The Impact of Dobbs on Pregnancy Care
By: Carole Joffe, PhD
As I observe the current state of reproductive health care, I find myself having imaginary conversations with my father, a cardiologist, who died twenty years ago. When I was about four years old, my father started taking me along on house calls to patients. These occurred in our small town in western Massachusetts and were common in the 1950s. What I remember most about those house calls was the deep bond that existed between the patients and my father. Even my four-year-old self could perceive the trust they had in him, and his evident determination to treat them as best he knew how.
In my imaginary conversations, I find myself explaining to him—or trying to explain—the aftermath of the 2022 Supreme Court decision, Dobbs v. Jackson Women’s Health, which overturned Roe v. Wade. Were my father alive, not only would he be appalled at the changes in obstetrical practice since the demise of Roe, he would simply not believe them. “How is it possible?” I imagine him saying, that doctors are forbidden to do what is so obviously in the best interest of their patients? Telling him that doctors in some states could be sentenced to life imprisonment for performing a medically indicated procedure would be akin to telling him aliens have landed on this planet. He would be devastated to see this degradation of his beloved profession of medicine.
My awareness of the impact of Dobbs comes from my work on the Care Post-Roe study at the University of California San Francisco. In this project, our team has been inviting clinicians, in both states where abortion is banned and those in which it remains legal, to submit confidential testimonies about how care has changed due to new laws passed since the fall of Roe. The study has collected more than 60 such testimonies so far. One of the most common phrases that occurs in these accounts is “our hands were tied” as providers in ban states describe, in heartbreaking and often angry terms, their inability to provide prompt and once routine care in the treatment of ectopic pregnancies, PPROM (preterm pre-labor rupture of membranes), severe fetal anomalies and fetal demise, hypertension, hemorrhage, and other pregnancy complications. Colleagues in the states where abortion remains legal express shock at the dire condition of medical refugees who are forced to travel from the ban states for care. One doctor recounted that a patient in preterm labor, who had undertaken the four-hour drive to the hospital, had arrived with an umbilical cord protruding through her vagina.
The greatest hardship imposed by Dobbs, of course, falls on the patients who are not getting the care they deserve. But these testimonies also reveal the anguish of the clinicians who can no longer care for patients as they were trained to do. One doctor, describing a case of a patient with ruptured membranes at 16-18 weeks of gestation and a severe infection, wrote, “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.”
Clinicians in the states with bans were also deeply frustrated at what they perceived was excessive timidity of colleagues. When a patient at 19-20 weeks of gestation was in advanced labor and a decision was made to proceed with an abortion, one doctor wrote, “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 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.’ “
Inevitably, some of those who submitted testimonies acknowledged, in follow-up interviews, that they are dealing with the wrenching decision of whether to leave their states because of intolerable conditions. An exodus of doctors from states with bans could be a serious fallout of Dobbs and of course has implications beyond abortion care. For example, five out of the nine MFMS in Idaho have left the state, and several community hospitals there have closed their maternity services due to a lack of obstetrician-gynecologists.
Narratives like these are a powerful way to show the fallout from the Dobbs decision and arouse both the medical profession and the public. No doubt, partly in response to accounts like these and of patients themselves, the state of Texas recently quietly passed legislation backtracking somewhat from its original near-absolute ban. As my colleagues and I at UCSF continue to document these cases, consider sharing this article with a colleague who might be experiencing these constraints, or submitting your own testimony. You can also read more about our initial findings in the Care Post-Roe report here.
Back to my father. I am not so naïve to believe that how medicine was practiced in the 1950s can—or should—become the norm again. But I cannot give up the belief that doctors and other clinicians will someday again be able to practice evidence-based medicine, including the provision of abortion care.
Carole Joffe, PhD is a professor of obstetrics and gynecology at the University of California San Fransico and is currently a co-investigator in the Care Post Roe Study. Her larger body of work focuses on the social dimensions of reproductive health, with a particular interest in abortion provision. Find her on Twitter at @carolejoffe.