One of the nation’s largest crisis pregnancy center support groups is instructing its clinics not to perform ultrasounds on women suspected of having ectopic pregnancies — a potentially life-threatening condition.
The guidance, issued by a legal group that advises faith-based centers, followed a lawsuit in which a woman’s ectopic pregnancy was allegedly misdiagnosed by a Massachusetts clinic, leading to a life-threatening emergency, according to recordings obtained by NBC News.
The National Institute of Family and Life Advocates (NIFLA), which supports hundreds of faith-based pregnancy centers, which are designed to prevent patients from seeking abortion care, told members at a recent meeting that ectopic pregnancies pose “the greatest medical and legal risk” to their clinics.
“I do not want to see on any website or advertising, ‘Come to us and we’ll rule out an ectopic,’” a NIFLA representative warned, according to recordings of the session.
“It is impossible to rule out an ectopic unless you’re doing HCG,” the representative added, referring to a blood test that measures hormone levels to confirm a pregnancy.
A lawsuit was filed in 2023 against Clearway Clinic, a crisis pregnancy center in Worcester, for allegedly misdiagnosing a woman’s ectopic pregnancy in 2022.
The patient, who remained anonymous in court filings, alleged that a nurse failed to take proper steps to confirm the pregnancy’s viability. A month later, her fallopian tube ruptured, requiring emergency surgery.
The center settled the case in June 2024 after a favorable ruling for the plaintiff, though it did not admit liability.
And just this week, Florida Republican Rep. Kat Cammack revealed that she almost died last year as a result of her state’s six-week abortion ban, which left hospital staff reluctant to treat her ectopic pregnancy for fear of criminal prosecution.
Speaking to The Wall Street Journal, Cammack, 37, reported her experiences in an unnamed Florida hospital’s emergency room on May 31, 2024 when it was discovered that there was no way for her baby’s embryo to survive and that her own life was in danger without action.
A doctor discovered the embryo implanted where the fallopian tube meets the uterus, a cornual ectopic pregnancy, and frankly told the representative: “If this ruptures, it’ll kill you.”
But after deciding against surgery, the facility’s doctors and nurses had to be persuaded to give her the shot of methotrexate she required to expel the pregnancy.
That was because the state’s six-week ban on abortion care had come into effect at the start of that month, causing staff to fear they could lose their medical licenses and be sent to jail if they gave her the drug, which blocks the flow of folic acid to the embryo to prevent its growth.
Florida regulators have since issued new guidelines to clarify the situation, and Cammack — who opposes all abortion care except in pregnancies from rape and incest or when the mother’s life is at risk — is pregnant again and due in August.
At the recent NIFLA conference, lawyers and a physician repeatedly advised caution when treating patients with low HCG levels — a marker that can indicate ectopic pregnancy or miscarriage.
“I’m not scanning,” one doctor said. “If you’ve got a level that’s low like that, it could be early pregnancy, but that is one of the cardinal signs of ectopic and one of the cardinal signs of miscarriage, slowly rising HCG. Please do not. She’s already got a provider. Dump it back on them.”
NIFLA has offered similar advice in the past. A 2018 policy document instructed member clinics to immediately refer women with possible ectopic pregnancies or miscarriages to emergency medical care — and not to offer ultrasounds in those cases. Yet experts say many centers haven’t followed that guidance.
“That seems like a very marked change, especially given that so many CPCs are using fear around ectopic pregnancy as a reason to come in and get scanned,” said Andrea Swartzendruber, a reproductive health epidemiologist at the University of Georgia College of Public Health who studies crisis pregnancy centers
These clinics, which do not offer abortion services or full-spectrum reproductive care, often market themselves as medical providers offering pregnancy tests and limited prenatal services. Many are located near abortion clinics and advertise ultrasounds to attract women considering terminating their pregnancies.
This approach can be deceptive, according to Debra Rosen, the executive director of advocacy group Reproductive Health and Freedom Watch.
“Unregulated pregnancy clinics masquerade as medical facilities, are not covered entities under HIPAA, and for decades have vigorously pushed back against even the most basic forms of accountability,” Rosen said.
“Women nationwide face real harms as these fringe clinics trap them between illusions of confidentiality and the actual legal protections they receive. This dangerous gap demands legislative action.”
At the NIFLA event, attorneys acknowledged privacy concerns, admitting that while some centers claim to be HIPAA-compliant, they are not legally required to follow the federal health privacy law.
“We want you to abide by those policies,” said one lawyer, “but don’t advertise yourself as HIPAA-compliant.”
NIFLA also voiced opposition to state-level efforts to strengthen licensing standards. Recent bills in Indiana and New Jersey would require anyone performing an ultrasound to be a licensed health care provider — a move that could restrict non-medical volunteers at pregnancy centers from conducting scans.
“One of these bills could be pretty damaging to centers,” a NIFLA representative warned. “If you hear of any in your state, we want to know.”
Indiana State Rep. Maureen Bauer said she introduced HB 1094 after hearing about a young student who lost her ability to have children following a misdiagnosed ectopic pregnancy at a crisis pregnancy center.
“That is why I filed HB 1094 to require licensure for anyone operating a sonogram machine in Indiana,” she wrote in a Facebook post, “to ensure we do not have any more tragic stories like the young IUSB student who lost her child, and her ability to have children in the future due to a required hysterectomy, because the individual who provided her with a sonogram at a crisis pregnancy center did not identify her ectopic pregnancy.”
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