Overturning Roe v. Wade: Legal implications for OB/GYNs
Key Takeaways
If Roe v. Wade is overturned, patients in affected states will have no choice but to leave the state to receive abortion care, self-manage an abortion, or give birth. The Supreme Court’s decision will have significant repercussions for reproductive health care.
There are many implications for healthcare providers—and specifically, OB/GYNs—who may be reluctant to intervene for patients who have inevitable miscarriages or ectopic pregnancies.
Another potential outcome of overturning Roe v. Wade: Medical residency programs will suffer, as residents will not have access to in-state abortion training.
The unprecedented leak of a draft Supreme Court opinion shows that the court’s conservative majority of justices are poised to overturn Roe v. Wade, the landmark case that ruled that the US Constitution protects pregnant women who choose to have an abortion.[]
The court could be set to overturn approximately 50 years of abortion rights by ruling on the Mississippi Dobbs v. Jackson Women’s Health case by the end of June. In this case, the state of Mississippi wants to uphold a law that would ban abortions after 15 weeks of pregnancy.
While the draft ruling is not a final court decision, if the Supreme Court ultimately overturns Roe v. Wade, abortion access will be decided at the state level.
Nearly half of the 50 US states stand to ban all or most abortions if Roe is overturned.
Abortion has become a highly politicized issue following the draft leak, which has masked its status as a major health care issue that will affect patients and healthcare providers alike.[]
In this article, MDLinx examines the implications of overturning Roe v. Wade on patients, OB/GYNs, and other healthcare providers.
How will patients be affected?
Patients who live in states with abortion bans will have only three choices: leave the state to receive abortion care, self-manage an abortion, or give birth.
Only individuals who have the proper resources and support can seek out-of-state care. According to a report by the Guttmacher Institute based on its 2014 survey, 75% of abortion patients at that time were low-income, with 49% living below the federal poverty line and 26% living at 100%–199% of the poverty level. Thus, out-of-state travel would be unattainable for many people in such circumstances.[]
The second option is self-managed abortion, using the FDA-approved combination of mifepristone and misoprostol, which has proven to be safe and effective. Patients who don’t have access to the medications could resort to ineffective, dangerous abortion methods, such as the insertion of objects or caustic materials into the cervix or vagina, ingestion of poisons, and intentional traumas.
Individuals who can’t act on either of these two options will be left with the only one remaining: to give birth. This will have far-reaching implications for the healthcare system beyond maternal care. Consider the long-term medical care needs for children born with disabilities or complex medical issues, when women can no longer end a pregnancy subsequent to diagnosis of a fetal abnormality.
Maternal mortality rates are also expected to increase, as abortion is much safer than childbirth, with estimates showing a 21% increase if Roe is overturned. These estimates don’t take into consideration any likely increases in death from unsafe abortion practices.
Impact on healthcare providers
Emergency medicine and primary care providers will have to become familiar with the normal course of self-managed abortions using medications, while watching out for any potential complications.
Patients who use the misoprostol combination, which is generally safe, will seek follow-up care to ensure that their abortion is complete. But those who choose unsafe methods may need critical care treatments for sepsis, hemorrhage, toxic exposure, and pelvic injuries.
Mental health providers will also see increased demand to address the mental health needs of pregnant women who are continuing unwanted pregnancies, including those due to sexual assault.
Implications for OB/GYNs
Overturning Roe v. Wade will have downstream implications for many aspects of reproductive health care.
OB/GYNs may be reluctant to intervene in cases of ectopic pregnancies, inevitable miscarriages, or lethal congenital anomalies—even in cases where fetal death is inevitable—due to fear of legal repercussions.
Furthermore, infertility care practices may be prevented from recommending selective reduction for multifetal pregnancies that commonly result from in vitro fertilization.
Selective reduction of high-risk plural gestations
Patients who conceive triplet pregnancies often face the difficult decision to undergo selective reduction of one or more of the fetuses. This is especially true for those undergoing fertility treatments. Pregnancy with triplets is associated with a significantly higher risk for both the mother and babies in comparison to twin gestations.
In an article published in Fertility and Sterility, selective reduction of one or more fetuses in a triplet pregnancy extended the time to delivery and increased the likelihood of delivery at or after 34 weeks of gestation.[]
Without the ability to undergo multifetal reduction, patients are at risk of loss of the entire pregnancy, premature delivery with increased risk of neonatal complications or death, and increased risk of maternal complications. In states that ban abortions and ban selective reductions, some IVF providers may choose to stop providing treatment altogether.
Incomplete and inevitable abortions
Incomplete, inevitable, and missed abortions are subtypes of spontaneous abortions that have an overall incidence of 10% to 15%.[] While their causes are generally unknown, they are thought to be caused by fetal chromosomal abnormalities.
Most incomplete abortions can be monitored with frequent OB/GYN visits, but some cases require additional medical or surgical interventions, such as surgical management with dilation and curettage. Complications of incomplete abortions include sepsis, hemorrhagic shock, and uterine rupture.
Pathologic and ectopic gestations
With the prospect of a court ruling overturning Roe v. Wade, there has been speculation on how abortion bans will impact treatment of ectopic pregnancies, which can be life-threatening.[] Approximately 1%–2% of US pregnancies are ectopic; ruptured ectopic pregnancies account for nearly 3% of pregnancy-related fatalities.
Patients with ectopic pregnancies can be treated with a medication called methotrexate, or with laparoscopic surgery if the pregnancy has ruptured. The issue with legislation that restricts abortion access is a lack of specificity and excessive stringency that proponents of abortion say could affect treatment of individuals with ectopic pregnancies–for example, by delaying treatment.
Impact on obstetrics and gynecology residency programs
If Roe v. Wade is overturned, it’s clear that the result will be substantial negative consequences on patient care in affected states.
In addition, this decision would also have dire implications for obstetrics and gynecology residency training programs.
An April 2022 Obstetrics & Gynecology article found that out of 286 accredited OB/GYN residency programs, 128 are located in states likely to ban abortion if Roe v. Wade is overturned.[] This amounts to 43.9% of current OB/GYN residents who will be likely denied access to in-state abortion training.
What this means for you
If the Supreme Court overturns Roe v. Wade, it will have legal implications for OBGYNs and other HCPs. OBGYNs may be hesitant to intervene in pregnancies, even when fetal death is inevitable, due to legal repercussions. If HCPs aren’t protected from intervening in cases such as multifetal pregnancies, inevitable abortions, and ectopic pregnancies, patients may need to travel to unaffected states (or even outside the US) for abortion care.