Idaho’s latest abortion ruling adds to confusion

By Cynthia Dalsing
Reader Contributor

Is anyone else experiencing whiplash as yet another ruling about abortion access in Idaho has been decided? I follow these rulings closely given that I’ve worked in obstetric clinics and labor and delivery for 40 years. I still have to check the latest decision to find my footing. 

Decisions about our health care are personal. With the Dobbs decision, the personal has become everyone else’s business. Court rulings, like the recent decision by Idaho U.S. District Judge B. Lynn Winmill is no substitute for established standards of care. The best maternity care cannot function well when physicians and patients operate under rules that keep changing with every court decision

The recent ruling by Winmill stating that the Constitution protects a pregnant woman’s life and health, can be seen as a victory — of sorts. It means that a physician can provide the medical care they were educated to provide. His decision also addresses a woman’s life and health — this is new. 

It states a physician can consider (without threat of criminal action by the state) a woman’s mental health when continuing a pregnancy could result in death from “self-harm.” The Maternal Mortality Review Committee that examines why women in Idaho die during pregnancy, or the year following, has consistently found that half the cause of maternal deaths in Idaho was due to mental health conditions. Allowing a physician to also consider a woman’s mental health when providing care could save Idaho women’s lives. It does not address access to mental health care, obtaining counseling and the cost. 

This ruling will be immediately appealed by Idaho Attorney General Raúl Labrador, once again throwing health care for women into the mixer. Once again, women are being jerked around by Idaho’s legislative and judicial branches. Once again, physicians will be reluctant to move to Idaho. Once again, access to obstetric care is being determined by our zip code.

An important aspect of Winmill’s ruling is it does not allow for a safe and personal decision to be made for a pregnancy with a nonviable diagnosis. 

I’ve witnessed unimaginable and heartbreaking births where a baby has a fatal diagnosis and is either stillborn or dies shortly after birth. I spent 40 years watching obstetric medicine become better at identifying risks and complications during my nurse-midwifery education. When I started, we didn’t even use ultrasounds. Prenatal care relied on skilled providers; regular, accessible prenatal care; close monitoring of milestones; and an intact referral system. Much less was known about the development of the fetus. 

Now, however, with high-resolution ultrasounds, genetic testing and improved prenatal care we have the ability to diagnose a baby or a mom at risk of developing a serious and possibly fatal medical complication. Earlier diagnoses, while stressful, can assist the mother and her family to make an informed decision about how to safely proceed with her pregnancy. 

With Winmill’s decision, women still have to travel out of state to intervene in a pregnancy that has a catastrophic outcome. It’s cruel to expect a woman who receives a devastating diagnosis to learn that her trusted physician cannot provide the care she needs in her community. 

Frequently women are left to navigate this whole process by themselves, without aid from the health care system. Women are plucked away from their community support system and frequently juggle travel, child care and costly health care. All of this happens on a tight time schedule that dictates where she can go and what type of care she can obtain. 

Some women actually end up going through this horrendous experience in a hotel room or by the side of the road in a “no cell” service location — alone and at risk. 

This is not “simply” a trip to Salt Lake City, Portland or Seattle. This uproots a woman and her family. She enters an unfamiliar health care system to walk her through one of the most difficult and traumatic experiences of her life. 

Currently Idaho has competing arguments for attention: interference with physician care, mental health treatment, fatal fetal diagnoses, out-of-state travel, physician departures and Proposition 1. 

Prop. 1 (the Reproductive Freedom and Privacy Act) can correct legal conditions affecting maternity care. It cannot return our maternity care to a well-organized system with the goal of decreasing maternal death and morbidity. It cannot undue the harm that the Dobbs decision inflicted on Idaho’s obstetric care and the people of Idaho. It cannot return our physicians. All of that will take years.

Cynthia Dalsing, MSN, is a retired certified nurse-midwife and Sandpoint resident.