LEILA FADEL, HOST:
Louisiana will classify two pills used for medication abortions as controlled substances starting October 1. This is causing panic among medical providers, because one of those drugs - misoprostol - is used to prevent women from bleeding out after giving birth or having a miscarriage.
JENNIFER AVEGNO: It's really a potential matter of life and death.
FADEL: That's Dr. Jennifer Avegno, the director of the New Orleans Health Department. She spoke with me about how the new law impacts medical providers like her.
AVEGNO: Misoprostol is often the first-line medication that is given when a woman is either at risk of having a severe hemorrhage or is demonstrating that she is hemorrhaging. It is safe. It is really easy to administer. And when you are in a patient's room in the labor and delivery suite, things happen very, very quickly. That's why most OBs, most hospitals, have some version of a hemorrhage cart that can be wheeled into the room, ready to go, with easily accessible medications - misoprostol being often the first line.
FADEL: This decision that doctors are going to have to abide by - how does it impact doctors?
AVEGNO: You know, we know that abortion is severely limited in Louisiana, so we're really not talking about abortion here. We are talking about the safe and evidence-based management of miscarriage, of childbirth, of postpartum hemorrhage. And classification of mifepristone and misoprostol as controlled, dangerous substances is scientifically and medically really without merit.
FADEL: Now, under this new law, what changes? I mean, it's being classified as a controlled substance, so in the same vein as drugs like Valium and Xanax, which are addictive drugs. How does this change, and how will doctors have access, if it's a controlled substance?
AVEGNO: Right. Well, that's the real concern. There's many steps that pharmacies have to go through for controlled substances that they don't for other drugs, so we're already hearing of challenges on the outpatient side for women to be able to simply pick up these prescriptions when they need it. On the inpatient side, it's really a potential matter of life and death. Even in the most well-resourced hospital, you will have to have a specific procedure for securing misoprostol, and it's several minutes longer.
FADEL: What does several minutes mean in an emergency situation?
AVEGNO: When you're talking about a hemorrhage, every minute counts. If we're talking about a rural or more of a critical access hospital, where you simply don't have the personnel to go and run to the special cabinet or the special cabinet is on a different floor, that's going to be a lot longer than a couple of minutes.
FADEL: How common and severe is hemorrhaging after childbirth? I mean, this was one of the most common ways that women used to die in childbirth, right?
AVEGNO: Right. And Louisiana has made incredible strides over the last few years in maternal morbidity and mortality from hemorrhage, thanks to really dedicated efforts at the state health department to work with hospitals, to develop protocols. This threatens to erase all of that progress if women now are at higher risk of more bleeding or bleeding out so severely that they die because they couldn't get a medication in time.
FADEL: By limiting access to a drug like misoprostol, does that then risk that these types of deaths will just increase again?
AVEGNO: Absolutely. And, you know, America has one of the highest, if not the highest, rate of maternal mortality of any developed country in the world. How much lower do we want to go? Our physicians just want to follow the law. They are acutely aware that medication abortion prescribed by a physician in Louisiana is illegal, and they're not trying to do that. So it's really trusting physicians who only want to do the right thing for their patients.
FADEL: So what does that mean for providers as they think about how to treat their patients?
AVEGNO: It's just another burden on providers, who are already facing some very restrictive laws in Louisiana that include criminal penalties for doctors if they are found to be providing abortions. You know, I'll tell you, the OBs and the providers that I talked to - they are not trying to provide illegal abortions. All they want to be able to do is safely care for their patients using the best practices they were trained on. You know, the chilling effect that our providers have been under since the original law was passed has only gotten colder.
FADEL: That's Dr. Jennifer Avegno, director of the New Orleans Health Department. Thank you so much for your time.
AVEGNO: Thank you, Leila. Transcript provided by NPR, Copyright NPR.
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