- The Supreme Court ruling that ended the right to abortion brought around an immediate shift in abortion laws.

And as a nurse and a mother, I've been watching this play out, and trying to figure out how it's affecting patients, healthcare providers.

and the broader medical profession.

- Me too, Sheena.

And what I'm hearing right now from my colleagues across the board, is worrying.

There are so many situations where the law is pretty clear cut and other times not so much.

And in so many cases where an abortion would be the standard of care to treat many maternal health conditions, complications in pregnancy, treatment is being delayed or even outright denied.

- To help us get a better handle on these changes, we have an exciting guest today.

Dr. Jennifer Lincoln is in the house.

- She's an OB GYN, an educator, a YouTuber.

She's incredible, Google her work.

Since last summer, she's traveled to states with abortion bans to talk to both patients and providers to see how it affects them.

Let's get to it.

(stately music) (sound whooshing) - Dr. Lincoln, lay out the basics for us.

What do these abortion laws mean for OB GYNs?

- These laws literally mean that our hands are tied.

So, medical procedures and treatments that we have been trained to do, which is part of full spectrum reproductive healthcare, we are now being told by lawyers and legislators that we can't offer these treatments.

Treatments that are life saving for many people.

So, in the state of Idaho that means we could go to jail for up to five years.

In the state of Tennessee, it's up to 15 years.

And in Texas it's up to life in prison.

That is not a decision that most healthcare providers are able to just say, "Oh, well I'll do it anyway."

There's money involved, there's training, there's your family, and there's literally facing life in prison.

And to go even a step further, it's not just that we can't do these, we can't even talk about them.

In Texas, for example, if you even talk about abortion that's considered aiding and abetting.

- When doctors can't perform abortions patients can't get the care that they need.

Now, there are many complications that can affect a pregnancy, and when these complications happen before 22 weeks gestation abortions are the standard of care.

- We have this idea that pregnancy is always beautiful, and easy, and planned, and wanted, and that's just not the case.

Pregnancy is one of the most dangerous things we, as reproductive age people, will ever do in a developed country.

And the language you'll see in these laws include, exception for the life of the mother, or to prevent permanent disability.

- These laws are not giving us any additional guidance for how to decide that.

I think especially when you start thinking about this life exception.

For all of us that work in medicine, we know that's a really hard thing to decide when something is a risk to life versus when someone is just sick.

- Even when women can access abortion care under the emergency exceptions of the bans, the delays to treatment and health risk are significant.

A study of two Texas hospitals has shown that women have had had to wait an average of nine days for their conditions to worsen enough for an abortion to be justified.

- Unfortunately, this is exactly what Amanda and Josh experienced, who I got to meet in Austin, Texas, to help them tell their story.

And her entire team diagnosed her with what's called an inevitable miscarriage.

And, so, instead of being given the care that she needed, which was a lifesaving abortion, she was told she had to wait, because that fetus still had a heartbeat.

And she waited many days, and got very sick, and nearly died because of it.

- When I found out that I was going to lose our baby, I was just a day shy of 18 weeks.

It was a Monday, and I didn't understand at the time what was going on, but I just felt off.

We were told that I had a condition called an incompetent cervix, or cervical insufficiency.

And what it meant, is that my body was dilating prematurely.

So, at 18 weeks the baby can't survive outside of the mother's body.

- In Texas, unless there's an immediate threat to maternal life, abortions are banned after six weeks of pregnancy - I had to wait until one of three things happened.

Either her heart stopped beating, I went into labor naturally, or I became so sick that my life was in danger.

And at that point, because of the laws the doctors would be able to induce me, and we could begin the delivery process.

I was first diagnosed on Tuesday, and it took until Friday for one of those three things to occur.

And for me, what happened was, I got really, really sick, really, really fast.

- That was an extremely terrible couple of days between our diagnosis, and when we ultimately were in the hospital.

She was very distraught, confused, upset, probably all of the emotions you could expect times a million.

And we just sort of felt trapped.

- [Amanda] Obviously, we live in the middle of Texas which is a giant state.

So, to get out of Texas, and to get to a neighboring state where we could have gotten healthcare, we would've either had to drive at least eight hours or fly somewhere.

And knowing that I could get sick, and it could happen very quickly.

- But we noticed all of the people on our healthcare team, nurses, doctors, specialists everybody kept telling us that they wish that there was something that they could do, but they couldn't because of these laws.

- Instead, you know, here we are now still cleaning up the damage three months later.

- Stories like what we just heard from Amanda and Josh just truly emphasize how dangerous, traumatizing, and complicated things can be when abortions aren't accessible.

- Dr. Lincoln, have you heard about similar patient outcomes as you've been traveling throughout the abortion ban states?

- The short version of that answer is, yes.

There are so many more stories that I have heard, and other OB GYNs have heard, in addition to Amanda and Josh's.

I wish that it was some exception, and something that is a rarity, but it's not.

That's because there are things that can go wrong, unfortunately.

Like Pprom, where the bag of water breaks too early, ectopic pregnancy where pregnancy happens outside the uterus, and will never result in a healthy baby, preterm labor, bleeding in pregnancy which can result in life threatening bleeding, developing other illnesses during pregnancy like cancer where the pregnancy then complicates your treatment.

So, when a patient might present in one of these banned states with one of these conditions, they're then oftentimes told that they have to travel somewhere else to get care, or they're expectantly managed, which means that they wait until they're sick enough, and very close to death, oftentimes landing in the ICU, before they can get the treatment that they need.

- Dr. Lincoln, given everything that's changed, is there any data showing an increase in complications either from maternal complications in pregnancy or fetal outcomes?

- Unfortunately, yes, and we have data from Texas, and there was a study that showed that pregnant patients who presented with complications, those who were forced into expectant management, had much higher risks of what we call maternal morbidities.

So, these are things like postpartum hemorrhage, sepsis, having to go to the ICU, really bad things.

So, those patients who didn't get the care that they needed, 57% of them experienced these morbidities, as opposed to only 33% of people who got the immediate care, the immediate intervention that they need.

And that was warranted in these situations.

- But even more common conditions are affected by the bans.

Take miscarriages, for example.

- About 10 to 15% of pregnancies end in miscarriage mostly during the first trimester.

No treatment is required when the tissue naturally exits the body, but that's not always the case.

- So, the two main treatments for miscarriage management, fall into one of two categories.

One, is medication, the other is surgical management.

Unfortunately, these abortion bans have had unintended consequences where we've heard of people going to the pharmacy, and being denied or refused their prescription, because the pharmacist thinks this is to induce an abortion, what we call an elective abortion.

There are situations where people who might need a surgical DNC, are being denied care as well, because there's fetal cardiac activity, and she's in a banned state, her doctor is not allowed to act.

So, she's sent home and told to come back when she's bleeding more heavily, and thus having to sit at home.

That is very mentally traumatizing for somebody who knows that they have a miscarriage and wants to finish this part of their pregnancy, and move on and maybe try again.

- When I'm doing my rounds, I definitely do not have the time or capacity to think like a lawyer.

It's patient care first and foremost.

But lawyers are now having to think like healthcare providers as hospitals assemble legal task forces to determine case by case if they're in compliance with state abortion laws.

- These laws are ambiguous, and in a lot of medicine there are gray areas.

I'm not a psychic, I can't predict exactly when my patient is going to decompensate and be within inches of her life, and know that's the exact right moment.

And I don't wanna wait.

And most people don't want their doctor to wait, until it's an emergency.

Some people say, "Well, doctors should just do it.

You should just go take that patient to the OR, and do that abortion."

I don't know of any doctor who does an abortion just by themselves.

It requires an anesthesia team, a nursing team, supervising team to get you into the OR.

So, in order for somebody to agree with me if I wanna take that patient to the OR, there's lots of other people who are going to weigh in too, and be scared and say, "No, no, we have to wait for legal to sign off."

And that's when people die.

- To make matters even more complicated some states are ignoring provisions in their own abortion bans, including exceptions for lifesaving care.

For example, a federal judge in Texas ruled that in abortion cases the state does not have to comply with EMTALA, a federal mandate saying that Medicare hospitals have to provide emergency care.

- We need to make one thing clear though, there are long term health consequences, even when abortions that aren't medically necessary are denied.

At UCSF, researchers launched a prospective longitudinal study of the mental health and socioeconomic outcomes of unwanted pregnancies for mothers and their families.

- In this study, they saw that people who wanted an abortion and were turned away fared much worse.

So, they had much higher issues of mental health issues, they were more likely to be in poverty or have worsened poverty.

And the children they then gave birth to also had worsening outcomes in terms of higher rates of emotional disorders, developmental disorders, all these things showed that when you can't access the abortion you need, you're actually much worse off.

And this goes against the false narrative that many anti-choice people say that abortion itself is associated with risks of mental health disorders.

In fact, it's the exact opposite.

- Now, back when I was a young doctor in training there were certain things that I had to understand, and train in, to become a board certified pediatrician.

Ranging from newborn care, to development, to the thousand and one things that can happen to kids from infectious disease, to autoimmune conditions, to traumas, to genetic, and metabolic abnormalities.

There's a long, long list.

- The same goes for OB GYN trainees, but now there's a hitch.

In states where abortion is banned, medical residency programs face prosecution if they offer abortion training, or the potential loss of their accreditation, if they don't.

- Now, that's alarming, because check this out, about 45% of the OB GYN residency training programs in America are located in states that are likely or certainly going to ban abortions.

- So, Wisconsin specifically, we have an 1849 abortion ban.

So, a ban that was put into effect long before common use of ultrasounds, or a lot of the modern day diagnoses that we use.

I am certainly concerned about the impact that has on on residents and medical students.

They aren't getting exposure to a routine part of reproductive healthcare, and I'm very worried that they are gonna graduate without the competency and the confidence to take care of these patients.

Right now, residency programs across the nation are working with residency programs in these haven states, or states where abortion is not banned, to try to organize partnerships to send residents into these states where abortion is still accessible.

It means them getting training licenses, in all of those states.

It also means them leaving their family, and leaving their partners, their children, et cetera, to go do a rotation in a different state.

And it also means securing a facility in one of these haven states that has the capacity to, not only, absorb the additional patients that they're seeing, but also additional learners.

But I think it's also important to remember that most trainees, medical students, residents, alike, are of reproductive age.

And I think that there's a lot of fear for them in themselves.

- Now, anti-abortion groups say claims about disruptions to care and other ripple effects are overblown.

They contend that life-threatening conditions are rare in pregnancy, and that abortion isn't the only treatment option.

Inducing labor or performing a C-section are alternatives.

Dr. Lincoln, what would you say to this?

- Yeah, I always find this argument a little confusing especially when they say that there's other things you can do instead of an abortion, like inducing labor or a C-section, because the medical definition of an abortion is the ending of a pregnancy, whether it's taking medicine, having a DNC, having an induced labor delivering vaginally, or having a C-section.

So, these laws ban all of those interventions, and on the idea that pregnancy complications are rare, they're not.

We know that complications in pregnancy are much higher than, for example, complications from abortion.

We know that anytime you limit any sort of healthcare, even if it's something that you think is rare, this has ripple effects to other things that we've spoken about already at length here.

- And just a follow up question.

The laws, as they stand right now, do they actually forbid this level of care, or is it just a lot of confusion and over cautiousness?

- I hear that question, and I think we're going to be hearing that more as we start to see pregnant people die from not getting the abortion they need right away.

And that is a narrative to, kind of, put the blame back on us and say, "Well, you've over interpreted these laws, and that's not what the laws were written to say."

Unfortunately, that is exactly what the laws were written to say, they are ambiguous.

And, so, when we as doctors are told, well we've waited too long, it's because our hospitals, our ethics team, and our lawyers are telling us we can't act before that, because we can't predict the future.

So, we're forced to sit on our hands.

- As abortion laws continue to evolve, you can expect more coverage from us about the consequences for reproductive healthcare.

- But before you go, we are looking for your feedback.

Each year, PBS Digital Studios conducts an audience survey.

It helps us understand what you like, and what you'd want to see more of.

You also get to help PBS pick new shows.

It only takes a few minutes, but your feedback is extremely valuable to us.

Check out the link in the description, and thank you for helping us out.

- And if you have more time on your hands, and you wanna learn more, you should check out our video about abortion myths, featuring Dr. Danielle Jones, an OB GYN and YouTuber, AKA Mama Dr. Jones.