Supreme Court Abortion Shreveport

An exterior photo of the Hope Medical Group for Women on Feb. 20, 2020, in Shreveport, La. The clinic is one of three in the state that provides abortions to women, and it is challenging a state law that requires doctors who perform abortions to have admitting privileges at a nearby hospital. The Supreme Court is hearing the case on March 4. (AP Photo/Rebecca Santana)

Obstetrics and gynecology medical residents at LSU train at a Shreveport abortion clinic. Where those students will get critical training needed to complete their residencies is up in the air as Louisiana’s three abortion clinics are likely to be shutdown within a matter of weeks or even days. 

All OB-GYN residents need to learn to do abortion procedures, even if they never perform elective abortions in their career. Physicians need to know how to perform them as they may be called upon to perform an abortion in an emergency situation when a pregnancy becomes life threatening. The same surgical techniques used in abortion clinics are also used to manage miscarriages. 

According to Nicole Freehill, the Associate Residency Program Director of Obstetrics and Gynecology at LSU New Orleans, the education of medical students, who are not yet physicians, will not be impacted to the same degree as residents, who are physicians who have graduated medical school but are still learning how to practice independently, because students will still receive basic training.

The basic training includes teachings on contraception, contraception options, pregnancy options, counseling for when patients come in, options to continue pregnancy, abortions and others, according to Freehill.

Students go through didactic training about abortions in their second year of medical school, and these teachings typically take place in a classroom setting. Their third year of medical school is when they undergo their OB-GYN rotation of learning, typically training in a clinical environment.

Abortion is a small portion of what LSU calls family planning, Freehill said. Family planning is about the reproductive life of a woman and includes contraception, pregnancy options including abortion and the postpartum period.

There will still be some opportunities to teach students about complications from abortions as abortions for medical indications are still allowed. 

Residents go to an abortion clinic to learn the procedure as there are not enough emergent abortion patients to come through their hospitals. At an abortion clinic, they can perform the procedure many times in a short period, which allows them to master the procedure. 

For medical students who will not go on to be OB-GYN residents, the infrequency of medically indicated abortions may mean that they do not have live exposure to the procedure.  

“We could easily have a rotation of students who are going through their OB-GYN rotation, who we don't have a situation like that come up,” Freehill said. “That is not an integral or always vital portion of their training, and they are given some abortion education, but on a smaller degree, because it is not something that they're always exposed to.”

LSU is dedicated to still get residents abortion training because it is necessary to save a mother’s life in certain circumstances, Freehill said.

“To get them that training, and since Hope Clinic at this point is closed, we are looking into options out of state to send our residents to still get that potentially around two weeks of intense training,” Freehill said. 

Dr. Valerie Williams is the former director of the Ryan Program at LSU Health Sciences New Orleans, which connected LSU residents with resources needed to receive abortion training in the state. That training is required for an OB-GYN program to be accredited. 

Before the Ryan Program started at LSU, residents had to travel out of state, often at their own expense, Williams wrote in a sworn affidavit filed in the case to enjoin the state’s abortion laws. 

Williams is concerned that if the abortion ban goes into affect, Louisiana’s OB-GYN residency programs could lose accreditation, as all OB-GYN residency programs are required by The Accreditation Council for Graduate Medical Education to provide abortion training. 

Even if the programs retain accreditation, Williams speculated that many students will be discouraged from studying in Louisiana. 

“Ever since the Ryan Program started at LSU Health, the quality of medical students applying to the LSU OB/GYN residency program has skyrocketed,” Williams said. “Students from all over the country are attracted to LSU in part due to the quality of abortion training.” 

Williams was one of more than a dozen Louisiana physicians have filed affidavits, a written statement confirmed by oath or affirmation used as evidence in court, in support of the preliminary injunction that would block Louisiana’s new abortion laws from going into effect.

The case, filed by Hope Medical Group for Women, its administrator Kathaleen Pittman and the New Orleans chapter of Medical Students for Choice, is pending a Monday hearing in East Baton Rouge Civil Court. Plaintiffs argue that the state’s abortion laws are too vague. 

“Because physicians tend to practice where they do their residency, this will, in the long term, negatively affect the quality of OB/GYNs in Louisiana overall,” Williams wrote. 

A March of Dimes analysis found over one-third of Louisiana’s 64 parishes have no practicing OB-GYNs at all, which many consider to be a contributing factor to the state’s high maternal mortality rate, which is the highest in the nation at 58 deaths per 100,000 births. 

Williams was not the only physician in the case to raise concerns about what the ban means for recruiting students. 

“Through fear of prosecution and the heavy penalties involved, the Trigger Ban will also discourage medical students to seek residency training in Louisiana, contributing to our physician shortage and ‘brain drain’ in the state,” Dr. Nina Breakstone, an emergency medicine doctor for Ochsner, wrote in another affidavit. 

While some abortions are technically legally permissible, like those  to save the life of the mother or if the fetus has a condition incompatible with life, the lack of specificity in the laws present concern for physicians. 

In the three weeks since Roe v. Wade was struck down, multiple cases in other states have received national attention, highlighting circumstances in which doctors have hesitated to provide abortion care to save the life of the mother or even provide miscarriage management due to fear of prosecution. 

While Louisiana’s abortion ban is temporarily blocked by a judge pending the lawsuit, several physicians filed affidavits in the case, raising concerns that nightmare scenarios like that could play out in Louisiana. 

Dr. Rebecca Gee, former secretary of the Louisiana Department of Health, wondered how badly a pregnant person’s health needs be before an abortion is allowed to save the life of the mother. State law includes language that allows for an abortion if a “life-sustaining organ” is threatened. 

“To satisfy these laws – does it have to be her heart that fails, what about her lungs, her kidneys, and so on, what organs would this law decide are necessary to protect her life?”

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