The Supreme Court decision to overturn Roe v. Wade has transformed not just abortion access but maternal health care across the United States, causing physicians in states with restrictive laws to shift treatment of conditions including ectopic pregnancy and miscarriage. The full scale of the impact, though, has been obscured in a polarized political climate where physicians are often afraid to speak out, or are blocked by their hospitals from talking about their experiences post-Dobbs.
The extent to which conversation has been silenced is evident from a STAT survey of 100 hospitals — two from each state — asking to speak with physicians about changes in maternal health care since the Dobbs ruling. Only six institutions made physicians available to speak about their work, and five of them were in states where abortion access remains protected.
Representatives from five additional hospitals said they would ask physicians if they were interested in speaking but were unable to confirm a time; the rest declined the request without providing a reason or simply didn’t respond to STAT’s request.
Several reproductive health physicians said the lack of response reflects a climate where fear of political scrutiny and financial repercussions has effectively quelled transparency.
“There’s so much uncertainty about what’s allowable that the conservative ‘safe’ approach is to not talk about it,” said Aileen Gariepy, director of complex family planning at Weill Cornell Medicine. “Even in an incredibly progressive state like New York, for those in C-suite, advertising, and PR, there’s always been a lot of concern and stigma around abortion care. That’s been magnified.”
Hospitals employ PR and marketing teams that typically reply quickly to reporters’ requests for interviews on other topics, but in this case, the response was far different. STAT reached out to a variety of hospitals, including those from major for-profit chains like HCA Healthcare’s Grand Strand Medical Center in South Carolina, teaching hospitals like University of Iowa Hospital, and OSF Heart of Mary Medical Center, a Catholic hospital in Illinois, all of which declined the interview request. Physicians were offered the choice of three days for an interview and given the option of suggesting other times that were preferable.
STAT asked to talk with physicians not about abortion specifically, but about changes in maternal health care more broadly post-Dobbs, such as whether there were shifts in the number of appointments for pregnant patients in their first trimester, or in monitoring and treatment for conditions such as ectopic pregnancy and miscarriage.
Of the six hospitals that did agree to interviews, physicians at Weill Cornell, Women & Infants Hospital of Rhode Island, Stamford Hospital in Connecticut, and Massachusetts General Hospital — all in states with permissive abortion laws — said they had not personally had to change care in response to the fall of Roe.
“All of us are aware that the case in Massachusetts is not the case elsewhere,” said Jeff Ecker, chief of obstetrics and gynecology at Mass General. “As we listen to colleagues, we share to some extent their distress. It makes us feel lucky.”
In many other states, the implications of Dobbs stretch beyond abortion. Physicians in Louisiana have responded to preterm premature rupture of membranes (PPROM), which renders pregnancy unviable and leads to infection and sepsis in the mother if untreated, by performing C-sections rather than providing medication, which is not standard care and creates risks including hemorrhaging and fertility complications. Other patients have been denied care for miscarriage and standard prenatal appointments during the first trimester. And physicians have on occasion turned away patients with an ectopic pregnancy, where the embryo implants outside the uterus. If left untreated, ectopic pregnancies rupture the fallopian tube, leading to serious health risks including death.
Heather Spies, an OB-GYN with Sanford Health in Sioux Falls in South Dakota, told STAT the state’s ban on all abortions except to save the life of the mother has changed the treatment approach for PPROM and lethal fetal anomalies. For the former, she said, physicians now take extra steps to collaborate with maternal fetal medicine specialists and confirm the diagnosis and risk to the mother’s life, and may also check with legal support teams before proceeding.
For example, she said, there are cases where membranes rupture well before a fetus can survive outside the womb, the fetus is halfway expelled, but there’s still a fetal heartbeat. “That does put us at a hard spot. It can create a conflict with the standard of care in some cases,” she said. Prior to Dobbs, physicians would be able to provide medication to fully expel the fetus and so reduce the risk of infection and hemorrhaging. But now, if there’s still a heartbeat, Spies said, that could interfere with how quickly physicians intervene.
And when there are anomalies that mean the fetus will not survive outside the womb, she said, physicians can now no longer offer an abortion even if the pregnancy carries serious health implications, as long as it does not risk the mother’s life. ”It could cause damage to the womb,” she said. “If there’s a maternal heart condition or kidney condition, something that’s going to potentially worsen, it would not fall under the law.”
Similarly Abigail Cutler, an OB-GYN at UW Health University Hospital in Wisconsin, told STAT she experienced a shift in the management of early pregnancy problems immediately post-Dobbs, before a Wisconsin judge last year invalidated a pre-Civil War law that had banned abortion. Management of patients with intrauterine nonviable pregnancies became more conservative, she said, as in the early days she said she knew of some providers who were uncertain about whether they could perform the standard care of providing medication or surgery to end the nonviable pregnancy for an ectopic pregnancy and PPROM.
She also felt pressure to wait for miscarriages to develop beyond the point of early bleeding and hormone level rises to make absolutely certain the fetus was not viable whereas, prior to Dobbs, she’d present patients with a range of treatment options including medication to hasten the miscarriage process.
“When we had the threat of a criminal abortion ban, there were moments of pause when we needed to make sure we were obeying the law, which sometimes meant we could not keep the patient’s preferences front and center,” Cutler said.
The physicians who spoke about their experiences, though, were in the stark minority, and several expressed frustration at the difficulties colleagues at other institutions face in talking about their work. “People want to speak up, but a lot of people are afraid for their jobs,” said Melissa Russo, maternal-fetal medicine specialist at Women & Infants Hospital of Rhode Island. “They could get in trouble just for talking to a reporter.”
Some are personally wary of talking publicly, said physicians, fearing both personal attacks and legal repercussions. Even when doctors communicate with each other, said Cutler — for example, when those in states with abortion bans are trying to find care for patients elsewhere — they’re often extremely conservative, choosing phone calls over writing. “Messages and asks for assistance can be pretty cryptic. They’ll say ‘This ectopic pregnancy is a threat to maternal health’ — which is obvious to us,” she said. “There’s a lot of muddy water about what is permissible and what’s not. Doctors don’t want to go to jail, we want to take care of people.”
And when doctors do feel comfortable talking, they’re often blocked from doing so, said several physicians. Hospitals similarly fear political and legal scrutiny, plus potential backlash from donors from being associated with abortion. “I know a lot of doctors who provide abortion care in hospital systems that muzzle them because they don’t want to broadcast that they provide abortion care for fear of losing funding, local political figures retaliating,” said Chelsea Daniels, a physician at a Planned Parenthood clinic based in Miami, who said these physicians fear losing their jobs if they talk openly.
Similarly Damla Karsan, a Houston-based OB-GYN who sought and was denied legal permission to perform an abortion for her patient Kate Cox last year, on grounds the pregnancy threatened her fertility and health, said she was only able to be so open about her patient’s experiences because she’s employed by a clinic, Comprehensive Women’s Healthcare, rather than a hospital.
She also knew of colleagues who’d been “muzzled” by fear of losing employment, she said, and worried the conversation around abortion and how Dobbs has affected health care had been muted. “That’s been one of my frustrations, that there hasn’t been more of a groundswell [of physicians speaking out].”
Ultimately, the restrictions on talking about the impact of Dobbs hurt patients, said Gariepy, especially marginalized populations such as teenagers and those who don’t speak English as a first language, who already have trouble accessing accurate information about abortion-related health care.
Even in New York, she said, her work isn’t publicized like her colleagues’ care in other disciplines. “You’ll see billboards about how we’re number one in orthopedics care, here’s a heartwarming story of a baby who had a heart transplant and is now an Olympian,” she said. “There are no billboards about how we were able to provide abortion care for PPROM at 19 weeks and now the mom has healthy kids.”
This story is part of ongoing coverage of reproductive health care supported by a grant from the Commonwealth Fund.