When the South Carolina Supreme Court this month upheld a ban on most abortions, the majority wrote they would wait another day for a decision on exactly when the fetal heart rate limit begins during pregnancy. Doctors practicing under the strict law cannot answer this question in the same way.

Doctors say the statute’s unclear guidelines are already making medical practice in the few abortion clinics operating in the conservative state chilling. With potential criminal charges looming, most abortions are halted as doctors grapple with the murky legal definitions.

These medical definitions they were trying to put forward are legislated and put forward by people who don’t practice medicine, said Dr. Dawn Bingham, president of the South Carolina chapter of the American College of Obstetricians and Gynecologists, or AGOC. This language creates uncertainty among medical providers, who may not be sure they are legally allowed to terminate a pregnancy.

South Carolina and Georgia are the only two states with such a ban. An Ohio court is considering another, and a six-week ban is pending in Florida.

In South Carolina, the Republican-dominated General Assembly bans abortion after what it calls a fetal heartbeat is identified. The law defines that term as cardiac activity, or the steady and repetitive rhythmic contraction of the fetal heart, within the gestational sac. Medical professionals can usually detect heart activity around six weeks of pregnancy, which is before most people know they are pregnant.

That language is clinically inaccurate according to the medical consensus, which states that such cardiac activity is not a heartbeat and that an embryo at that stage has not yet become a fetus. A 2013 study from the University of Leeds found that the four well-defined chambers in the heart that appear from the eighth week of pregnancy remain a disorganized jumble of tissue until about the 20th week.

South Carolina law requires health care providers to perform an ultrasound on any patient seeking an abortion, display the images, and record a description of the fetal heartbeat, if any. But the judges left a legally undecided question as to whether the cardiac activity and the described rhythmic contraction of the fetal heart relate to the same point or to two separate points during a pregnancy.

From a medical point of view, the ACOG says that electronic impulses indicating heart activity can be recognized early on, but an actual heartbeat cannot be detected using ultrasound until about 17 to 20 weeks gestational age.

Charleston-based gynecologist Jessica Tarleton said the presence of the word or between the terms in the language of the law creates two different definitions and is vague. It always takes lawyers some time to draft advice on any restrictions on abortion, she added.

Defining a structure as a heart would put the definition later in pregnancy than earlier when you would see rhythmic contractions of some kind of heart structure,” she said.

In his dissenting opinion, South Carolina Supreme Court Chief Justice Donald Beatty questioned how doctors and their lawyers could comply with the law without a determination of this important point.

Senate Majority Leader Shane Massey rejected the idea that the definitions lack precise guidelines for medical professionals. He said the state has long required doctors to perform ultrasounds so patients can see the images before having an abortion.

Now it just says that if there’s heart activity on the ultrasound and if you can hear the heart beating, you can’t have that abortion, Massey told reporters Wednesday.

On Thursday, abortion providers filed a petition for a rehearsal based on what they called the ambiguity arising from the definition of fetal heartbeat. While some South Carolinans will continue to be eligible for abortion under the law, Planned Parenthood Attorney Catherine Humphreville predicts widespread confusion following the ruling.

Meanwhile, doctors have been there

Cancel

abortion appointments.

Appointments at a Planned Parenthood location in Columbia have been postponed, according to Dr. Katherine Farris, Chief Medical Officer of Planned Parenthood South Atlantic. The Center for Reproductive Rights reported similar delays at another clinic in the state, and Farris heard the same thing from colleagues in hospitals.

Abortion providers who violate the law could face charges up to two years in prison and the loss of professional licenses. That threat causes them to interpret these kinds of laws very conservatively, Tarleton said, meaning that many abortions have stopped altogether.

In the context of very high penalties, Farris says, the only option for providers is to pause while we try to figure this out.