Genetic Counselors Scramble Post- Roe to Provide Routine Pregnancy Services without Being Accused of a Crime

The Supreme Court's decision to overturn the abortion law of Wade struck close to home for genetic counselors, the medical professionals who are often tasked with advising and consoling prospective parents. There are a small percentage of people who seek abortions based on health concerns, but they are disproportionately affected by the new restrictions because it takes a long time to confirm a pregnant woman's health. The FDA only approves the drug for use during the 10th week of a pregnant woman's life. State restrictions on how far along a pregnant woman can be makes it difficult for patients to make a decision.

The need for patients to travel out of state for abortion care has made it difficult for pre-natal counselors to help patients without financial means. Poor and pregnant people are more likely to have health risks. Shannon Barringer is concerned about maternal mortality. She has worked for 25 years in Arkansas, where a law went into effect on June 24 that makes abortion illegal in cases where the fetus is not expected to live. New legislation may make it harder for her to give help. She says that legislators are working with national organizations to draft language that might make it difficult for health providers to refer patients out of state.

Existing and proposed laws that restrict abortion are so extreme that they are likely to affect all pregnant women. In a recent series of interviews conducted by two graduate students at Sarah Lawrence College, prenatal genetic counselors said that the need to send patients out of state if they were to need an abortion made time pressure affect many aspects of their care. The author of this article is a teacher. There is evidence that earlier scans will miss some fetal anomalies and give less definitive information on others, but some counselors are rescheduling scans to be done at 18 or even 16 weeks.

In Texas, where a law went into effect making all but the earliest abortions illegal, a full picture of the effect on genetic counseling can be found. Any citizen who is willing to take someone to court for aiding or abetting an illegal abortion can do so for a fee. The law has created an atmosphere of fear and suspicion, despite the fact that few of these suits have made it to the courts. Four genetic counselors from Texas were interviewed by Scientific American and all of them said that their institutions required them to speak publicly. Since the law passed, a counselor in Houston has tried to make the counseling session a safe place for people to go. I wonder if I or my colleagues are opening ourselves up for lawsuits.

There is a tension between optimal patient care and self-preservation. Health professionals can provide guidance to their patients. A bill recently introduced in the South Carolina legislature would make it a felony to offer information to anyone trying to obtain an abortion, even if the person only directs them to a website. With the threat of legal jeopardy, some genetic counselors may be deterred from even engaging in routine conversations that help determine which types of prenatal tests are best for an individual patient.

Concerns about liability have raised questions about whether to limit what is in a medical record. A Houston counselor says they have debated it. Some people in our department feel strongly that documentation of a legal procedure out of state should be in the chart so that the patient can get the best possible care, whereas other doctors will say, 'Why not avoid that language and just kind of be.'

Medical providers should be aware of the fact that their own e-mails may be used by law enforcement officials prosecuting abortion, according to a recent editorial by a law professor. Doctors aren't the only ones scared. Patients don't want to know about their past pregnancies because of the uncertainties, according to Barringer. Barringer is concerned that a lack of medical history could interfere with providing the safest care possible in a future pregnant woman.

Patients are concerned about sharing information on the use of pills that induce an abortion because of the Arkansas law that criminalizes harm to the fetus. The new abortion restrictions will make it harder for people to communicate. A law professor at the University of California, Irvine argues in her 2020 book that there is an increase in jeopardy for pregnant women and people of color who have been the target of prosecutorial overreach. It will be difficult to establish the atmosphere of trust that is a bedrock of good medicine with both genetic counselors and patients worried about what is safe.

Some patients don't want to fill out the intake form for pregnancies. I have had people tell me things they don't want to say in the paperwork. She can't do her job if she's not having the information. Not knowing about an exposure to a drug that could affect fetal development is what this means. It might mean not being able to address the risk of the problem recurring if you don't know about a previous pregnancies that ended in a miscarriage or abortion.

In one recent case, a patient with abnormal scans came to believe that they could have been caused by an abortion she didn't tell her doctor about. After the patient felt comfortable enough to talk to her, the counselor could address her emotional needs. The counselor said that she wanted to know if she was to blame. She was guilty of a lot of things.

Genetics counselors are concerned that attacks on abortion may make it harder to get a pregnant woman tested. Nipper testing, which looks at snippets of fetal DNA floating in the maternal bloodstream for missing or added genes, is very popular with patients. They can be seen as a step towards abortion. Rick Santorum was ignored when he said that health insurance companies shouldn't have to pay for amniocentesis because it was used to encourage abortion. Santorum's position was extreme ten years ago. Arkansas is one of a number of states that prohibit insurance companies from offering policies that cover abortion.

The use of expensive genetic testing for people who can't pay for it out of pocket would result in a lower standard of care for people who live in abortion-friendly states. The chance to prevent the birth of a child with a genetic condition is lost by some. The chance to prepare for the birth of a child with special needs is lost by others who would not have terminated.

PreNatal genetic counseling is hard to find even for those who can afford it. The strain of working in an environment in which they could not help their patients as they once did made it difficult for the genetic counselors from Texas to serve their patients. In an e-mail to Scientific American, a counselor from Dallas wrote that she was worried for days about not giving information to a patient who asked for guidance on finding an abortion clinic out of state. She was concerned about whether what she had said could be seen as aiding or abetting.

There is a limited amount of genetic counseling available. Demand is outstriping supply in a field that is growing quickly. It may be hard to find candidates for positions with fringe benefits. Barringer, who has counseled patients for 25 years, is considering turning her back on the job she loves. I don't know if I'll be able to continue if that happens here. I don't know what I'd do if I couldn't help my patients through some of the worst things they can go through.