LINCOLN — Gov. Jim Pillen spent Tuesday seeking to explain how Nebraska physicians should care for ectopic pregnancies and miscarriages while wading into the waters of competing abortion-related ballot measures.

Pillen did not directly refer to either ballot measure at a news conference he held with four medical providers, Lt. Gov. Joe Kelly and the state chief medical officer. State law prohibits elected officials from directly using state resources for campaigning. Pillen held his press conference in the governor’s hearing room at the State Capitol. 

But the group made clear they were speaking against a “political agenda for abortion.” 

They said they were seeking to fight “misinformation” about ectopic pregnancies or miscarriages, but they repeatedly declined to specify where they had heard the “misinformation” other than “in media” and “on TV.”

Ads promoting the abortion-rights ballot issue offered by Protect Our Rights feature doctors who say Nebraska patients struggle to get certain types of care for nonviable pregnancies or in emergency situations. 

“To be clear, crystal clear, under current law, a woman in Nebraska can obtain care for miscarriage throughout her entire pregnancy,” Pillen said. “It is unconscionable for anyone to claim otherwise.”  

Nebraska is the first state nationally where voters will weigh two competing abortion-related constitutional amendments this general election:

• Initiative Measure 434, offered by Protect Women and Children, seeks to prohibit most abortions after the first trimester.
• Initiative Measure 439, offered by Protect Our Rights, seeks to allow abortions up to the point of fetal viability, as determined by the treating health care provider.

Both campaigns have spent millions in advertising.

‘Desperate misleading propaganda’

Sponsors and backers of the abortion-rights constitutional amendment, from Protect Our Rights, said the timing of Pillen’s news conference seemed “absolutely intentional.” In a statement, the campaign derided the event as “desperate misleading propaganda.”

Dr. Emily Patel, a maternal-fetal medicine specialist in Omaha, was one of four medical providers who took part in a counter event later Tuesday organized by Protect Our Rights.

Patel said pregnancy is a high-risk condition that can threaten the life of expecting mothers, cause infertility or lead to death.

Patel told the Nebraska Examiner that Pillen’s event raised multiple “red flags” by focusing on current law without specifying where the “misinformation” came from. She said she and other supporters of the abortion-rights ballot measure have spent their own time combating information about their campaign.

“Being truthful with patients, to me, means giving them all the options that are available to them,” Patel said. 

Dr. Catherine Brooks, a neonatologist who supports the abortion restrictions amendment by Protect Women and Children, said “fetal viability” has no clear medical definition and is “a gray area” for providers.

“Women expect precision from their health care professionals, but fetal viability has no precise definition,” Brooks said in a statement. “[Initiative] 439 is not medically acceptable.”

The current 2023 law prohibits most abortions after 12 weeks gestational age, or at the end of the first trimester, during which most abortions are performed.

The current scientific standard for fetal viability is at about 22-24 weeks gestation.

‘The confusion is out there’

Dr. Timothy Tesmer, the state chief medical officer, said his duty is to ensure that the medical community understands clearly what the law means.

“The confusion is out there,” Tesmer said. “Not only with patients in the public, but also with medical providers.”

Current state law, adopted in 2023, included explicit language protecting treatment of ectopic pregnancies, and Tesmer said most questions he fields from medical providers relate to the exceptions language. He noted that the Nebraska Department of Health and Human Services offered guidance on exceptions at least once in spring 2023, when the Legislature was debating a near-total abortion ban. 

Tesmer said in vitro fertilization is allowed under current state law. 

Lt. Gov. Kelly said the law includes no criminal penalties for doctors, and Tesmer said no Nebraska doctor’s license has been sanctioned or revoked since LB 574 took effect in May 2023.

“If they follow the law and exercise their reasonable medical judgment, there are no adverse consequences to their medical license,” Tesmer said.

Pillen encouraged any Nebraska women who have been told by a medical professional that they can’t receive care for miscarriages or ectopic pregnancies to reach out to DHHS.

Tesmer said he has heard no complaints from women about access to care. If physicians have questions, he said they should reach out to their legal representatives or to DHHS.

Possible delays in care?

Patel said Tesmer’s answer illuminated some of the concern doctors are feeling. She said asking for legal advice could delay care.

“At 2 a.m. on a Sunday, that’s not the kind of situation that you want your doctor to be in when you’re in a life-threatening situation,” Patel said.

Dr. Elizabeth Constance, a reproductive endocrinologist in Omaha, said the governor’s news conference often conflated care for miscarriages and ectopic pregnancies with treatment for patients with non-viable pregnancies.

“There is no confusion about whether this [miscarriages] can be managed,” Constance said.

Constance said if voters adopt the abortion-restrictions ballot measure offered by Protect Women and Children, there would be no way later to add other exceptions. That could include lethal fetal anomalies, or conditions that physicians decide will result in an infant’s death at or shortly after birth.

Tesmer said he would leave any decision on fetal anomalies to the Legislature.

‘A walking coffin’

Kimberly Paseka of Lincoln took part in the event supporting the abortion-rights measure and is appearing in ads for Protect Our Rights.

Paseka said Tuesday she miscarried early on in her first pregnancy and had a tough second pregnancy before giving birth to a healthy boy in 2021. Then last year, she was pregnant for a third time, and while she said she was fearful after the U.S. Supreme Court overturned Roe v. Wade in 2022, Paseka and her husband, hoped for the best.

Partway through her pregnancy, facing a diminishing fetal heartbeat, Paseka’s doctor sent her home for “expectant management,” meaning her condition would be closely monitored,without providing treatment, unless symptoms changed.

By then Paseka’s pregnancy was past the 12-week abortion limit. She said her doctor didn’t act because of confusion over LB 574. She described having intense pain and contractions that took a heavy toll on her mental and physical state, until she lost her baby at home.

“The tough part was knowing that my health wasn’t in immediate danger, but I had to wait for death to happen inside me,” Paseka said.

“I use the term ‘like a walking coffin,’ and I don’t know how to explain it any better than that, that it’s just waiting,” Paseka continued. “You’re just, you know death is happening, but there’s nothing you can do about it.”

In her fourth pregnancy, Paseka said, she got an abortion after facing complications early on, which she said gave a sense of control over her own care.

The standards of care

The physicians who joined Pillen said they have been with women in their worst moments but feared that some of the rhetoric being used in the current political campaigns would discourage some women from seeking care.

For example, Dr. Richard Wurtz, a family medicine doctor with a specialty in obstetrics, said when faced with challenging medical situations, physicians “step up to the plate” and “rise to the challenge.”

He said current law ensures that life is respected and that women get proper care.

“Anyone who says this is not the case is not telling you the truth,” Wurtz said. “This is predicated on sound medical practice and on sound law.”

The physicians with Protect Our Rights said other more restrictive laws nationwide have harmed women or access to IVF. They said they oppose any impediment to care.

Patel said physicians will support patients no matter what path they choose.

“I think it’s really important for people to understand that we are not pushing a patient toward a termination or an abortion,” Patel said. “We are simply providing them with that option because that is what our standard of care is as obstetricians.”