Healthcare providers caring for pregnant patients in the months after the US Supreme Court’s decision to strike down Roe v Wade have been unable to provide standard medical care in states where abortion is effectively outlawed, leading to delays and worsening and dangerous health outcomes for patients, according to an expansive new report. In the wake of the Supreme Court’s ruling last year, individual reports from patients and providers have shed some light on the wide range of harm facing pregnant women in states where access to abortion care is restricted or outright banned. But a first-of-its-kind report from the University of California San Francisco captures examples from across the country, documenting 50 cases in more than a dozen states that enacted abortion bans within the last 10 months, painting a “stark picture of how the fall of Roe is impacting healthcare in states that restrict abortion,” according to the report’s author Dr Daniel Grossman. “Banning abortion and tying providers’ hands impacts every aspect of care and will do so for years to come,” he said in a statement accompanying the report. “Pregnant people deserve better than regressive policies that put their health and lives at risk.” The report collected anonymised narratives from providers who observed complications facing their patients. The most common scenario involved preterm pre-labor rupture of membranes (PPRM), in which the amniotic membrane surrounding the fetus breaks. In several of the cases, patients developed a severe infection, including cases that put patients in hospital intensive care units. Patients in many cases were instead sent home and told to return to a hospital when labor started or when they experienced signs of an infection. In one case, a patient returned to a hospital’s intensive care unit two days after her water broke at roughly 16 to 18 weeks of pregnancy in a state where abortion is banned. “The anesthesiologist cries on the phone when discussing the case with me,” the physician wrote, according to the report. “If the patient needs to be intubated, no one thinks she will make it out of the [operating room].” The report notes that “miraculously” the patient survived. Following the termination of the pregnancy, the patient asked the doctor whether any of them broke the law. “She asks me: could she or I go to jail for this?” the doctor said, according to the report. “Or did this count as life-threatening yet?” Providers also described other cases where patients showed evidence of inevitable pregnancy loss, but their care teams had their “hands tied” under state laws. Health providers also submitted stories of patients experiencing ectopic pregnancies. Delays to treat one patient resulted in a ruptured ectopic pregnancy that required surgery to remove her fallopian tube. Another patient was denied an abortion for a Caesarean scar ectopic pregnancy, a life-threatening condition where a pregnancy implants in the scar of a prior Caesarean section. Other physicians reported the inability to treat patients with fetal anomalies and patients who faced delays receiving treatment for miscarriages. “Unfortunately, this report confirms that our fears about abortion bans are valid,” said Dr Chloe Zera, a maternal-fetal medicine specialist and associate professor at Harvard Medical School. “As someone who cares for patients who have high-risk pregnancies, I need to be able to provide care consistent with evidence-based guidelines,” she said in a statement accompanying the report. “This research underscores the completely preventable harm that is now happening to our patients because of barriers to abortion care.” The report also outlines the moral dilemmas facing physicians operating in states or treating patients from states that have outlawed the potentially life-saving care they previously provided. Some physicians said they were considering quitting or relocating, or noted the immense coordination required between health providers in multiple states to treat patients, and outlined the ways in which restrictive state laws have complicated other care unrelated to abortion. In one case, a physician refused to remove an intrauterine device for a patient who was between 10 and 12 weeks pregnant, despite the partially expelled IUD posing a risk for infection or miscarriage. “The doctor did not feel comfortable” removing the IUD, one physician wrote, according to the report. “The context provided was concern over the recent changes in law that create [the] possibility for felony charges for providers causing abortion in our state shortly after the Roe decision was overturned.” During a “heated exchange” among health providers, “the doctor [said] the patient had... been examined by the nurse practitioner, who was unable to visualize the IUD, and that ‘even if I could see it and it was easily removable, I wouldn’t remove it because of the law,’” according to the physician’s description in the report. “Abortion bans that block providers from offering standard medical care have the greatest impact in states like Texas that have some of the poorest indicators of maternal health,” according to Dr Kari White, lead investigator of the Texas Policy Evaluation Project at The University of Texas at Austin. “Pregnant people should be able to rely on their healthcare provider to provide the best possible care, regardless of where they live,” she said in a statement accompanying the report. More than a dozen states, mostly in the South, have effectively outlawed or severely restricted access to abortion care after the Supreme Court’s decision in Dobbs v Jackson Women’s Health Organization last June. Read More Alabama Republicans would charge abortion patients with murder under proposed legislation Louisiana Republicans refuse rape and incest exceptions to state’s sweeping anti-abortion law North Carolina governor vetoes 12-week abortion ban, launching Republican override showdown A Texas man sued his ex-wife’s friends for allegedly helping her with an abortion. Now they’re suing him Supreme Court preserves abortion drug approval as legal case plays out

A 27-year-old woman with a rare genetic disorder who could only identify with Mickey Mouse while growing up due to the shape of the Disney character’s hands is trying to be the role model she never had as a social media influencer, to show people with disabilities they are “fully worthy and capable” of achieving anything. Rochelle Muir, who lives in Colorado, was born with ectrodactyly, which means she has three fingers and a thumb on each hand, two toes on her right foot, and four toes on her left foot. The condition causes difficulties in buying footwear, and with relationships – with one of her ex-boyfriends splitting up with her due to the possibility of their child being born with ectrodactyly – but she is now happily partnered with Charles, 31, a primary school counsellor who, along with her father Bill, is her “biggest cheerleader”. Rochelle, who is a client engagement manager for a healthcare company, could identify with characters such as Mickey Mouse growing up as he also has four digits, but she said “being like a cartoon is not exactly the role model you want”. She now posts pictures and videos on her social media platforms to educate others about ectrodactyly, raise awareness of the limb difference community, and share her hobbies, including gaming. “I remember specifically always loving the characters which had brown hair whenever they were in Barbie movies because I thought, ‘Oh, she’s like me!’,” she told PA Real Life. “But I never had that feeling when it came to my limb differences.” Rochelle has never let the disorder hold her back despite being teased and bullied at school, but when she entered the dating world in her 20s, she faced rejection multiple times and felt she was not “capable or worthy of having an amazing relationship”. “I’ve never been rejected over something that I couldn’t change about myself, something I was born with, and that was probably the first hit to my confidence with my limb differences where I felt awful about being born the way I am, about being disabled,” she said. “I just thought, I’m never going to find a meaningful relationship, I’m not worthy, I’m not capable, and that was the dialogue that kept going through my brain over and over again.” Rochelle has since removed “that nasty little voice out of (her) head”, found love with partner Charles, and shared her story publicly on social media, as she wants to “uplift” others among the disability community and show the world that “disabled is not a dirty word”. She said she is no longer “worried about showing (her) true self” and wants to encourage others to do the same. “Most people usually point out the negatives, but there are so many great positives with going and finding other people that look like you, other people you can connect with, and just creating this amazing community where you can uplift each other,” she said. “That’s one of the things I love about social media so much because when I came out about my limb differences, other people reached out and said, ‘Hey, I look exactly like you, this is so exciting, I’ve never seen anyone else that has the same hands as me’. “So it’s one of my favourite things now – and, yes, it’s sad that we didn’t have that growing up, but at least it’s there now and we can have that moving forward.” Ectrodactyly is a rare genetic disorder, and symptoms can vary, the National Organisation for Rare Disorders says. Rochelle underwent surgery to minimise the gap between her fingers and remove the longer toe on her right foot, enabling her to have improved grip and wear shoes from a young age. However, finding the right shoes has been an ongoing challenge and, when she was younger, she could not understand why she could not wear the same shoes as “able-bodied” people. “I remember specifically, there was a time, I think I was about five, that I tried to get my mum to buy me a pair of flip flops – they were pink, and they had butterflies and flowers on them,” she said. “My mum was so heartbroken because she couldn’t fully explain to me, ‘No, you can’t wear these shoes, they are going to be too dangerous for you’. “She eventually just caved and got me the shoes, and we were going up the escalator to go to the next floor in the mall, and I tripped, and we fell. “Ever since then, I’ve thought, I’m going to wear shoes that will stay securely on my feet.” Throughout her life, Rochelle has used humour to “defuse” awkward or uncomfortable situations and to enhance her confidence, but when it came to dating, for the first time in her life she felt self-conscious and “unworthy of having a real relationship”. She remembers one boyfriend who “was like a deer in the headlights” when he saw her feet for the first time, and another who ended the relationship over the possibility of their child being born with ectrodactyly. “He talked to his family, and his mum at the time said, ‘You need to decide whether you want to have kids because if you do, you have to break up with her’,” Rochelle explained. “The relationship ended, and I thought, I can’t blame him, but when I spoke to my friends, they said, ‘You’re amazing. What’s wrong with having a child with a limb difference?’ “That’s when I realised that I had internal ableism, where I told myself that having a disability is awful – ‘you’re not capable, you’re not worthy of having an amazing relationship’.” Ableism is discrimination in favour of able-bodied people – and it was at this point that Rochelle decided she wanted to do something about the lack of representation for people with ectrodactyly on social media. This “lit the fire” in her to share her story publicly for the first time, aged 25, and she has never looked back. Since then, she has launched her own Instagram, TikTok and YouTube channels on which she discusses ectrodactyly, limb differences and other disabilities, along with her hobby of gaming, and she has met Charles. Reading positive comments and messages, including from mothers of children who describe her as “an amazing role model”, has been “heart-warming” and makes her emotional – and she wants to continue to “fight ableism and bring more representation for the limb difference community”. “The biggest thing for me is representation for the limb difference community, but also for other disabilities as well, because the more we have that out there, the more of a norm it will be,” she said. “I want to be that role model, that person I wanted to look for in social media growing up, that person that younger me would be proud of and say, ‘Oh yeah, I know her, she’s so awesome, I’m just like her’. “It’s a younger me that inspires me to keep going forward and talking about these things, and I want to give the message that disabled is not a bad word, it’s not a dirty word, and you are fully worthy and capable of anything you put your mind to.” Find out more about Rochelle and her social media channels at beacons.ai/goodmornindreamer Read More Tempted to try barefoot running? 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Waterloo Road star Adam Thomas has announced he has rheumatoid arthritis ahead of his Strictly Come Dancing debut next month. In an Instagram post shared on 11 August, the actor, 35, told his followers that he initially thought that the condition was something people were diagnosed with “later on in life”. “As much as I act like a kid, my body is telling another story…” he wrote. “I thought that was something people, later on in their life get… but that’s not the case, clearly!” “I’ve been in a lot of pain since January,” he continued. “It started with my knees and then travelled to my wrists, fingers and now ankles and toes.” Thomas explained: “I never knew what was happening and finally after several blood tests and back and forth to doctors and hospitals, I’ve been diagnosed with rheumatoid arthritis!” The actor, who is competing in this year’s instalment of Strictly Come Dancing but has said that he is “up for the challenge”. “It really couldn’t have come at a better time I’m a firm believer of everything happening for a reason, and I know the journey I’ve been on was meant to happen, to never take small things in life for granted!” he assured fans. “…Like going for a run, playing with my kids and just being able to walk with no pain!” “I know it’s going to be tough and I’ve definitely got my work cut out but am up for the challenge and can not wait to get on that dance floor!!” What is rheumatoid arthritis? Rheumatoid arthritis is an autoimmune disease and long-term condition that typically affects the hands, feet and wrists. Benjamin Ellis, a Consultant Rheumatologist and Senior Clinical Policy Advisor to Versus Arthritis (the UK’s largest arthritis charity), told The Independent: “Rheumatoid arthritis affects people of all ages, and happens when the immune system – the body’s natural defence system – goes out of balance and attacks the joints making them inflamed, swollen and painful.” Some people with rheumatoid arthritis also experience problems in other parts of the body, or more general symptoms such as tiredness and weight loss. According to the NHS, the condition often starts when a person is between 30 and 50, and women are more likely to be affected than men. What causes rheumatoid arthritis? The NHS states that it is not clear what triggers this problem with the immune system, but women, people who smoke, and people who have a family history of rheumatoid arthritis are at increased risk. Depending on how much pain a person experiences, their daily tasks can become difficult and take longer to do. Is there a cure for rheumatoid arthritis? There is no cure for rheumatoid arthritis but an early diagnosis and treatment allows people with the condition to have long periods between flare-ups. The NHS states that the main treatment options include taking medicine to relieve symptoms, supportive treatments like physiotherapy and surgery to correct any joint problems. Ellis told The Independent that early treatment can reduce the risk of long-term joint damage. “Urgent and intensive treatments to rebalance the immune system improve symptoms and reduce the risk of long-term, disabling joint damage caused by this inflammation, but NHS delays mean that not everyone is getting the treatment they need, as quickly as they need it,” said Ellis. “Keeping moving is great for the joints, whatever type of arthritis you have. The best thing is to pick something you enjoy, and listen to your body to do the right amount that works for you, whether that’s walking, yoga, swimming or dancing.” What are the complications of rheumatoid arthritis? Having rheumatoid arthritis can sometimes lead to other conditions like carpal tunnel syndrome or inflammation of other areas of the body, causing additional symptoms. The NHS states that some complications can be more serious, like an increased risk of heart attack and stroke. But it advises that managing the condition early on can help to reduce the risk of complications. You can find out more about living with Rheumatoid arthritis on the NHS website here. For further support and information about arthritis, visit www.versusarthritis.org or call the free Versus Arthritis helpline on 0800 5200 520 . Read More Adam Thomas diagnosed with long-term health condition ahead of Strictly Come Dancing Husband ‘ruins’ dinner because of his wife’s typo: ‘The worst kind of control freak’ Fan who went into labour at Pink concert names newborn son after her Adam Thomas diagnosed with long-term health condition ahead of Strictly Come Dancing From Angela Scanlon to Zara McDermott: The fashion of this year’s Strictly contestants Linda Evangelista opens up about co-parenting with son’s stepmother Salma Hayek

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