Louisiana Doctors Are Performing Risky C-Sections to Avoid Liability Under State’s Abortion Ban

Louisiana’s total abortion ban has completely altered how many doctors in the state are providing care to pregnant people, per a new report from Physicians for Human Rights, the Center for Reproductive Rights, Lift Louisiana, and Reproductive Health Impact, first reviewed by NPR on Tuesday. Louisiana’s abortion ban threatens abortion providers in violation with up to 15 years in prison and $200,000 in fines, and consequently, doctors are trying to avoid “even the appearance” of abortion, per NPR—sometimes at the expense of pregnant patients’ safety. 

Through interviews with 30 health care providers and 13 patients conducted in 2023, the reproductive health groups found Louisiana doctors are increasingly performing C-sections for medical emergencies and nonviable pregnancies, even though this is riskier than performing a simple abortion. Doctors said they’ve done this in cases when patients suffer from preterm premature rupture of membranes, a condition that occurs when someone’s water breaks early in pregnancy before the fetus is viable. In one such case, Dr. Michele Heisler of Physicians for Human Rights told NPR that a C-section was done “to preserve the appearance of not doing an abortion.”

Dr. Nicole Freehill, a New Orleans OB-GYN interviewed for the report, called this practice “absolutely ludicrous,” explaining: “The least safe thing that we do, no matter if it’s early in pregnancy or full-term at your due date, is a C-section.” Several OBGYNs interviewed by NPR (but not interviewed for the report) told the outlet that C-sections for nonviable pregnancies are not standard care and come with a greater risk of hemorrhaging, impaired future fertility, and other complications. When doctors provide the emergency C-section, they explain to the patient that for future pregnancies, they can no longer deliver vaginally and are also at risk of a ruptured uterus. An unnamed OBGYN told NPR, “I want to emphasize that this is not what’s in the best interest of the patient. This is what’s in the best interest of…the physician in protecting themselves from criminal prosecution.”

Another striking finding in the report shows that all kinds of pregnancy-related care including routine prenatal appointments are being delayed, as doctors try to wait out pregnant patients’ first trimester due to the high risk of miscarriage in the first 12 weeks of pregnancy. A patient interviewed in the report said that one doctor’s office told her they would wait until she was at 12 weeks to see her, as doctors wanted “to eliminate some of the spontaneous abortions, or miscarriages, that may happen up until that 12-week mark.” To be clear, a miscarriage isn’t an abortion. But under abortion bans, that no longer seems to matter because all pregnancies are subject to innate, criminal suspicion by the state. “Frankly, I am worried that I could go to prison just for handling a miscarriage as I always have,” one doctor in the state told Jezebel in 2022.

Delayed prenatal care can put patients, including those with existing health conditions, at severe risk, and also delay their ability to detect severe fetal conditions. The report showed that in several cases, people with conditions including cancer, heart problems or kidney failure, and even women who had previously experienced life-threatening pregnancy complications, were denied time-sensitive emergency abortion care, essentially forced to wait until they were almost dying. 

One OBGYN recounted treating a patient with a severe heart condition and being unable to immediately provide a medically necessary abortion. Instead, they were forced to simply prescribe her cardiac medicines. “What if she doesn’t want to wait that long because she could have a heart attack and die? At what point can you act? How many cardiac meds have to fail?” they said in the report. Louisiana’s abortion ban allows emergency abortions for people suffering from a highly specific list of pregnancy-related complications. But those who suffer from life-threatening afflictions that aren’t on the list are denied care, as we’ve already seen in the case of one woman in 2022 whose fetus didn’t have a skull. Another Louisiana woman was forced to endure a “painful, hours-long labor to deliver a nonviable fetus, despite her wishes and best medical advice,” per a 2022 affidavit filed by Louisiana doctors, because her doctor wasn’t permitted by the hospital to perform an emergency abortion. Even worse, when Louisiana doctors deem that they’re unable to provide emergency abortion care, the report found that they don’t help patients navigate how to seek abortion care outside of Louisiana, out of fear of legal repercussions.

“There are going to be deaths that didn’t have to happen. There are going to be severe complications that didn’t have to happen,” Freehill said in the report. One report from 2017 showed states where abortion is more restricted had higher maternal mortality rates. Louisiana already had one of the highest maternal mortality rates in the nation before its ban took effect, and we haven’t yet seen post-Roe v. Wade data. But the report out this week suggests maternal health in the state probably hasn’t improved: One patient recounted suffering from an ectopic pregnancy—a condition where the embryo implants outside the uterus and can only be treated with abortion—received such delayed abortion care that her fallopian tubes ruptured. “I could have died,” the patient said in the report. “I really could have died.”