Doctors Detail Dangerous Pregnancy Care in States With Abortion Restrictions

A new report details how doctors in states with strict abortion laws have been forced to offer lower-quality care, including refusing to provide treatment to pregnant women facing complications until their situations became life-threatening.

In “Care Post-Roe: Documenting cases of poor-quality care since the Dobbs decision,” the Texas Policy Evaluation Project (TxPEP) reports preliminary findings from a study that asked doctors to evaluate how their practices have changed since the Supreme Court’s June 2022 decision in Dobbs v. Jackson Women’s Health Organization. Since then, 14 states have either enacted near-total bans on abortion or passed additional restrictions.

“Between September 2022 and March 2023, we received 50 submissions from health care providers describing detailed cases of care that deviated from the usual standard due to new laws restricting abortion,” states the report. The submissions were collected as part of the group’s Care Post-Roe Study, which allowed health care providers to submit confidential stories that were in some cases followed up on with in-depth interviews.

“The post-Dobbs laws and their interpretations altered the standard of care across [pregnancy] scenarios in ways that contributed to delays, worsened health outcomes, and increased the cost and logistic complexity of care,” the report suggests. “In several cases, patients experienced preventable complications, such as severe infection or having the placenta grow deep into the uterine wall and surrounding structures, because clinicians reported their ‘hands were tied,’ making it impossible for them to provide treatment sooner.”

The researchers received multiple reports of cases involving second-trimester rupture of membranes, a condition associated with “a very high neonatal mortality rate,” as one 2017 study in the Journal of Perinatal Medicine put it. Managing it “requires balancing the potential neonatal benefits from prolongation of the pregnancy with the risk of intra-amniotic infection and its consequences for the mother and infant.” Typically, patients who experience this are offered an abortion; now, patients are being sent home and told to come back when they start going into labor or experience signs of an infection. “In several of the cases, patients developed a severe infection, including cases where the infection required management in the intensive care unit,” notes the report.

In a number of cases, patients presenting risky but not-yet-life-threatening symptoms were forced to wait until their conditions worsened before an abortion could be legally performed. For instance, one doctor describes a woman who was 15 to 18 weeks pregnant and experiencing significant bleeding when admitted to the hospital for observation. Doctors couldn’t do anything but wait.

“When I objectively look at her case, there is no way that this woman was going to make it to [fetal] viability (6 [additional] weeks) and [she] was becoming clinically unstable,” wrote one doctor. “The paralysis that the overnight team exhibited by not treating this inevitable abortion as such again demonstrated that physicians are perseverating about whether they can legally provide standard-of-care medical treatment.”

Another doctor describes a woman going into labor early at around 19–20 weeks: “Anesthesiology colleagues refused to provide an epidural for pain. They believed that providing an epidural could be considered [a crime] under the new law. … I will never forget this case because I overheard the primary provider say to a nurse that so much as offering a helping hand to a patient getting onto the gurney while in the throes of a miscarriage could be construed as ‘aiding and abetting an abortion.’ Be