Louisiana hospitals have locked up a key drug used to stop women from bleeding out after giving birth as a new state law takes effect Tuesday.
The law, named Act 246, classifies two common pregnancy medications, mifepristone and misoprostol, as controlled dangerous substances. The drugs have many uses, such as treating ulcers or miscarriages and inducing labor, but they can also induce abortions.
The Schedule IV classification comes with added restrictions and surveillance on how doctors can prescribe the drugs.
Hospitals are being forced to lock up the drugs in secure cabinets. Doctors say that could lead to dangerous delays in accessing misoprostol to treat hemorrhaging after birth. Prior to the law, some hospitals used to keep the drug on obstetric hemorrhage carts or in labor and delivery rooms, within arm’s reach of staff caring for women in labor: Some nurses walked around with it in their pockets.
“Somebody's just bleeding profusely, and at that point, if it takes even two minutes to access that medicine versus 20 seconds that it used to take when it was on the hemorrhage cart in the room, those seconds matter,” said Dr. Nicole Freehill, a New Orleans OB-GYN.
Women can lose blood quickly, she said, and could need blood transfusions or surgery to stem the bleeding if they’re not treated within minutes. Uncontrolled hemorrhaging is one of the leading causes of maternal death in the U.S.
Dr. Jennifer Avegno, the director of the New Orleans Health Department, said doctors are running drills to see how much longer it will take them to get the drug from locked cabinets or pharmacies.
Doctors warn of risks to women’s health and lives
The law is “a nuisance at best, and fatal at worst,” said Dr. Jane Martin, a maternal-fetal medicine specialist in New Orleans. She noted misoprostol is one of the first medications doctors reach for to treat postpartum hemorrhage.
On Monday, the American College of Obstetricians and Gynecologists, which represents 60,000 OB-GYNs across the U.S., denounced the law as “legislative interference in the practice of medicine.”
“Scheduling mifepristone and misoprostol as controlled substances demonstrates that opponents to abortion will risk the lives of all pregnant patients, even those who need obstetric and gynecologic care,” said ACOG president Stella Dantas.
In commentary published by MSNBC Monday, Louisiana’s leading expert on maternal health, Dr. Veronica Gillispie-Bell, warned the law "endangers" women and raises the risk they "will bleed out after childbirth.” She first criticized the law in an interview with WWNO/WRKF, calling it part of a “slippery slope” of interference with doctors’ ability to use best medical practices to care for women.
Gillispie-Bell reviews every maternal death in Louisiana and leads a team that works to improve maternal and infant health in the state. Their work has reduced the number of women who die from postpartum hemorrhage, she said.
“I do have a concern that this law is going to interrupt some of the work that we have done to try to improve our maternal outcomes,” Gillispie-Bell told WWNO/WRKF.
Supporters argue law protects women’s health
Republican Sen. Thomas Pressly introduced the law to increase criminal penalties for anyone who gives women medications to induce an abortion against her knowledge or consent, which happened to Pressly’s sister in Texas.
In the final committee hearing on the bill, Pressly added an amendment to make mifepristone and misoprostol controlled dangerous substances. Over 270 doctors who heard of the amendment after it passed the committee wrote a letter to lawmakers urging them to drop it, saying it would harm women’s health.
Pressly and Louisiana Right to Life, which helped craft the law, said the amendment would help crack down on abortion pills being mailed into Louisiana from out of state. According to Louisiana Right to Life, crisis pregnancy centers have received calls from women who took pills they ordered online and had questions about their symptoms.
“It was crafted for the protection of women. That was the goal of the legislation,” said Sarah Zagorski, Louisiana Right to Life’s communications director.
Zagorski said she’s aware hospitals are having to change how they store these drugs.
“With any law taking effect, there's going to be changes in procedure that have to happen,” she said.
She referred doctors to guidance released by the Louisiana Department of Health and a statement from Attorney General Liz Murrill, which said hospitals have “maximum flexibility to access these medications if they are needed.”
Doctors told WWNO/WRKF that the health department’s guidance and Murrill’s statement did not change the requirements for all controlled substances under Louisiana law to be stored in “a securely locked, substantially constructed cabinet.”
Ochsner Health said misoprostol will be stored in its hospitals’ Pyxis medication dispensing machines.
LCMC Health said it had “developed processes in collaboration with physician and nursing leaders, pharmacists, and other stakeholders to ensure rapid access to medications to treat hemorrhages related to childbirth that are compliant with the law.”
Pregnant women are exempt from criminal penalties
The New Orleans Health Department will be studying the impacts of the law. Since Louisiana banned nearly all abortions, doctors have seen an uptick in pharmacists refusing to fill prescriptions for misoprostol for patients who are miscarrying.
The health department will track any delays in accessing mifepristone or misoprostol as a result of the restrictions.
As of Oct. 1, anyone caught with mifepristone or misoprostol without a valid license could face up to 10 years in prison. But pregnant women are exempt from any criminal penalties. That means that those who order pills online to give themselves abortions won’t be imprisoned under the law. A 2022 study found that online requests for abortion pills spiked after the state enacted its near-total abortion ban.
One Louisiana maternal-fetal medicine specialist described the new law as “just another example of a political attack on women.” It will make misoprostol more difficult to get in the legal health care system, he said, but he argued it won’t do what advocates say it’s supposed to: stop the influx of abortion medications.
“It’s so stupid,” he said. “You can still go online and order it from another state. It accomplishes nothing.”
