Afraid to treat?

In over a decade of practice across three states, Dr. Omari Hodge says no state or federal law has ever changed how he treats pregnant patients. “Every pregnant woman I see, I see two patients. I see mother and child,” he said. “The policies that I follow from a medical perspective have not changed based on what the laws of the land are.”

Hodge has worked as a family medicine physician in Georgia, South Carolina, and now Florida and led multiple residency programs. As a Christian, he is staunchly pro-life. Even before the Supreme Court overturned Roe v. Wade in 2022, he never felt that he had to sacrifice his convictions in order to provide the best care his patients needed. “I simply want to do no harm and give the best medical advice I can to give that child the best chance of life and give mother the best chance at recovery,” he said.

But since the Supreme Court ruled in Dobbs v. Jackson Women’s Health Organization, abortion advocates have claimed that state laws protecting unborn babies put women in danger. They say some doctors question if the laws block them from treating women experiencing a miscarriage or from delivering a baby early when a mother has a dangerous medical condition.

Now, four years after Dobbs, doctors, media reports, and even health journals are still repeating claims that laws intended to protect unborn babies from abortion are hindering their ability to care for the babies’ mothers. And while pro-life doctors and organizations soundly refute the claim, some say the public discourse could fuel fear in young physicians.

Every pro-life law in the country includes exceptions for emergencies, and many explicitly say that treating miscarriages and ectopic pregnancies is not the same as an elective abortion. But those exceptions did not quell public confusion.

Dr. Ingrid Skop, the director of medical affairs at the Charlotte Lozier Institute, blames ideology for the poor response to Dobbs among abortion proponents in the medical community. She noted that some major medical societies and state-level medical boards were slow to release clear guidance related to pro-life laws. That patchwork response, combined with media reports blaming the laws for tragic deaths of pregnant women, solidified concerns among doctors, Skop said. “All they had to do was reassure the doctors that it was ‘business as usual’ because there’s this exception in the law,” she said. “If that would have happened, none of this would have ever gotten blown up like it did.”

A study published earlier this summer in the Journal of the American Medical Association found that doctors who practice in pro-life states believe those laws cause delays in care, fear among physicians, loss of patient autonomy, and lowered trust in physicians. In the study, researchers interviewed 40 family medicine, obstetrics and gynecology, and emergency medicine doctors across nine states.

Many respondents said their frustration with the laws stemmed from their uncertainty about diagnosing conditions like ectopic and molar pregnancies, which are normally not viable. “We’re waiting longer and putting more people at risk because we feel pressured to have an absolute definitive diagnosis before treating,” said one family medicine doctor in the study.

Skop said that performing additional testing and consulting with specialists is standard practice when a pregnant woman is not experiencing a life-threatening condition. While some of the respondents said they had wanted to end a woman’s pregnancy based on their initial evaluations that she was experiencing a serious complication, some admitted that after more tests and time the woman either miscarried or continued her pregnancy without interventions.

“I think it’s disingenuous for them to complain that they have to do additional tests in order to be certain of a diagnosis,” Skop said. “If it’s not the appropriate intervention, it can have consequences.”

Skop also noted the study’s small sample size. Only 18 of the participants were OB-GYNs, and respondents’ average time spent in practice was about eight years. The doctors either volunteered to take the study or were referred by someone they knew who had already participated. “It was snowball sampling,” Skop said. “We have to assume that there was a selection bias in the doctors who were chosen.”

Though many of the study participants said they or their colleagues were confused about what exceptions to state pro-life laws applied to them, at least one emergency medicine doctor said that the medical board in his or her state had provided clear guidance. “We could do whatever was medically necessary,” the respondent said. “That’s always been clear to me, but I guess it hasn’t been clear to others.”

Dr. Sean Hutzler is an emergency medicine doctor in Texas, where the state medical board just last year introduced training and guidelines for physicians regarding the state’s pro-life laws. “That guidance includes clarifications regarding exceptions for emergency conditions, circumstances in which the law does not apply,” Hutzler told me in an email.

Medical boards in states like North Dakota, Indiana, and Iowa have also issued guidance, while other pro-life states rely on the legislation itself or the local department of health to offer clarity. And Hutzler said that all emergency medicine residency programs already require training in obstetric and gynecologic emergencies and complications. “None of these situations require what is commonly understood as an elective abortion,” he wrote. “As a result, the law has not created uncertainty in the emergency care I provide.”

Earlier this year, the Texas Medical Board sanctioned three doctors who reportedly delayed care for two pregnant women. Both women died as a result of the doctors’ failure to respond appropriately to their health emergencies. And while media reports suggested the doctors had not offered them treatment for fear of violating pro-life laws, Skop, who also practices in Texas, says most doctors would not have hesitated to perform lifesaving treatment. It isn’t clear that the law played a role in their deaths, she added.

But stories like those have stirred up genuine concerns. “There has been so much effort to confuse and to frighten doctors that undoubtedly there have been a few that have become frightened and there probably has been delayed care,” Skop said.

In the JAMA report, some respondents believed that their inability to perform an elective abortion or to begin treatment for a suspected miscarriage or ectopic pregnancy erodes trust in physicians as a whole. “I think we’re causing some harm in our patients by not being able to provide them what they want if they have a good understanding of the diagnostic certainty,” one emergency medicine doctor said.

Dr. John Pierce, an OB-GYN, has practiced in Virginia for more than 25 years and serves as the vice president of missions and medical education for the Christian Medical and Dental Associations. He has taught young doctors during his whole career and says that one of the hardest things for them to learn is how to listen to and counsel patients rather than jumping to a diagnosis or treatment.

“There is this pressure that you should have the exact right answer right away. And it’s not real, it’s not accurate, and I really don’t think it’s good medicine,” he said. “Sometimes a little bit of time helps us clarify, and that’s OK.”

When Hodge, the family medicine doctor in Florida, trains residents, he brings actors into the classroom to act out common challenges and pitfalls the residents may see in obstetrics. “I’ll take my residents through as a way to create a simulated environment in which their decision-making is put on the line,” he said. He aims to expose students to potential complications or mistakes before they see patients so they can learn how to respond and what to do if they are unsure.

Most healthcare professionals do not discuss abortion questions at length when they talk with students about standards of care for pregnant women, Hodge said. But he says that physicians in training scenarios should be open and honest with young doctors about the issue so they know the law and know how to respond when an emergency arises.

“The more these subjects are taboo, regardless of how you feel personally or how your residents may feel, the more we cause that chasm and that gap and the potential for poorer outcomes for mothers,” he said.