When Legal Restrictions Endanger Lives: The Impact of Abortion Bans on PPROM Patients

In a hair salon bathroom in Miramar, Florida, Anya Cook experienced an agonizing ordeal. She was forced to deliver her nearly 16-week fetus alone, knowing it would not be born alive. Cook had intended to deliver in a hospital, but after her water broke prematurely, she was sent home to wait despite the life-threatening risks associated with her condition.

Pre-viability preterm pre-labor rupture of the membranes (PPROM) occurs in less than 1 percent of pregnancies. According to the American College of Obstetricians and Gynecologists (ACOG), standard care for PPROM involves inducing labor or performing a surgical procedure to end the pregnancy. However, in states where abortion is banned before fetal viability, hospitals are increasingly turning away PPROM patients due to legal risks.

The medical exceptions included in abortion bans to protect the mother’s life are often described in vague language that does not clearly cover pre-viability PPROM. A 2022 study found that 57 percent of PPROM patients in Texas, who were not given the option to end their pregnancies, experienced serious maternal complications, such as infection or hemorrhage, compared with 33 percent of those who chose to terminate in states without abortion bans. The study also reported isolated maternal deaths due to infection in early PPROM cases.

Florida’s abortion law bans the procedure after 15 weeks, except when an abortion would save the pregnant woman’s life or avert a serious risk of substantial and irreversible physical impairment. However, it does not address PPROM. The state’s Republican-led legislature is moving toward passing an even stricter law banning abortion after six weeks of pregnancy, which also does not address PPROM.

Pre-viability PPROM is one of the most widespread pregnancy complications affected by abortion bans. One day after Cook was turned away from the hospital, her close friend Shanae Smith-Cunningham experienced a similar situation 19 weeks into her pregnancy.

Shanae Smith-Cunningham, in the midst of her pre-viability preterm pre-labor rupture of the membranes (PPROM) ordeal, switched her sanitary pad multiple times to minimize infection risk. Despite her cervix being dilated four centimeters, she was denied hospital admission. Her OB/GYN, Ivonne Reynolds, suggested she leave Florida for treatment in New York.

Smith-Cunningham spent Christmas Day searching for answers online, fearing complications like infection and sepsis. Eventually, she delivered her fetus in a hospital. Both Smith-Cunningham and her friend, Anya Cook, sought answers from their fertility specialist, Dr. Daniel Christie, about their chances of having a baby after their traumatic experiences.

At their appointment, both women learned they would need surgery to remove retained pieces of placenta, which could reduce their chances of carrying to term. The surgery worked for Smith-Cunningham, but Cook required another operation, further limiting her fertility.

Florida State Senator Lauren Book (D) shared the women’s story in a debate about the six-week abortion ban. She questioned whether the bill’s intention was to send women home in situations like Cook and Smith-Cunningham’s. Republican Sen. Erin Grall argued that the medical exception covers these situations, accusing doctors of playing “games and politics.”

Dr. Nikki Zite, an OB/GYN and ACOG spokeswoman, refuted this accusation, stating that physicians would not put patients at risk for political gain. She called for lawmakers to clarify pre-viable PPROM situations in the law. However, Florida’s six-week abortion ban passed without a specific exception for PPROM.

Both Cook and Smith-Cunningham plan to try getting pregnant again, although they worry about the potential consequences under the stricter abortion law. As they face an uncertain future, they find solace in each other’s Support.

In light of these harrowing experiences, we encourage everyone to stay informed about reproductive rights and advocate for policies that prioritize the health and well-being of pregnant individuals. Reach out to local representatives, and we can work towards a future where women don’t have to fear the consequences of their own pregnancies.

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