Physician Response to HB 491

Respected Legislators,

I am a board certified pediatrician with 26 post residency years spent caring for newborns and children.
I co-lead UAB’s Neonatal ICU Follow Up Clinic where we care longitudinally for Alabama’s tiniest NICU
graduates, those born below 29 weeks of gestation. These infants were born at just over one half of a
37-40 week term pregnancy. I hope to shed light on the horrific yet truly hypothetical scenario outlined
in this bill.

Critical to neonatologists and families is a concrete medical definition known as the limit of viability.
This limit defines the standard of care governing resuscitation of extremely preterm newborns. Today,
in Alabama Neonatal Intensive Care units, no infant, even with maximal medical support, can survive if
delivered before 22 in utero weeks. While an infant delivered below this gestational age may briefly
have a heartbeat and take a breath or two, the infant cannot and will not survive. Organ development is
simply too premature to sustain life. The brief presence of vital signs does not equal true viability.
Infants miscarried before this age are generally not resuscitated as their ability to live outside the womb
is essentially zero. Not one infant in my statewide longitudinal NICU follow up clinic was born before 22
weeks gestation.

Not one of the three Alabama clinics performing elective terminations will end a pregnancy where the
infant scans (by ultrasound) to 22 weeks or beyond. One imposes a 15 week ceiling. In Alabama,
terminations are not performed when the limit of viability is surpassed. Thus, to medical providers, HB
491 is a fallacy, actually, a painful joke. It is incompatible with current standards of medical care.
Please, do not further vilify Alabama’s physicians who work to sustain and improve life, by creating a
viscerally gruesome yet medically implausible scenario to further blaze a path to overturn Roe. My
patients, their families and my colleagues deserve no less.

With gratitude,

Morissa Ladinsky, MD

Associate Professor of Pediatrics

UAB Medicine

Birmingham, AL

The viewpoints shared are my own and do not necessarily reflect the viewpoints of the University of
Alabama at Birmingham.