Dr. Sheehan's Testimony in Opposition of LB 626

Nebraska Senate Committee Meeting

February 1, 2023

LB 626 Opposition Testimony by Meghan Sheehan, MD

Thank you, Chairperson and Members of the Department of Health and Human Services, for allowing me to testify today.

My name is Dr. Meghan Sheehan, and I am here to voice my opposition to LB 626.

I specialize in reproductive psychiatry and work with my OBGYN colleagues to help women throughout Nebraska safely achieve their reproductive goals. In addition to the concerns expressed by my colleagues, LB 626 endangers patients specifically by 1) removing psychiatric diagnoses and emergencies from medical emergencies and 2) severely limiting the time we need to help patients make complex and difficult decisions regarding pregnancies. 

According to the CDC, mental health conditions, including suicide and substance use disorders are the leading underlying causes of pregnancy-related deaths (23%). This is no small issue. Women, especially women of color and socioeconomically disadvantaged women, are struggling and dying from mental health conditions and emergencies at rates higher than bleeding complications, infections, cardiac conditions, blood clots, and other, more well recognized pregnancy associated causes of death.

Under section 3b of LB 626, it states that “no condition shall be deemed a medical emergency if based on a claim or diagnosis that the woman will engage in conduct which would result in her death or in substantial and irreversible physical impairment of a major bodily function.” LB 626 removes psychiatric illnesses and emergencies from medical emergencies as exemptions to the abortion ban. This both discounts the seriousness of these illnesses and puts into question the veracity of mental illnesses being medical illnesses.

Forcing the continuation of an unwanted pregnancy in the face of serious mental illness and suicidality is not just a legal and ethical issue, but from my own professional experience, it is a logistical issue for which our state is ill prepared.

For example, a woman who was denied an abortion, walked into a field with a knife and a one piece swimming suit in a backpack. She was found with lacerations across her abdomen and was planning to remove the fetus and use the swimsuit to bind her self-inflicted wound. She was psychotic and persistently suicidal. She was hospitalized in the only inpatient perinatal psychiatric unit in the country at the time and was held until she delivered several weeks later. The baby was taken by the state, as were her other children, and though she was not suicidal or psychotic at the time of discharge, she died from suicide about a year later.

This example is not isolated, or even infrequent, as we know from the CDC data on mental illness and suicide in pregnancy. Hospitalizing patients who are suicidal and/or have other emergency mental health conditions until they deliver is not something Nebraska has the capacity to do. Psychiatric hospitals will not accept patients for whom delivery is imminent, or who have medical complications related to pregnancy, or who are at risk of self harm requiring emergency medical care for a fetus or mother. Obstetric floors will already be overcrowded and will not be able to safely house suicidal and mentally ill patients for long periods of time. When these cases arise now, it causes immense disruption and safety issues for staff and other patients.

I have sent women from Nebraska to that unit for treatment of postpartum psychosis and depression. One woman, a physician with no past history of mental illness, started to have terrifying thoughts of hurting her children and auditory hallucinations. She was able to be treated acutely, then eventually stabilized without the need for antipsychotic medication. She later returned to my care after learning she was 8 weeks pregnant. Fortunately, we were able to make medical decisions that were best for her and her family. That time is what BL 626 prevents and in doing so, it puts patients and families at risk. 

The care of pregnant patients is much more complicated than can be addressed by legislation that uses an arbitrary embryologic development as a cut off for abortion while simultaneously and erroneously taking the brain and its diseases out of consideration of medical emergencies. LB 626 will lead to increased mental illness, irreparable generational trauma, increased children with immense care requirements due to exposures, neglect, and abuse, further healthcare and social inequities, and increased tragedies including deaths from suicide, homicide, and infanticide. These are not outcomes that protect and value the lives of Nebraskans.

Thank you for the opportunity to speak today and I ask for you all to oppose LB 626.