This again. The Savita Halappanavar scenario, in the US, in a Catholic hospital. It happens a lot but it seldom gets reported on. This one got reported on because the woman is a nurse. Most women this happens to aren’t nurses or doctors.

Jennifer had been experiencing heavy vaginal bleeding for over a week when she went to her physician’s office. He told her she was miscarrying and discussed her need for a dilation and curettage (D&C) to stop the bleeding and protect her health. A D&C is a procedure to empty the uterus; the same technique is used for both miscarriage management and abortion.

Abortion, unsurprisingly, is firmly prohibited in Catholic hospitals (along with contraception, sterilization, most fertility treatments and related services). Care must comply with the Ethical and Religious Directives for Catholic Health Care Services written by the U.S. Bishops.

That “must” is interesting. “Must” according to whom? The bishops, the Vatican, the hospital administration, the hospital staff, the patients, the law?

And how is a hospital that “firmly prohibits” normal legal medical procedures a real hospital? Don’t people generally expect the full range of medical treatment at an institution that calls itself a hospital? Very small and/or underfunded and/or struggling ones may not provide all possible medical treatments, but then it’s a matter of “we can’t,” not “we forbid.” What business does a hospital have forbidding normal legal medical procedures? None, in my view.

Due to her heavy bleeding, Jennifer’s pregnancy wasn’t viable, but there was a chance that the fetus still had cardiac activity. Preferring not to plead with the Ethics Board about the necessity of the doing a D&C, her doctor ordered a transfusion to address her extremely low iron levels from all the bleeding, and advised expectant management, which involved waiting for Jennifer’s body to expel the pregnancy on its own. The transfusion raised her iron levels, but she still wound up in the hospital 12 hours later, as the bleeding continued. She knew she needed a D&C. Unfortunately for her, things did not move quickly in the emergency room.

There you go – Savita Halappanavar all over again. A D&C is standard of care, but instead Jennifer got something much more risky. Why? Because bishops. Not a good reason. A very bad reason.

It might not be completely clear to the lay reader — or the typical patient — where Catholic doctrine slowed down her treatment. But it was clear to Jennifer, since she worked in obstetrics. She knew they were trying to make sure the fetus had died before doing the D&C, so the miscarriage treatment would not be perceived by the Catholic hospital’s Ethics Board as an abortion. Jennifer recalled,

They did so many ultrasounds. They ended up doing, I think, three, although I may have missed one. And I remember telling them over and over again, “This is not a viable pregnancy. I’ve been bleeding enough to need a transfusion for a week. This is not viable.” And they’re like, “Well, we just need to make sure.” And I’m like, “Have you found any cardiac motion?” “No. But we need to check again because maybe we missed it. It’s very early in your pregnancy.”

They “need” to put the woman in danger because they “need” to check for a pulse in a very early pregnancy. That’s where fanaticism gets you.

Then there were more problems later in Jennifer’s life because of the transfusions.

Transfusions present risks. C-sections present risks. Both are necessary and life-saving at times. But Jennifer would have preferred not to endure those risks purely because of the hospital’s religious commitments, especially since those commitments were not her own. Had Jennifer not had so much obstetric knowledge, she would not have necessarily known that in a non-Catholic hospital she would have been offered a D&C at the outset (before the transfusions, before the seven hours of unnecessary ultrasounds). What are the chances that the average patient could understand how Catholic doctrine hindered standard treatment for miscarriage management in this case and caused unnecessary suffering?

They are slim, and of course the hospitals and their staff don’t tell the average patient that Catholic dogma is fucking up their treatment.

The burning question from a variety of outside observers of the controversial problem of Catholic hospital expansion in the U.S., including those on both sides of the debate is: If there is really a problem, why don’t we hear it from patients? Why don’t they sue? Where are their voices in this matter? Everyone wants to know including those who defend the U.S. Bishops’ right to restrict care and those who are concerned about patient autonomy and welfare.

I hope my research collecting patient experiences will shed light on these questions. For now, based on my previous research and Jennifer’s story, I can think of three possible answers: 1) patients who don’t work in obstetric care don’t fully understand how their care was affected by doctrine (i.e. might have differed in a non-Catholic hospital); 2) when patients do understand they don’t want to cast blame on health professionals who were doing their best to care for them given the institutional religious constraints; and/or 3) patients don’t want to be known in their communities for complaining about personal health care experiences that can be highly emotional and potentially stigmatizing.

Don’t forget 4) the hospitals and the bishops don’t tell anyone.