Iowa’s medical board adopts abortion rules if law is upheld

DES MOINES — Iowa’s medical board approved some guidance Thursday that abortion providers would need to follow if the state’s ban on most abortions after about six weeks of pregnancy is upheld by the Iowa Supreme Court.

The restrictive abortion law is currently on hold as the court considers Gov. Kim Reynolds ' appeal of the lower court’s decision that paused the crux of it. But the medical board was instructed to continue with its rulemaking process to ensure physicians would have guidance in place if the court allows the law to take effect.

While the board’s language outlines how physicians are to follow the law, the specifics on enforcement are more limited. The rules do not outline how the board would determine non-compliance or what the appropriate disciplinary action might be. Also missing are specific guidelines for how badly a pregnant woman’s health would have to decline before her life is sufficiently endangered to provide physicians with protection from discipline.

The new state law would prohibit almost all abortions once cardiac activity can be detected, which is usually about six weeks of pregnancy and before many women know they are pregnant. That would be a stark change for women in Iowa, where abortion now is legal up to 20 weeks of pregnancy.

The rules instruct physicians to make “a bona fide effort to detect a fetal heartbeat” by performing a transabdominal pelvic ultrasound “in a manner consistent with standard medical practice.”

Like many Republican-led efforts to restrict abortion, the legislation is crafted around the detection of the “fetal heartbeat,” which is not easily translated to medical science. While advanced technology can detect a flutter of cardiac activity as early as six weeks’ gestation, medical experts say the embryo at that point isn’t yet a fetus and doesn’t have a heart.

The rules approved Thursday had been revised to include terminology that doctors use, a representative from the Attorney General's Office explained during the meeting. It supplements the law’s definition of “unborn child” to clarify that it pertains to “all stages of development, including embyro and fetus.”

The rules also outline the information physicians must document for a patient to be treated under the limited exceptions carved out in the law.

The documentation should be maintained in the patient’s medical records, enabling physicians to point to the information, rather than rely on memory, and thus avoid a “battle of witnesses” in the event that “someone gets brought before the board,” the attorney general’s representative said.

The law would allow for abortion after the point in a pregnancy where cardiac activity is detected in the circumstances of rape, if reported to law enforcement or a health provider within 45 days; incest, if reported within 145 days; and fetal abnormality.

In the circumstance of fetal abnormality, the board specifies physicians should document how they determined a fetus has a fetal abnormality and why that abnormality is “incompatible with life."

The law also provides for an exception for “medical emergency,” which includes pregnancy complications endangering the life of the pregnant woman and cases in which “continuation of the pregnancy will create a serious risk of substantial and irreversible impairment of a major bodily function of the pregnant woman.”

But the board did not provide any additional guidance on just how imminent the risks must be before doctors can intervene, a question vexing physicians across the country, especially after the Texas Supreme Court denied a pregnant woman with life-threatening complications access to abortion.

Most Republican-led states have drastically limited abortion access since the U.S. Supreme Court overturned Roe v. Wade and handed authority on abortion law to the states. Fourteen states now have bans with limited exceptions and two states, Georgia and South Carolina, ban abortion after cardiac activity is detected.

Four states, including Iowa, have bans on hold pending court rulings.