Jewish OB-GYN in Phoenix sees a perilous future for her pregnant patients:

vaginal lacerations.

The baby died soon after the birth. It was one of the worst deliveries Contant oversaw — and it didn’t have to happen.

“I circled back with the provider who had taken care of this patient during her pregnancy and I asked why she was never given the option to terminate or made to understand what would happen during met, the Arizona Court of Appeals issued a stay enjoining the 1864 ban temporarily and leaving the 15-week abortion ban in place. On the final Friday of 2022, the same court ruled unanimously that the 1864 ban could not be enforced. The new Democratic Attorney General Kris Mayes will not appeal the ruling, which means the 15-week ban is the law of the land.

It turned out the OB-GYN in question was a devout Catholic whose faith kept him from giving all the information to his patient. However, he well knew that anencephaly is an anomaly that’s not compatible with life outside the uterus.

This scenario and others like it weigh heavily on Contant, especially with the lack of clarity surrounding abortion restrictions in Arizona following the U.S. Supreme Court’s reversal of Roe v. Wade, the case that legalized abortion nationally, in June. Abortions in the state dropped 53% the month following the decision, according to Axios’ #WeCount/Society of Family Planning.

Gov. Katie Hobbs, who had planned to hold a special session on her first day in office to repeal the 1864 ban before the court handed down its decision, said she is determined “to restore reproductive freedom” by striking down the “restrictive and backwards” 15-week ban. Before 2022, abortion was legal in the state until viability, typically 23 weeks or 24 weeks. However, to reach a majority for any new abortion legislation, the new governor would need two Republican votes in each chamber of the GOP-led Legislature.

Hobbs said that voters may ultimately need to figure it out for themselves with a ballot initiative, something advocacy organizations are working on for 2024. But that takes money, coordination and voter education.

Contant is committed to educating people about what is at stake and why abortion rights advocates insist that abortion is health care. She pays close attention to politics and views abortion rights as a litmus test for candidates, even though for years she was pooh-poohed by some of her family who thought Roe would never be overturned.

“Republican family members told me, ‘it’s never going to happen,’ but being so close to women’s care, women’s choices and living in Arizona, I’ve known it’s been threatened, and in the last 10 years, I’ve really seen the anti-choice movement become very cunning and undermining,” she said.

Over the course of a 29-year career as an OB-GYN, one horrific delivery still haunts Dr. Tracy Contant.

Roughly 20 years ago, not long after moving to Phoenix, she was faced with a patient delivering a baby with anencephaly, a condition that prevents brain and skull development. Even if an anencephalic infant survives the birth, its death is imminent.

When a baby comes through the birth canal, its head is usually first and serves as a dilating wedge, spreading tissue to make way for the rest of the body. But when babies don’t have a fully-developed brain and skull, after the head comes through, the shoulders can get stuck.

That’s what happened to the woman in front of Contant. She had “the most horrible, lengthy shoulder dystocia” and in order to deliver the baby, Contant and her team first had to maneuver its shoulder out and then the rest.

“It was frantic,” Contant said. “The mother didn’t understand what was going on. Her regular OB-GYN never fully explained the condition or that she could terminate the pregnancy. She thought that if she didn’t deliver promptly, that was going to be what caused the baby to die.”

The patient’s pubic symphysis was cracked in the process of disengaging the baby’s shoulder, and the rest of the delivery left the woman with horrible

Though Gov. Doug Ducey signed SB1164, a 15-week abortion ban early in 2022, Arizona Attorney General Mark Brnovich went to court in August to lift the injunction on the state’s 1864 total abortion ban. On Sept. 23, Pima County Superior Court Judge Kellie Johnson ruled in his favor.

The Civil War-era ban outlawed all abortions except in cases of preserving the life of the mother. However, the determination of whether the woman’s life is in danger was left to “the physician’s good faith clinical judgment.” This unclear metric confused doctors and clinics who didn’t know whether they could perform a potentially life-saving procedure for fear of legal ramifications; abortion providers throughout the state largely shut down.

On Oct. 7, six Greater Phoenix rabbis led an interfaith clergy prayer circle “to call attention to the draconian laws that are happening in Arizona,” Rabbi Bonnie Sharfman, president of the Greater Phoenix Board of Rabbis, told Jewish News.

Contant, who works at Valleywise Health Medical Center and is a Congregation Beth Israel congregant, came to lend her support. “I want to be part of something bigger than myself when I advocate for women every day,” she said.

Just hours after the religious leaders

Now, during every visit she advises her patients to be on prenatal vitamins or reliable contraception if they’re of childbearing age and sexually active, even when they’re coming to see her for a completely separate issue.

“‘Are you on birth control? Do you need to be?’ I ask them. I make a plug for it,” she said.

For those uninterested in contraception, in particular, she talks about prenatal vitamins and tells them, depending on where the legislation goes, they may not have the option for an elective termination and they need to do everything possible to make sure it’s a healthy pregnancy.

“That was a real conversation that I started emphasizing this summer with a little bit more passion,” Contant said.

Most people who seek an abortion for an unwanted or unplanned pregnancy do so early. In 2019, 93% of abortions occurred during the first trimester — at or before 13 weeks of gestation — according to the CDC. An additional 6% occurred between 14 and 20 weeks of pregnancy, and 1% were performed at 21 weeks or later.

Women who wait longer than 15 weeks likely don’t have the resources to get to an abortion provider or don’t discover a significant anomaly until later. Contant has pregnant patients who fear what will happen if they get bad news at 16 weeks or later.

“The impact on a woman who is faced with a lethal or significant fetal anomaly can be devastating. It shakes me to the core that I may not be able to help someone or heal someone. That’s what’s on the line,” she said.

For example, it’s not uncommon for people in the second trimester to have a rupture of membranes and patients can end up with a significant infection, she said.

The road to a life-threatening infection is a slippery slope, and she contends that many OB-GYNs would say that if someone has an infection in the membranes of the fluid around the baby, that pregnancy needs to be concluded. If a pregnancy is less than 24 weeks, it needs to be terminated for the safety of the mother. If it’s over 24 weeks, it needs to be delivered to protect the mother and because the infected baby is better off on the outside getting antibiotics.

There’s a risk that the blood supply to the uterus and the placenta can cause a life-threatening infection quickly, and the patient could die or lose her uterus.

“I’ve seen that happen and it’s horrible,” she said. “Who gets to decide when someone has tipped over to an infection that may be serious enough? That’s a big issue.”

She regularly counsels patients about genetic screening and they fall into one of three categories: They won’t terminate whatever the findings so they don’t want to know; they won’t terminate but want to know, to be prepared; or they likely would terminate if there’s a problem.

Contant sees her role as providing the information and supporting a patient’s decision. Some of her patients decide to carry atypical pregnancies — Down syndrome, Edward syndrome, significant you can or cannot do with your own body is not right,” she said.

Contant is also an assistant clinical professor at the University of Arizona and Creighton University in Phoenix, where she teaches new generations of OB-GYNs.

She’s had students who have refused to participate in terminations on a religious basis, even a resident physician who declined to assist in the termination of weren’t getting comprehensive answers to routine questions. cardiac anomalies, etc. — to term. They have been some of the strongest women she’s ever met and their children will be well loved, she said.

With all of the fear caused by the vicissitudes of abortion accessibility, she would still choose to be an OB-GYN if she were entering medical school now. The only thing she would change is to be more politically involved from the beginning. In the days leading up to Rosh Hashanah, she decided she would be more vocal in her advocacy, even though that doesn’t come naturally.

That’s why she agreed last month to speak to a gathering of more than 100 Jewish women distressed over the state of abortion rights. She shared her experience with patients and exhorted attendees to read every abortion bill put forward by the Legislature closely, being sure to check the science or lack thereof.

Contant is certain her hospital would support her if she were to testify in front of the Legislature because she would be relaying “reasonable and prudent” medical facts.

“If someone chooses not to terminate a pregnancy, I support them. If someone chooses to go to the brink of death, while pregnant, I support them. I will support everybody, so why not let people choose what is good for them and their families?”

That goes for patients past childbearing age and those who have not even begun to think about whether they want to be parents.

“Not having the right to choose what an ectopic pregnancy that would have killed the mother and the fetus. Instead, he stepped away from the table.

“It’s my job to advocate for women, and students need to do some real selfexamination as to where their religious beliefs come into contact with caring for patients. If I educate one student, they’re going to educate the others,” she said.

She has fond memories of her own days as a med student, when she fell in love with her specialty. It encompassed her love of problem solving, working with her hands, surgery and answering women’s questions. She was unnerved by how many women

This fall, she was comforted somewhat when the American Medical Association, a historically conservative group, adopted new policies opposing restrictions on abortion, including new ethical guidance explicitly allowing physicians to perform the procedure in keeping with “good medical practice” even in states that ban it.

Contant also wants future medical students to know that being an OB-GYN is unique.

“I’m not just treating a condition; I’m treating a person. I guess you can say that about any specialty but this touches people differently because so much of who we are is tied to our female parts. People let me into their lives and it’s a privilege.” JN