Report sheds light on OB-GYNs’ struggles after overturn of Roe v. Wade

Wisconsin OB-GYNs struggled with how to help patients and protect themselves amid legal ambiguity and inconsistent guidance from health systems after the overturn of Roe v. Wade, according to a study published Monday in the Journal of the American Medical Association.

Pregnant patients experienced “substandard, delayed and fragmented” care, noted the report from University of Wisconsin Collaborative for Reproductive Equity researchers. To the collaborative’s knowledge, the study is the first to document the harm caused by an 1849 state law widely interpreted as a criminal abortion ban.

A Dane County court blocked the 1849 law in 2023, and Planned Parenthood of Wisconsin resumed abortion services in September of that year. Some Wisconsin hospitals resumed abortion services, after a final decision that December.

The Wisconsin Supreme Court is now weighing the law. As of February, some hospitals and health systems cite legal uncertainty as a reason for “withholding certain services for pregnant patients,” noted the study.

Researchers interviewed 21 OB-GYNs between June 2022 and December 2023. They found OB-GYNs faced uncertainty about how to provide standard clinical care under the 1849 law since it failed to say when they could intervene to save a patient’s life. Doctors turned to institutional leaders for guidance, which varied widely among hospitals and health systems. Some provided guidance, while others didn’t.

“One of the most alarming things that emerged was that there was a total lack of clear, consistent guidance across the state regarding how this 1849 law should or shouldn’t apply to actual clinical practice,” said Dr. Abigail Cutler, a UW OB-GYN and assistant professor who led the study.

For example, a big question for doctors was how to treat previable preterm premature rupture of membranes, or previable PPROM. That’s when a patient’s water breaks early in the pregnancy, and the fetus is unable to survive outside the womb on its own. Patients with the condition have a high risk of developing an infection or experiencing a life-threatening hemorrhage.

Some institutions allowed their doctors to immediately terminate the pregnancies of patients who presented with the condition, whether or not they were showing signs of infection, Cutler said. Others deemed that standard of care too legally risky until a patient’s life was more at risk.

In one case, a physician couldn’t intervene until a patient’s life was in danger due to an infection. The patient delivered a stillborn infant and became so sick she was admitted to the intensive care unit with concerns for sepsis. A less-than-48-hour stay turned into a five-day hospital admission, according to the OB-GYN.

The differing guidance meant that patients experiencing the same pregnancy complication “could receive completely different care or be offered different options depending on where they found themselves,” Cutler said.

Not all OB-GYNs trusted the guidance they received, meaning care varied even within the same institution. Some saw their health systems as protecting themselves over patients or physicians.

Whether or not health systems offered guidance, OB-GYNs had to make decisions on how much risk they would be willing to face, in case of a potential felony charge where their institutions may or may not be able to provide legal support for them. Several said medical malpractice insurance would not cover the criminal liability posed by the 1849 law.

When it came to patient care, clinicians were unable to consider patients’ individual needs, including those with cancer or chronic health conditions. Doctors had to be cautious and often pursue more diagnostic testing to ensure a pregnancy was failing.

OB-GYNs noted an increase in transfers of care between hospitals and health systems within the state, due to differing interpretations of the 1849 law. Transitions of care are costly, lead to delays in care and can send patients far from home and their support networks, Cutler said.

Larger referral hospitals often received patients from institutions whose doctors were uncomfortable with treating or not permitted to treat previable PPROM. Patients with fetal anomalies had to travel out of state for abortion care, facing transportation and child care barriers that often posed the greatest hurdles for marginalized and underserved populations.

Some institutions took “exceedingly conservative positions” regarding services related to abortion, including counseling for pregnancy options, the study noted. One OB-GYN said they weren’t allowed to provide any written information about obtaining pregnancy terminations.

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