This makes me sad and very angry. More than 35 years ago I was pregnant for the first time. Routine ultrasound showed the baby had multiple neural tube defects. We were stationed in Louisiana at the time. We were sent to an AirForce hospital in Mississippi, and they determined that the defects could cause a miscarriage and a threat to my health, and the defects precluded life outside the womb. The pregnancy was terminated. And now, same type of defect, and the mom has to carry to term... The agony that poor mom must be in.

Louisiana hospital denies abortion for fetus without a skull

Baton Rouge woman's predicament illustrates gray area in Louisiana's abortion rules

BY EMILY WOODRUFF | STAFF WRITER
AUG 17, 2022 - 1:20 PM

At the beginning of July, Nancy Davis started feeling nauseous. The Baton Rouge resident considered COVID-19 or the flu, then decided to take a pregnancy test just in case. She saw the two blue lines denoting a positive test and ran to the living room to tell her boyfriend. They were both elated.

But their happiness was short-lived. At the first ultrasound, at Woman’s Hospital, the largest birthing center in Louisiana, the technician looked troubled and left the room. A woman in a white coat entered. Davis knew that wasn’t good..

The doctor pointed to the top of the head. There was no skull, she told Davis, an unsurvivable condition. The doctor tried to comfort her, saying this was one of the conditions that qualifies as an exception under the state’s abortion laws. Davis, about 10 weeks into her pregnancy, was still heartbroken.

“There was nothing I would have preferred more than to have this baby,” said Davis, 36. Instead, she prepared herself to pay an estimated $5,000 for an abortion at the hospital.

But that’s not what happened. Even after doctors at the hospital said they would provide an abortion once she got the diagnosis of acrania, a rare and fatal condition, from a specialist, the hospital called to tell her it would not be able to do it, she said. The hospital directed her to a Florida abortion clinic instead, or to carry the baby to term.

'Medically futile'
Davis' predicament illustrates the gray area in Louisiana's new abortion law and the administrative regulations that attempt to explain it to medical professionals and the public. They all but forbid abortion, except to save the life of the mother or when the fetus is "medically futile," according to a list of conditions issued by the state.

Acrania does not appear on the state’s list of accepted conditions for abortion. But the state also has a broad exception for any “profound and irremediable congenital or chromosomal anomaly existing in the unborn child that is incompatible with sustaining life after birth in reasonable medical judgment.”

Two physicians must sign off on the anomaly. But Woman’s still said it would not perform the abortion.

“In the absence of additional guidance, we must look at each patient’s individual circumstances and remain in compliance with all current state laws to the best of our ability,” said Caroline Isemann, a hospital spokesperson, in a statement.

That's not how some doctors have interpreted the law.

'They just won't function'
“Acrania, to me, is synonymous with anencephaly, and it’s on the list,” said Dr. Cecilia Gambala, a maternal fetal medicine specialist at Tulane University School of Medicine, referring to another brain and spine defect. “There is no skull.”

Gambala said that even if hospital attorneys were uncomfortable with giving the go-ahead for an abortion based on the acrania diagnosis, they could use the broad exception that the state allows for when a fetus is incompatible with life. And acrania, in Gambala's opinion, meets that description.

"Babies can be born alive, they just won't function," Gambala said. "Their heart might be beating, they can breathe, but they have no brain tissue to actually develop as far as comprehending what's happening or reacting to anything."

Cases like this will become more common until there is more clarity surrounding the law, whether from legislation, additional guidance from the state Health Department or litigation, said Matthew Brown, a New Orleans-based attorney specializing in health care law.

“The problem is very specific,” Brown said. “And that’s why the law doesn’t address it.”

Brown said the hospital may view the fetus as currently viable because acrania is not immediately fatal and there is still a heartbeat. It also doesn’t immediately endanger the life of the mother, even though the health risks and psychological risks are significant as the pregnancy continues.

Other hospitals may see the situation differently. Until there is more clarity, scenarios like this will continue to play out, he said.

"Any pregnant woman at this point, even the ones [who] are hoping for a healthy child and planning to give birth, is facing additional uncertainty about how they're going to be cared for under bad circumstances because of this law," Brown said.

After seeing a maternal fetal medicine specialist, Davis starting researching the condition on her own. She found devastating images of infants and fetuses who looked like they were missing parts of their heads. She read that babies with acrania are stillborn or die shortly after birth, just like her doctors told her.

“I haven’t run across a case where these babies live,” Davis said.

Time is running out
The nearest abortion clinic that can take Davis is an eight-hour drive, and would require a week's stay because she needs a consultation before the procedure.

“I can’t just get up and shoot out; I have kids,” said Davis, who has a 13-year-old and a 1-year-old and no transportation, after a hit-and-run wreck totaled her car a few months back.

Florida also bans abortions after the 15th week of pregnancy, and Davis is now nearing 14 weeks. The next-closest state, North Carolina, is a 15-hour drive.

In desperation, Davis visited Care Pregnancy Clinic, a pregnancy crisis center that discourages abortions, on Flannery Road. Staff gave her information on how to bury the baby and said their prayers were with her.

“It makes me feel horrible, like I’m alone in this,” Davis said. “It makes me feel like they just threw me to the wolves.”

After being told to go to Florida, Davis said she wanted other people to know how laws decided in the Louisiana Legislature play out in real life.

“I never in a million years thought it would affect me like this,” she said. “It seems like Louisiana is the hardest place right now to get that done. They don't even wanna say that word.”