Pregnant patients increasingly aren’t showing up for prenatal visits. Those who are are asking if they can have fewer. 

Some are going without proper nutrition because they’re scared to go to the grocery store.

One provider said that in the past two months, she’s seen multiple cases of a rare complication that often leads to miscarriage after not seeing patients for months. 

Across the country, health care providers have said that people are increasingly skipping prenatal visits, citing concerns about raids by Immigration and Customs Enforcement (ICE). But in Minnesota — the target of what the U.S. Department of Homeland Security has called its largest-ever immigration enforcement operation, and where federal agents have killed two people — the consequences of that fear are particularly apparent.

Six providers in the Twin Cities area said no-show rates have increased for prenatal visits, which are essential in detecting, treating and preventing complications such as gestational diabetes, preeclampsia and even stillbirth. Some patients, afraid of encountering law enforcement officials, are changing their delivery plans to opt for home births — sometimes without communicating it to providers. 

“We are seeing significant no-show rates for prenatal care visits in our clinics,” said Dr. Chelsea Thibodeau, a Minneapolis-based family physician who provides prenatal care and delivers babies at one of the hospitals. “We’ve certainly heard from patients in my clinic where they don’t feel safe coming in.” 

The American College of Obstetricians and Gynecologists recommends that pregnant patients get regular prenatal care. Typically, that involves 12 to 14 visits over the course of a pregnancy, though the number can be higher for those with more complications or at higher risk. Those visits often require ultrasounds and bloodwork, making them poor candidates for care via phone or videoconference. Complications, if not treated early, are more likely to result in irreversible harm. 

“Many, many conditions in pregnancy — whether it is anemia or high blood pressure or gestational diabetes or a growth restrictions — identifying those early and addressing them early, that can make a profound difference in fetal development and in the health of both a pregnant person and the fetus,” Thibodeau said. 

Another obstetrics provider, who asked that her name be withheld because she worries her clinic will become a target of immigration raids, said that since the start of the federal campaign, patients have been less likely to show up for visits, or to answer their phones. Those who do come in for care have expressed nervousness about coming back, or want to reduce their number of visits. 

Many, she said, are running out of food, which is particularly concerning in pregnancy, when doctors recommend patients consume an extra 300 calories per day. And when patients do come in, she said, she is seeing many at higher risk of gestational diabetes and high blood pressure, conditions that are most effectively treated when caught early in a pregnancy. 

One nurse-midwife, who works in the Twin CIties and predominantly treats Latinx patients, has seen three cases of preterm premature rupture of membranes (PPROM) — a rare complication in which someone’s water breaks early — since the start of the federal blitz, with two of those three resulting in miscarriage. She had not seen any such cases for several months prior to December, she said. PPROM and preterm labor generally can be brought on by extreme stress. 

“I can’t say that’s why that happened and but it certainly is remarkable,” said the nurse-midwife, who asked that her name be withheld because she is afraid of her clinic being targeted by immigration officials. “There’s been a remarkable increase in what I’ve seen of PPROM in our practice, and gestational hypertension and gestational diabetes.” 

Her patients are also consistently registering symptoms of depression, she said, a concern echoed by other providers across the area. Depression during or after pregnancy not only threatens the health of a pregnant person, but can harm a newborn, making it more difficult to breastfeed and undercutting the bonding between parent and infant.

Some obstetrics and gynecology providers are pivoting to in-home visits and mailing medications. But that isn’t possible to provide on scale, said Dr. Erin Stevens, an OB-GYN in Minnesota. Patients are increasingly requesting home births, including those with high-risk pregnancies that may require complex interventions.

Some patients are requesting doctors’ notes stating they are pregnant, said Dr. Kendra Harris, an OB-GYN in St. Paul whose no-show rate has also increased. The idea, she said, is that a physician’s endorsement might encourage ICE agents to treat them more gently. 

Previous research has linked immigration raids to adverse birth outcomes, including higher rates of preterm birth and low birth weight. It’s too soon to say definitively if the federal efforts in Minnesota — or similar campaigns last year in cities such as Los Angeles, Chicago and Washington, D.C. — are having those same consequences. 

That said, “I do think that there is evidence to suggest that these localized raids might also exert a health toll on immigrants and coethnic communities,” said Aresha Martinez-Cardoso, an assistant professor at the University of Chicago who studied the link between immigration raids in Postville, Iowa, and pregnancy-related health. 

“As a researcher, I’m sure in a few years we’ll be able to see spikes in adverse pregnancy outcomes that we can attribute to widespread social stressors,” said Dr. Lynn Yee, a maternal-fetal medicine specialist at Northwestern University, who practices in Chicago. 

Some of those outcomes may already be emerging. And with patients less likely to attend key visits, physicians said they worry they are missing chances to intervene. 

“That’s the reason we see people for prenatal care is to make sure things are healthy and well to make sure we can catch complications,” Stevens said. “We’re going to have a lot of people showing up when it’s time to have their baby with complications we don’t know about.”

Thibodeau recalled one recent patient with a history of previable delivery, putting her at higher risk of losing her pregnancy. A patient with that medical history requires careful monitoring, so that if doctors see signs of another early birth — which before 23 weeks gestation, almost always results in infant death — they can take steps to reduce the risk of delivery. 

This patient, Thibodeau said, asked to postpone one of her monitoring appointments by a few days, citing concerns about nearby ICE officers. But in the time between her original monitoring appointment and her rescheduled one, she delivered at 20 weeks, losing the pregnancy. 

“Would something have been identified had she gone in that day? You can’t know,” Thibodeau said. “But it’s possible if this was something imminent, she could have been offered an intervention.”