Dr. Jennifer Smith, an OB-GYN in St. Louis, was among 800 Missouri medical professionals who signed a letter in support of Amendment 3, which would legalize abortion up to the point of fetal viability (Annelise Hanshaw/Missouri Independent).
Dr. Betsy Wickstrom says she’s still lacking clarity on what constitutes a medical emergency under Missouri’s abortion ban, despite the law having been in place for more than two years.
In Missouri, health care providers who perform abortions not deemed necessary emergencies can be charged with a class B felony, which means up to 15 years in prison. Their medical license can also be suspended or revoked.
So Wickstrom, a high-risk obstetrician in Kansas City more than three decades into her career, must first consult a team of lawyers.
“When we have something that looks like it’s skirting the line and there’s a flicker of a heartbeat, but someone is desperately ill, sure I can call up the attorney,” she told reporters Monday. “But they’re not going to put the hospital’s licensure on the line. They’re going to say ‘you know, good thing you live next to Kansas.’”
Dr. Jennifer Smith, an OB-GYN in St. Louis, agreed.
“I don’t think that many hospitals feel comfortable testing this law because the government hasn’t provided us any clarity on it,” Smith said.
Wickstrom and Smith are among more than 500 physicians and more than 300 other medical professionals who signed a letter in support of Amendment 3. If approved by a majority of Missourians on Nov. 5, the amendment would overturn Missouri’s near-total abortion ban and legalize the procedure up until the point of fetal viability.
Missouri became the first state to enact a trigger law banning abortion except for cases of medical emergencies following the fall of Roe v. Wade in June 2022. There are no exceptions for survivors of rape or incest.
“As a result, Missourians are being denied abortions and forced to continue life-threatening pregnancies, risking their health and lives,” the medical professionals wrote in a letter through the Committee to Protect Health Care. “Doctors can’t treat patients with heartbreaking pregnancy complications until they are on the brink of death. Otherwise, they could be put in jail.”
The situation in Missouri leaves pregnant patients with few options, the group of physicians contend.
“It forces many to leave the state to receive care,” the letter continues, “while others are forced to carry a pregnancy against their will. No one should ever have their health deteriorate or need to flee to receive care, nor should anyone have to carry a pregnancy against their will.”
Between June 2022 and March 2024, 64 abortions were performed in Missouri under the state’s emergency exemption, according to data from the Missouri Department of Health and Senior Services.
Missouri among worst states for women’s overall health, reproductive care, study finds
Wickstrom said she often has difficult conversations with women about growing their families — conversations made more difficult by the ban.
She has patients diagnosed with cancer who were advised not to start chemotherapy while pregnant. And she has patients with heart disease who might not survive another pregnancy.
“But can I do anything about that in Missouri?” Wickstrom said. “No. These are people that have to find their way out of the state to get life-saving care.”
Smith, who has been an OB-GYN in eastern Missouri for more than 20 years, said the questions she’s hearing from patients now are unlike any she’s heard in the past.
“People are very hesitant to start their families and expand their families in this environment,” she said.
In the past two years Smith said she’s had men ask her to promise to save their partner before their baby if something were to go wrong during a wanted pregnancy.
Patients planning their families face similar fears.
“Do you think that it’s safe to be pregnant here? What if I have an ectopic? What if I have a miscarriage?” Smith said she hears often from patients. “What if something’s wrong with the pregnancy? What if something’s wrong with me?”
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