Louisiana’s top expert on maternal health has come out against a new law that will reclassify common pregnancy medications as dangerous controlled substances.
When women in the state die while pregnant or after giving birth, the leading doctor who reviews their cases is Dr. Veronica Gillespie-Bell. She also helps review severe complications from pregnancy and birth, as well as infant mortality. Gillispie-Bell, an OB-GYN in New Orleans, is also a national expert on maternal health who works with the American College of Obstetricians and Gynecologists and the Alliance for Innovation on Maternal Health, an initiative to make births safer across the U.S.
Gillispie-Bell is among nearly 300 Louisiana doctors and medical students who oppose a new law that will reclassify two common pregnancy medications, mifepristone and misoprostol, as controlled dangerous substances. The law targets the medications because they can also induce abortions. As of Oct. 1, they will need to be locked away in hospitals or held in pharmacies.
“I now have to worry about laws that are created that interfere with my ability to give my patient the best care,” Gillispie-Bell said. “Where does this end? And I think the real answer to that question is there is no place that it ends, and that is very scary.”
In her first interview with media about the law, Gillespie-Bell spoke with WWNO/WRKF’s Rosemary Westwood about her concerns. This conversation has been edited for length and clarity.
Rosemary Westwood: So Louisiana’s law is the first of its kind in the U.S., and it will make the medications mifepristone and misoprostol harder to access for routine care and in emergencies. And I want to start with reminding our listeners: What are mifepristone and misoprostol used for, and how important are these drugs for pregnant women’s health?
Dr. Veronica Gillispie-Bell: So mifepristone and misoprostol, I think, typically get somewhat of a bad reputation or politicized because the two of them can be used for inducing an abortion. But we use them commonly in practice for patients that are having a miscarriage and need medication to finish the miscarriage because they’re hemorrhaging. We also use misoprostol in particular for treatment of postpartum hemorrhage. We also use it for induction of labor, and then we also use it in gynecology, misoprostol in particular, for softening the cervix for certain procedures, like placements of IUD or for post-menopausal patients that need to have an endometrial biopsy.
So what do you think then, of this new law that will make these drugs control dangerous substances?
Now that they are considered controlled, that means that when we are in the hospital that those medications have to be under lock and key, and so that can make it more difficult to access those medications in the middle of an emergency.
So as you’ve said, misoprostol is a key drug for treating postpartum hemorrhaging, and we published reporting from the Louisiana Illuminator showing that the drug is already being removed from obstetric hemorrhage carts and kits. My understanding also is that the whole point of this, these kits and these carts is that these drugs are on hand, in arms reach, because time is of the essence. Is that true?
That’s very true. So, for patients that are experiencing a postpartum hemorrhage, there are things that we do to be ready. Part of that is assessing their risk for hemorrhage. The other part of that is that when we’re going into delivery, to make sure that we have medications available that can, can cause the uterus to contract down to stop that hemorrhage. There are a few medications that we can use for postpartum hemorrhage. We can use Methergine, we can use another medication called hemabate, but there are contraindications. I will say, in the time that I have practiced, I have had a patient that had contraindications to both of those medications. And so misoprostol ended up being the first line medication that was, that we could use for that patient for those reasons. And so again, if these are medications that we want to give when we start seeing hemorrhage taking place, minutes count. And if we have to go through the process of verifying through pharmacy and getting it out of a locked location and all of those things, then those, those are our hindrances to being able to treat those conditions quickly. Many hospitals have what’s called a Pyxis system, which is a locked system for where we have medications that are considered controlled substances or Schedule IV medications, but the locations of those Pyxis may not be in proximity to that patient, especially thinking about patients coming into hemorrhage in the emergency room. They may or may not have a Pyxis that has that medication readily available to be able to access it quickly for that patient coming into the emergency room.
So this law was written by and authored by Sen. Thomas Pressly, and he was helped by Louisiana Right to Life. Both have said that this law is necessary because of the number of women who are ordering abortion pills online and giving themselves abortions in Louisiana despite the state’s near total ban. What’s your reaction to that?
So it makes me think about a quote that I learned in, I believe, the 10th grade that I always keep with me from Ernest Hemingway The Sun Also Rises. The pathway to hell is paved with good intentions. I think that the intent of the law I understand. However, the impact that we will experience in the hospital, and even for our patients that are needing the medication for non-obstetric purposes in the outpatient setting, I think that the impact is going to be far greater than the intent of what the law was.
So this law is coming in the context, as I’ve said, of Louisiana’s abortion ban. That ban was also something that physicians have told us really changed how they can practice medicine. And I’m just wondering about that bigger context of this law, the abortion law. How do you see those together, impacting care?
As physicians, or as a physician, I’ll speak for myself although I know I speak for others, when you have decisions that impact your ability to take care of your patients based on your clinical training that doesn’t feel good, and some of these decisions that have been made, the ramification is that I as a physician can go to jail — not for doing something that’s wrong in terms of how I practice medicine, but it’s wrong because there’s been an arbitrary law that’s been that’s been created. And so that does not feel good as a provider. And what we have seen since the overturning of Roe v. Wade and the, the Dobbs decision, those states that have the strictest abortion bans have had a decreased number of medical students and residents applying to do their residency programs in those states. We already know we have a workforce shortage, that we’re going to be short 5,000 OB-GYNs across the United States by 2030, about 2,200 OB-GYNs in the south. And if we’re not increasing that workflow, if we’re not having providers come in, then where is that going to put us in terms of our patients and in terms of improving overall health?
I just want to ask, finally, why you’re speaking to me now. This law passed in the spring, and we’re a few weeks away now from it taking effect, so why speak out now? And what do you hope to accomplish by talking about this?
I think for me, I have a bit of frustration, because I again, I understand what the intent of the law was, but I see the ramification. And I feel like we’re on a very slippery slope. When I, as a physician, who went to four years of medical school, four years of residency, I am responsible through my state licensing board, I am responsible to my specialty board to make sure that I am practicing medicine in an evidence based way, but I now have to worry about laws that are created that interfere with my ability to give my patient the best care, where does this end? When? Where do we stop making laws that affect that relationship? And I think the real answer to that question is there is no place that it ends, and that is very scary.
Dr. Veronica Gillespie Bell is an OB-GYN in New Orleans and an expert on maternal health. Thank you so much for talking with me.
My pleasure.
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Publish date : 2024-09-18 07:52:00
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