These doctors treat pregnant women without fear of abortion laws

Dr. Damon Cudihy is a practicing OB-GYN in Louisiana, one of the 13 states that protect unborn babies from abortion throughout pregnancy. Just last week, he said, he performed a dilation and curettage procedure on a woman who had naturally miscarried. The procedure, also called a D&C, involves using a suction device or a rounded metal tool to suck or scrape out the contents of the uterus. It’s the same procedure sometimes used to abort living, unborn children in the first trimester of pregnancy.

Before performing the D&C, Cudihy said he prescribed the woman misoprostol, a drug also used in chemical abortions, to help her body deliver her deceased baby. The medication didn’t work as desired, requiring the surgical intervention—a procedure that a recent ProPublica article wrongly claims is a felony in the state of Georgia.

Recent reports by the online news outlet echoed oft-repeated claims that pro-life laws are causing delays to women getting lifesaving care for pregnancy-related complications. But WORLD talked with doctors like Cudihy who provide exactly that kind of care on a regular basis in pro-life states without fear of the law.

“It never crosses my mind—not in the context of caring for my patients,” Cudihy said. He estimates that he’s dealt with at least 10 similar cases in the past six months. He and others with whom WORLD spoke say that the widely reported deaths of women from pregnancy complications could have stemmed from a variety of causes but not from pro-life laws.

Original intent

A ProPublica article published Sept. 16 highlighted the story of Amber Thurman, a young Georgia woman who consumed abortion pills in 2022 after obtaining them in North Carolina. Body parts of Thurman’s aborted twins or other pregnancy tissue remained inside of her for days after she took the drugs, causing an infection. She died after doctors failed to clean out her uterus in time. The article blamed the delayed emergency care on Georgia’s law protecting unborn babies from abortion once they have detectable heartbeats. That law went into effect in 2022 after the U.S. Supreme Court released its Dobbs v. Jackson Women’s Health Organization decision overturning Roe v. Wade.

To Suzanne Guy, a longtime pro-life activist in Georgia, the story was personal: She and her daughter had lobbied for the law. They met with other pro-life activists and lawmakers to discuss the bill as early as 2016.

In a campaign speech in Atlanta on Sept. 20, Vice President Kamala Harris recalled hearing from women since the Dobbs decision who told her emergency rooms turned them away after they suffered miscarriages, including one who said she was able to receive emergency care only after developing sepsis.

“And now we know that at least two women—and those are the only stories we know—here in the state of Georgia died—died—because of a Trump abortion ban,” Harris said. On Sept. 18, ProPublica published the story of a second woman who died of complications after taking abortion pills because she was afraid of facing legal penalties if she sought treatment.

“The people who created these laws knew women would die,” wrote pro-abortion writer Jessica Valenti on her Substack on Sept. 19. “Everything they say now is the result of decades of work preparing for this moment.”

But, as Guy, the longtime pro-life activist, tells it, that is not true. “My whole life is dedicated to helping women in crisis. So everything I do is as much for that mom as it is for the baby,” she said.

Once a draft of the heartbeat bill was ready, Guy met with a group around her own kitchen table to proofread the text. She said those who worked on it were careful to account for difficult pregnancy cases. “We were just trying to be … very intentional that women would be protected if they found themselves in an emergency situation,” said Guy. “That’s why I say over and over, our heartbeat law did not end the life of that precious woman.”

Broad discretion

Cudihy, the Louisiana OB-GYN, blasted claims like those made in the ProPublica article that pro-life laws prohibit miscarriage care.

“It’s so blatantly a lie,” he said. “It is absolutely a misrepresentation and a flagrant lie, if it is claimed that any laws in the states that have outlawed induced abortions would prevent legitimate treatment for caring for a woman who has had a miscarriage—for treatments to remove the remains of a child that’s died.” Cudihy added that no law prohibits the removal of a baby that died in utero, even as a result of an induced abortion.

Cudihy said he testified in the state legislature to defend the original bill. To him, the law’s health exceptions are “exquisitely clear.” “If they could be more clear, we would make it more clear,” he said. “I would be involved in the process.”

Cudihy said the woman he saw last week carried the remains of her dead baby for about three or four weeks—a length that he said is common among the women he treats. After finding out that her baby did not have a heartbeat, she wanted to avoid taking drugs or undergoing a procedure, so she waited for her body to expel it naturally. But when weeks went by without that happening, she opted for the medication. The week after that didn’t work, Cudihy performed the D&C.

Throughout the process, he said, the woman stayed otherwise healthy. In his more than two decades in practice, Cudihy said he has never seen a woman develop an infection after a natural miscarriage. But he has treated infections following induced abortions that failed to remove the entire body of the dead baby and the rest of the pregnancy tissue—something he said he hasn’t seen in Louisiana since the state’s pro-life law went into effect.

Infections from retained tissue after a chemical abortions are “known side effects,” Cudihy said. “They’re not terribly common, but they are known side effects, and it’s why the abortion pills are not as safe as Tylenol, as the abortion industry falsely claims.”

Georgia’s law clarifies that removing an unborn child who died in a “naturally occurring” miscarriage is not considered an abortion. The ProPublica article acknowledges that and admits the medical staff who treated Amber Thurman at Piedmont Henry Hospital have not explained why they did not immediately remove her retained pregnancy tissue when she presented with an infection. But the writers suggest Thurman died because doctors knew she had used drugs to abort the babies and worried removing what remained would violate the law. Representatives for the hospital did not answer WORLD’s request for comment in time for publication.

“Just because in the statute we provide a second layer of protection to make sure it’s very clear the removal of an ectopic pregnancy or a miscarriage could never be construed as an abortion doesn’t mean that the removal of a dead unborn child for other reasons isn’t completely legal,” said Georgia state Sen. Ed Setzler, the former state representative who sponsored the heartbeat bill in the House back in 2019.

He pointed to Thurman’s infection as another reason doctors should have felt comfortable performing a D&C. The law allows for abortions on babies with detectable heartbeats if a physician determines in his “reasonable medical judgment” that “a medical emergency exists.” That exception, Setzler said, gives “broad discretion” to doctors.

Unfounded fears

While reports such as the one from ProPublica suggest doctors are worried a court could determine that their judgment in such cases was not reasonable, Setzler says that message creates unnecessary confusion. “In a criminal context, you’ve got to be convicted beyond any reasonable doubt in the minds of all 12 of 12 jurors,” Setzler said. That means if only one juror agrees with the doctor that he acted to save the mother’s life or prevent damage to a major bodily function, “there’s no conviction.”

Joshua Edmonds, the former executive director of the Georgia Life Alliance, said he wrote the original draft of the heartbeat bill. He said reports of doctors’ fears in providing miscarriage or post-abortion care rely on the false assumption that a district attorney would be willing to bring charges in such a case in the first place when a woman’s life was on the line. “I don’t think that there’s a district attorney in Georgia, let alone the country, who would bring those charges,” Edmonds said.

ProPublica and other media outlets have quoted doctors who feel pro-life state laws inhibit them from intervening when a pregnant woman faces a health concern. But that experience isn’t universal. Cudihy and other OB-GYNs WORLD interviewed said physicians in their circles haven’t had to change their approach to pregnancy complications because of pro-life state laws.

“Where are the examples of people who did give appropriate medical care and then were convicted or their lives were ruined—they went bankrupt, they lost their job— because of these things?” said Dr. Jonathan Scrafford, an OB-GYN in Kansas.

To him, the lack of examples doesn’t match the level of concern about doctors facing prosecution in these cases. “There has to be some burden of proof at some point about these concerns,” he said. Scrafford points to OB-GYNs in pro-life states who are doing D&Cs for miscarriages and removing ectopic pregnancies—“day in and day out”—without facing consequences.

Although state law in Kansas is very permissive of abortion, Scrafford practices in a Catholic hospital. Long before current state laws protected unborn babies, Catholic hospitals maintained policies against elective abortions. Scrafford’s hospital still does, but he said it doesn’t prevent him from performing D&Cs and similar procedures in other scenarios.

“I treat miscarriages and ectopics on a regular basis,” Scrafford said. “Almost every week for miscarriages, probably once every month or two for ectopic pregnancies.” On top of that, he estimates that he sees women with incomplete chemical abortions five to 10 times a year—a condition generally requiring him to perform a D&C—and has never experienced pushback from the hospital.

Dr. William Lile, an OB-GYN in Florida, also works in a Catholic hospital system. He said when the state’s law protecting unborn babies after six weeks of gestation took effect, various departments in the hospital discussed how it would affect the care they provide. Florida law states that abortion does not include procedures to “remove a dead fetus” and allows for terminations of pregnancy when “in reasonable medical judgment, the termination of the pregnancy is necessary” to save the woman’s life or prevent impairment to a major bodily function.

“It made no change in our management of any patients,” Lile said, adding that even in Catholic hospitals, doctors can remove a living baby if they determine the pregnancy is a direct threat to a mother’s health or life.

“My colleagues are literate, and anybody who is literate can read the statute and clearly understand what the limitations and what the exceptions are,” Lile said.

While Lile has not encountered women suffering from incomplete chemical abortions since his state’s pro-life law took effect, other pro-life doctors in states prohibiting most elective abortions have. Texas OB-GYN and vice president and director of medical affairs for the pro-life Charlotte Lozier Institute Dr. Ingrid Skop said in an email she has performed D&Cs on women with retained pregnancy tissue after chemical abortions “both before and after Dobbs. No one ever considered that illegal.” Texas prohibits abortion throughout pregnancy except when the woman faces the risk of death or physical impairment.

In Indiana, where babies are also protected from abortion throughout pregnancy, American Association of Pro-Life Obstetricians and Gynecologists CEO Dr. Christina Francis said in an email that the group she works with has performed D&Cs on women suffering from incomplete chemical abortions. “There has not been any concern that they could not intervene due to the law,” she wrote. “In fact, our hospital gave us the official guidance that nothing about our practice needed to change,” given that her hospital didn’t do elective abortions before the law took effect.

Contrasting views

On Tuesday, Francis testified before a U.S. Senate committee that the cause of confusion about pro-life laws is not the laws themselves but rather the dangerous political rhetoric about the laws. That rhetoric, she said, “falsely tells doctors D&Cs are banned, when in fact D&Cs for every indication other than to induce an abortion are not prohibited.” The title of the hearing was “Chaos and Control: How Trump Criminalized Women’s Health Care.”

Two seats to her right sat Kaitlyn Joshua, a Louisiana woman who experienced a threatened miscarriage in 2022—“threatened” because she was bleeding profusely but the baby still had a heartbeat. She had told her story on the stage at the Democratic National Convention, blaming Louisiana’s abortion ban for the fact that two emergency rooms sent her away without giving her drugs or performing a D&C. She went into more detail before the Senate committee Tuesday, telling them it ultimately took her two weeks to “pass the pregnancy” at home on her own.

Cudihy said he sees women with threatened miscarriages “frequently,” and the standard of care typically involves what Joshua experienced: sending the woman back home to wait and observe. Cudihy said most cases of threatened miscarriages that he sees go on to be healthy pregnancies—information that both Cleveland Clinic and Mayo Clinic affirm on their websites. He remembers one patient who stood up from the exam table in his office and there was blood on the floor, she was bleeding so much. “I thought … for sure she was gonna have a miscarriage,” he said. “And she didn’t. The baby did fine.”

Scrafford wonders if many of the stories of poor medical outcomes attributed to pro-life state laws actually boil down to a disagreement between what the patient and the provider consider to be the appropriate treatment in a particular scenario. “Patients sometimes define ‘care’ as specific interventions that they desire, whether they be medically appropriate or not,” Scrafford explained. “A provider may in good conscience decline to provide such type of ‘care’ if their professional assessment is that it is not medically appropriate, especially if they are able to offer a more appropriate alternative.”

Other times, he said, providers just make difficult calls that have nothing to do with the political environment.

That might have been the case for Amber Thurman, the Georgia woman featured by ProPublica. Michael Seibel, a medical malpractice attorney in New Mexico who analyzed the ProPublica article in a guest post on the pro-life group Live Action’s website, told WORLD that details in the article suggest doctors had a nonpolitical reason for delaying the D&C. When Thurman presented at the hospital, her blood pressure was already “perilously low,” the article says. ProPublica reported that, as doctors continued to push off the D&C, they gave her Levophed, a medication used to increase blood pressure.

“One of the things I think they might have been thinking in this situation is, unless we get her blood pressure up, I’m not going to do surgery, because if I do, I’m going to kill her because her blood pressure is too low,” Seibel said.

Scrafford agreed that was a plausible explanation, although he would generally disagree with that approach to the situation. “This is a good example of how tragic cases like this are much more likely due … to poor medical decision-making than poor political [or] legal decision-making,” he said.