Sebastian's Point

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Telemedicine, Rh-Negative Blood Type  & Substandard Abortion Care

 Katie Glenn, J.D.  &  Natalie Hejran, J.D.  |   17  September  2020

Twenty years ago this month, the federal Food and Drug Administration (FDA) approved the sale of Mifeprex, a drug approved for the sole purpose of terminating early pregnancy. Since then, the abortion industry has used chemical abortion drugs as a way to dissociate abortion from medicine and erase the ethical and legal protections owed to their patients.

             

Though abortion is never “safe,” there are some simple but necessary requirements to lower the risk of serious complications inherent to chemical abortion. Some are obvious, like performing a physical examination and an ultrasound to accurately determine the gestational age and whether the pregnancy is ectopic (located outside the uterus). Some are psychosocial: does the pregnant woman understand the risks? Does she know her options, including public and private resources? Is she being coerced by a partner, parent, or abuser?

 

Still, other medical concerns have nothing to do with abortion, but with the pregnancy. This is where pregnant women seeking abortions most often receive substandard care. When the abortion industry narrows its focus to just the abortion at hand, it treats fertility or future pregnancies as outside the scope of care. Women expecting to get a full range of treatment are left underserved and exposed to needless risks.

 

Rh-negative blood type and its impact on future pregnancies is a tragically under-discussed element of abortion and has rarely entered the conversation about at-home or telemedicine abortion. When a pregnant woman goes to her doctor for her first prenatal visit, there are many things she and her doctor will discuss, including medical history and any past pregnancies.[1] The woman will also undergo a physical exam, which may include an ultrasound and a series of lab tests, which could consist of bloodwork to determine blood type and Rh status. “Rhesus (Rh) factor is an inherited trait that refers to a specific protein found on the surface of red blood cells.”[2]

 

If the blood contains the protein, the woman is Rh-positive, and if the blood does not contain the protein, the woman is Rh-negative.[3] When a woman is Rh-negative, and her fetus is Rh positive, the woman’s body may produce antibodies after exposure to the fetus’s red blood cells.[4]

 

Maternal exposure to fetal blood results from miscarriage, amniocentesis, delivery, and abortion.[5] It makes no difference whether a woman is carrying to term or having an abortion; she needs specific treatment if she has an Rh-negative blood type.

 

An Rh immune globulin injection (called RhoGAM) prevents the production of these antibodies.[6] Without the injection, the antibodies can damage future pregnancies by creating life-threatening anemia in fetal red blood cells.[7] If a pregnant woman has an Rh-negative blood type, her doctor should ensure that she receives a RhoGAM shot.

 

When a pregnant woman goes to an abortion clinic, she should be given the same level of care a pregnant woman seeking to carry her child to term would receive. Nothing about whether or not a pregnancy is “wanted” alters the reality of the mother’s basic health needs. Rh-negative blood typing is a necessary test, and it cannot be done during chemical abortions that are conducted entirely via telemedicine. Yet the abortion industry is increasingly willing to toss aside basic health requirements if it means expanding abortion access by doing away with any sort of in-person visit.

 

Blood typing and administering RhoGAM is standard practice for OB/Gyns during a wanted pregnancy or a miscarriage. Still, not all abortion doctors see this as their ethical obligation, placing the burden on the woman to independently obtain this treatment from another doctor.[8] RhoGAM can be framed as a suggestion[9] and abortion doctors sometimes downplay the seriousness of Rh-incompatibility in circumstances where blood-typing and administering the injection would slow down in-person abortion or prevent at-home abortion.[10] No matter how early in pregnancy an abortion occurs, an Rh-negative woman still needs RhoGAM.[11]

 

A major claim of the abortion industry is that an abortion will not impact future pregnancies,[12] yet by divorcing themselves from the mandates of obstetrics and gynecology, abortion doctors risk the health, safety, and fertility of the women they claim to serve.

 

It is irresponsible to treat pregnant women who want to carry their pregnancy to term with greater care than pregnant women seeking to terminate the pregnancy. Abortion doctors still have the duty to provide the best care they can for their patients. Women seeking an abortion must be aware of all the potential risks, so they can make the best decision and seek the care they may require. Treating Rh negativity is just one of the many reasons that chemical abortions performed entirely via telemedicine are dangerous and wrong.

 

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[1] Pregnancy Week by Week. Mayo Clinic, 7 Aug. 2020, https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-care/art-20044882.

[2] Pregnancy Week by Week. Mayo Clinic, 7 Aug. 2020, https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-care/art-20044882.

[3] Rh Factor Blood Test. Mayo Clinic, 17 June 2020, https://www.mayoclinic.org/tests-procedures/rh-factor/about/pac-20394960.

[4] Rh Factor Blood Test. Mayo Clinic, 17 June 2020, https://www.mayoclinic.org/tests-procedures/rh-factor/about/pac-20394960.

[5] Rh Factor Blood Test. Mayo Clinic, 17 June 2020, https://www.mayoclinic.org/tests-procedures/rh-factor/about/pac-20394960.

[6] Frequently Asked Questions. RhoGAM Ultra-Filtered PLUS, Accessed 18 Aug. 2020, http://www.rhogam.com/faq/.

[7] Rh Factor Blood Test. Mayo Clinic, 17 June 2020, https://www.mayoclinic.org/tests-procedures/rh-factor/about/pac-20394960.

[8] FAQs. The TelAbortion Project, Accessed 18 Aug. 2020, https://telabortion.org/faqs.

[9]; according to Gynuity's protocols for the "TelAbortion Study”: “If your blood type is Rh-negative, we may recommend that you get an injection of a medicine called Rh(D) immune globulin before you take the mifepristone.” But this is the woman’s responsibility to obtain independently of the study. FAQs. The TelAbortion Project, Accessed 18 Aug. 2020, https://telabortion.org/faqs.

[10] The British Pregnancy Advisory Service appears to offer the shot at the time of in-person abortion (https://www.bpas.org/abortion-care/anti-d/), but there is no mention of “anti-D” (RhoGAM in the United Kingdom) on the website for at-home abortion (https://www.bpas.org/abortion-care/abortion-treatments/the-abortion-pill/remote-treatment).

[11] Frequently Asked Questions. RhoGAM Ultra-Filtered PLUS, Accessed 18, Aug. 2020, http://www.rhogam.com/faq/.

[12] How Safe is the Abortion Pill? Planned Parenthood, Accessed 18 Aug. 2020, https://www.plannedparenthood.org/learn/abortion/the-abortion-pill/how-safe-is-the-abortion-pill.

 

Katie Glenn serves as Government Affairs Counsel for Americans United for Life (AUL) in Washington, D.C., where she oversees federal and state policy for AUL.

 

Natalie Hejran serves as Staff Counsel for AUL, focusing her practice on research and policy development as well as legislative testimony.