstances,” said Dr. Jeannie Kelly.

Dr. Jeannie Kelly, a Washington University OB-GYN, is concerned for pregnant patients in Missouri.

After the U.S. Supreme Court overturned Roe v. Wade, Missouri became one of the first states to ban most abortions. There’s an exception in cases of medical emergency, which the state defines as “serious risk of substantial and irreversible physical impairment of a major bodily function.”

Kelly told St. Louis on the Air that the law’s definition lacks nuance.

“Medicine, in general, is not really black and white in many circumstances,” said the associate division director of maternal-fetal medicine at Washington University.

“There are many clinical situations that we are concerned [about],” she added. “The law is vague, and the law is not well defined [regarding] these trickier situations where we're not sure: ‘Is this a medical emergency? Does it qualify as an exception to this abortion ban? Or would we be risking our licenses and we'd be risking jail time if we perform the abortion in this circumstance?’”

The law states that any person who knowingly performs or induces an abortion shall be guilty of a class B felony and that they could face the suspension or revocation of their medical license.

Kelly said that she and her colleagues have been preparing for how to approach medical situations that fall into gray areas — and that they’ve been watching what happens in Texas. That state’s legislature passed a bill that banned abortion after the detection of electric activity in embryonic heart cells, which normally occurs after about six weeks of pregnancy.

“There are some very concerning stories that have come out from our colleagues in Texas. Hospitals, doctors [and] health care systems have sat on really scary cases, like an ectopic pregnancy where the embryo is implanted outside of the uterus,” Kelly said.

In those cases, she said: “There's 0% chance that that pregnancy could be normal. There's 0% chance that a baby can be born from that pregnancy that will survive. And the risk for mom — for a death or reversible bodily harm — is extremely high in that circumstance, unless the pregnancy is removed.”

Knowing what obstetricians and gynecologists in Texas have gone through, Kelly said she and her team made sure to remind themselves of their Hippocratic oath to their patients — while understanding how to follow the new law in Missouri.

Dr. Jeannie Kelly joins St. Louis on the Air

Despite the law’s vagueness about what exactly constitutes a medical emergency during pregnancy, Kelly said she and her team will do everything in their power to take care of their patients.

“This has been an ongoing conversation ever since the leak came out a few months ago,” she said. “We wanted to make sure that we all understood it is still our job, and within the law, to provide care that saves a woman's life and/or prevents bodily harm.”

What questions do you have about gynecological and obstetrics care in the wake of Roe v. Wade being overturned? Tweet us (@STLonAir), send an email to talk@stlpr.org or share your thoughts via our St. Louis on the Air Facebook group, and help inform future coverage on this topic.

St. Louis on the Air” brings you the stories of St. Louis and the people who live, work and create in our region. The show is produced by Miya Norfleet, Emily Woodbury, Danny Wicentowski and Alex Heuer. Avery Rogers is our production assistant. The audio engineer is Aaron Doerr.

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Emily is the senior producer for "St. Louis on the Air" at St. Louis Public Radio.

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