"Dangerously warped": Care for pregnant people since Dobbs is "compromised," doctors say

Since the Supreme Court overturned Roe v. Wade with the Dobbs decision, doctors on the frontlines have shared horror stories about how medical care for pregnant people has changed. Women are being pushed to have abortions later in pregnancy due to the barriers they have to overcome to access care. Women who can’t travel are being forced to carry nonviable or unwanted pregnancies, which experts say is a human rights violation. Doctors in states with abortion bans can’t provide their standard treatment of care putting women’s lives at risk.

This week, a new report from the University of California San Francisco’s Advancing New Standards in Reproductive Health (ANSIRH) tells more in-depth stories about how healthcare providers are unable to provide proper medical care to pregnant people in abortion-ban states. Through the accounts of 86 healthcare providers between September 2022 and August 2024, the report documents a range of harm occurring, such as situations of increased risk of death, complications and delays in care causing worsened health outcomes.

"Our findings suggest that, rather than increasing clarity and identifying workarounds over time to provide evidence- based care, abortion bans have fundamentally altered how pregnancy-related care — and even other medical care for people with the capacity for pregnancy — is delivered," the report authors wrote. "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."

"As a consequence, patients’ health and wellbeing are being compromised. In order to provide evidence-based, high-quality care and avoid these harms, abortion bans must be repealed," the authors added.

“In the two years since Roe fell, medical care has become dangerously warped as states with abortion bans continue to tie the hands of providers,” said Dr. Daniel Grossman, ANSIRH Director and lead report author in a media statement. “This research shows that every pregnant person in these states is at risk of being denied the care they need.”

In one story, a physician described the case of a patient who had preterm prelabor rupture of the membranes (PPROM) between 16 and 18 weeks gestation. Doctors denied this patient an abortion because of a new state law. The patient was sent home only to develop a severe infection requiring management in the intensive care unit two days later. The patient eventually delivered her fetus, who could not survive outside the uterus, but required a procedure to remove her placenta. The physician wrote in their story: “The anesthesiologist cries on the phone when discussing the case with me — if the patient needs to be intubated, no one thinks she will make it out of the OR.”

The doctor proceeded to do a typical dilation and curettage (D&C) to remove the placenta, from which the patient bled “from everywhere.” While the patient survived, the physician recounted the patient was still in fear that she maybe broke the law: “She asks me: could she or I go to jail for this? Or did this count as life threatening yet?”

PPROM is when a pregnant woman’s water breaks early. The likelihood of a fetus surviving under 22 weeks of gestation is low. At the same time, when a pregnant woman’s amniotic fluid sac breaks during the second trimester, it puts the woman at an increased risk for infections like chorioamnionitis and sepsis. Prior to Dobbs, the standard of care in states with abortion bans was to immediately offer patients the option of a dilation and evacuation (D&E). According to the report, doctors in these states are now frequently sending patients home or admitting them for observation. Even with careful monitoring in the hospital serious complications are occurring.

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“Patient presented with previable [PPROM], was admitted,” another doctor shared in the report. “Due to laws, we can only provide expectant management until fetal demise or immediate threat to patient life.”

Despite the patient’s desire to terminate the pregnancy, medical providers “were forced to manage expectantly until she developed an intraamniotic infection, which progressed to sepsis requiring IV antibiotics for multiple days.”

In some states with abortion bans, physicians have to coordinate care with doctors in a different state to provide emergency care. In one case, a patient pregnant with twins at 17 to 19 weeks gestation experienced the death of one of the fetuses and developed HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. HELLP syndrome, considered a variant of preeclampsia, is a rare and life-threatening pregnancy complication. However, the care team could not offer to terminate the pregnancy under existing state law resulting in an increased risk of death, and a transfer to another state where they could legally terminate the pregnancy.

“[The patient’s] condition worsened during the duration of transport time,” the doctor wrote. “The patient was separated from family and resources. Astronomic hospital costs. Ultimately at the time of procedure [the patient] had demise of the second twin.”

An ectopic pregnancy is when a fertilized egg implants and grows outside of the uterus in the abdomen, a female's cervix or more commonly, the fallopian tubes. It is a life-threatening condition; there is no way that an ectopic pregnancy can become a full-term pregnancy. Despite some abortion bans having exceptions for the life of the mother, or specifically for ectopic pregnancies, physicians are documenting that care for ectopic pregnancies in abortion ban states is being delayed, too.

In some cases, pregnant patients with underlying medical conditions from previous pregnancies — like peripartum cardiomyopathy, which can be fatal — had to travel out of state to terminate their pregnancies. “The risk of her dying from childbirth would have been extremely high—but she was unable to find anyone in her state willing to do the procedure,” a doctor wrote, noting it took her six weeks to find an appointment, and she had to drive 10 hours to get reach care.

“This study shows that abortion bans are fundamentally degrading medical care – not just in a single state or for a certain type of patient but for people with a range of health conditions living anywhere these bans are in place,” Dr. Kari White, executive director of Resound Research and study co-author, said in a media statement. “That a high proportion of patients described in the study narratives are Black and Latinx makes this even more concerning given the long-standing structural barriers to high-quality care that these groups encounter in the U.S. medical system.”