From hospitals to doctors’ offices, the frantic questions women are asking about the new abortion law
Over the next few months, the nuances of Florida’s new six-week abortion ban will start to play out. Women who face complications during pregnancy will face new challenges. Doctors are already fielding questions about future care.
On May 1, reproductive care in Florida will change.
Anyone more than six weeks pregnant will be prohibited by law from getting an abortion.
Obstetricians who work privately, or on a hospital staff, already are fielding questions from patients, while also trying to understand the effect on their practices. A wrong call could lead to criminal charges — for a woman or a doctor.
There are exceptions to the new abortion law. A woman in Florida can get an abortion after six weeks if two physicians certify, in writing, that it is necessary to save her life or to prevent serious injury. Also, abortions will be allowed through 15 weeks if the pregnancy is caused by rape or incest. In those cases, the woman has to show documentation such as a medical record, restraining order or a police report.
For the last two years, abortion has been legal in Florida through 15 weeks. Florida lawmakers put that restriction into effect after the U.S. Supreme Court in June 2022 overturned Roe v. Wade, which had protected the right to have an abortion. Before that, abortions were legal in Florida through 24 weeks.
In Florida, a waiting period is in effect, too. Anyone who wants an abortion has to wait 24 hours after an initial doctor’s visit before returning to undergo a procedure.
Over the next few months, the nuances of the new six-week ban will play out. Women who face complications during pregnancy will face new challenges. Here are some of the medical questions women are asking:
Q. How will six weeks be calculated?
A. Florida measures gestational age from the last menstrual period. So, for women who have consistency in their periods — every 28 days — it would be two weeks after a missed period. But as doctors point out, not every woman is consistent. “A lot of women have cycle that vary from 21 to 35 days,” said Dr. Cecilia Grande, a Miami OB-GYN with FemWell Group Health. “Some will skip a month, and that’s just normal for them.”
OB-GYNs will do ultrasounds to help figure out how many weeks the gestational duration is in the pregnancy, and then try to confirm the results with the dating by last menstrual period. During the scan, a sonographer takes specific measurements of the pregnancy.
“Ultrasound dating is not exact,” Grande said.” You have no idea how difficult this will be for doctors to measure.”
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Q. What are the early signs of pregnancy that might be noticeable in six weeks?
A. Lots of people in early pregnancy will have cramping and light vaginal bleeding, symptoms that might be confused with having a period. They also may have symptoms that include nausea, tender or swollen breasts, a late period, feeling tired, feeling bloated, frequent urination, and mood swings.
“However, especially very early on, you may be pregnant without experiencing any of these symptoms,” said Dr. Robyn Schickler, chief medical officer of Planned Parenthood of Southwest and Central Florida.
“Every pregnancy is different, too. Some do not have any symptoms at all in the first trimester and may have no idea they are pregnant until later in the pregnancy. Some people have irregular periods and so they don’t miss a period,” she said.
How many weeks into pregnancy do women test for abnormalities? And what will happen now if one is discovered?
A. “The first set of testing we can do is a blood test, which is a genetic test that happens around 10 weeks into pregnancy,” said Dr. Chelsea Daniels, a fellow with Physicians for Reproductive Health and an abortion provider in South Florida. “That screens for the most common chromosomal abnormalities. A scan for anatomical abnormalities happen at 18-22 weeks.”
If there is an abnormality, the law says the only exception to the six-week ban is if it’s “fatal fetal abnormality,” or if an abortion is necessary to save a mother’s life.
Q. What happens when a woman miscarries? Can a health professional still perform a D&C?
A. Dilation and curettage (D&C) is a surgical procedure to remove tissue from inside the uterus after a miscarriage or abortion. Health care professionals perform D&Cs to prevent infection or heavy bleeding.
Dr. Shavonne Ramsey Coleman, a South Florida obstetrician with the Ob Hospitalist Group, said if the woman has miscarried, a D&C is legal even with the six-week ban. “If the fetus is deceased, then there’s nothing viable.”
Q. What happens if a sonogram reveals a fetus no longer has a heartbeat or has a condition from which it will die before birth?
In 2022, there were 1,523 stillbirths in Florida, fetuses that no longer had a heartbeat after 20 weeks’ gestation. Even with the change in law, a doctor can still induce a women to deliver immediately if the baby no longer is alive.
However, if the fetus is alive and two physicians have certified in writing that in reasonable medical judgment, the fetus has a fatal fetal abnormality, the pregnancy may be terminated. There’s a caveat though. The bill that created the six-week ban includes language requiring that the pregnancy must not have “progressed to the third trimester,” which could be interpreted to mean that abortions for fatal fetal abnormalities are banned after 27 weeks. A full-term birth is 40 weeks.
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Q. What are provider concerns and how does the six-week ban change physician-patient interaction?
A. “The biggest concern from a provider’s perspective is caring for a patient and being criminalized, or having to share private medical data with law enforcement,” said Dr. Ramsey Coleman, who belongs to a national network of obstetricians that work exclusively in hospitals. “That’s some of the the challenges that colleagues have experienced in Texas that we are concerned about in Florida.”
Another concern, she said, is that pregnant women who arrive at a hospital won’t be forthcoming with doctors. “We are concerned we won’t get a true history because the patient doesn’t to want to tell us the real story of what happened to them and why they’re in their situation. So it makes caring for patients harder. You’re trying to piece together a story to figure out how to take care of a patient. And in the meantime, they can decompensate and really take a bad turn. So I think those are some of the challenges that we are already experiencing and fear we will be experiencing even more.”
Dr. Grande, the Miami OB-GYN, says she will be having more conversations with patients about birth control, something she has been doing after the 15-week ban took effect.
“I am spending more time describing all the forms of contraception and informing patients about changes in the abortion law,” she said. “I tell them if the condom breaks, you need to know about emergency contraception”
Q. What might need to change with the six-week ban when it comes to birth control?
A. “I probably see at least a handful of patients or more per clinic day that become pregnant while on birth control,” said Dr. Schickler with Planned Parenthood. “Though we have very effective forms of birth control, not everything is 100%. In addition, these very effective forms of birth control can be completely inaccessible for many patients due to high cost.”
The effectiveness can depend on the type of birth control a person is using, she said.
“Risk of pregnancy is higher if a patient misses pills, or if a condom breaks,” she said “We see patients on all sorts of birth control that may become pregnant, simply because nothing is 100%.”
Doctors say they will be more proactive in suggesting patients take emergency contraception if they have had unprotected sex. Often called the morning-after pill, emergency contraceptive pills are available over the counter and can be taken up to five days after having unprotected sex.
With the six-week ban forcing women to be more aware, Schickler advises: “Track your menstrual cycle (to the best of your ability) and take a pregnancy test immediately after you miss a period. For patients who have irregular periods, consider taking a pregnancy test once a month to be safe.”
Q. What are the gray areas in obstetric care that may emerge after May 1?
A. It will be up to doctors to interpret the new law, and that can lead to denied care, Schickler said.
“These laws tie our hands and put us in a position where we can’t just look at providing care from a medical perspective; now we have to consider it legally as well,” she explained.
What happens when a membrane ruptures and there is bleeding, or when a pregnant woman leaks amniotic fluid, asks Grande, the Miami obstetrician.
“We previously would have sped up the natural process to force a delivery of the baby to avoid sepsis (infection) for the mother,” she said. “Now the new law will lead to a delay of care. The doctor will wait to intervene until the situation is life-threatening.”
Daniels says another gray area like will be around the definition of a birth defect that would be fatal to a fetus and therefore qualify as an exception to the abortion law.
“That’s very difficult to medically interpret,” she said. “Does it mean that a pregnancy after birth couldn’t survive for an hour, two hours, 24 hours? It’s very difficult to define. … doctors will be forced to make challenging decisions in the best interest of their patients, but on an unstable foundation.”
What is the law regarding medication abortion in Florida?
A. Medication abortions are the most popular form and typically use a combination or two drugs to end a pregnancy. Florida law requires anyone who obtains a medication abortion to take the first pill in person with a healthcare provider. The FDA has approved the two-drug regimen for pregnancies up to 10 weeks.
But it’s possible after May 1, Florida women will turn to the internet to order abortion pills, either illegally or through telemedicine appointments with out-of-state doctors, who can prescribe them due to “shield laws” that protect the medical providers from out-of-state prosecution.
The pills are widely considered safe to use up to about 10 weeks.
Florida clinics can still offer follow-up exams to those who obtained the abortion pills online, but they would have to direct a woman out of state if there still is fetal cardiac activity and gestation is greater than six weeks.
“Medication abortions are safe and extremely effective, especially in early pregnancy,” Daniels notes. “If someone were to need to go to a clinic, it would be rare.”
Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.