Sultan: Missouri doctors describe the horrors of working in an abortion-ban state
A pregnant woman came to a hospital in St. Louis bleeding profusely, her placenta breaking off from her uterine wall. The fetus had no chance of surviving.
The woman was not at immediate risk of dying, but she was too sick to be discharged safely.
"She was stuck in the gray zone," a doctor who treated her said. The physician is prohibited by the hospital from speaking publicly about what patients in Missouri have experienced under the GOP-backed near-total abortion ban in place since the protections of Roe fell.
When pregnant women in Missouri are given a fatal diagnosis for the fetus they are carrying, doctors' hands are tied.
"So (in) many cases, we refer them to surrounding states," the physician said.
That's what often happens: Once the doctors stabilize a patient, the bleeding pregnant woman has to get in a car and drive across the state line for further care.
Dr. Jennifer Smith, an obstetrician who works in private practice in St. Louis, described a patient who desperately desired her pregnancy. She came into her early appointments asking about prenatal supplements. But during an ultrasound, Smith detected genetic abnormalities.
"Rather than being cared for by her physician in the privacy of a hospital, I had to refer her to Illinois," Smith said. During a follow-up visit, the heartbroken woman described having to walk past anti-abortion protesters screaming at her, calling her a "baby-killer" and pounding on her car windows at the Planned Parenthood center.
"She was going through the worst possible thing she could deal with," Smith said. The Missouri ban worsened her suffering.
Lauren Nacke, a maternal health care counselor in St. Louis and board president of Abortion Action Missouri, said she has had devastating conversations with patients in the two years since the ban has been in place. It's worse when the patient lacks paid sick days or the funds to travel.
"I have worked with patients who have traveled hundreds of miles, as far as from Mississippi, who felt in limbo until they could get an appointment in Illinois or even farther away," she said. Nacke has witnessed physicians treating a pregnant woman in distress while staying on the phone, for hours, with a lawyer. The lawyer advises the doctors on what they can legally do — even when they already know what the patient needs.
"Those patients have been held hostage," Nacke said.
One of her colleagues told her that until the Dobbs decision, she never thought much about getting involved in abortion politics. But after she saw the fallout of abortion bans and women being charged with crimes after having a miscarriage, she has become more politically engaged on the issue.
This colleague's mother had suffered a miscarriage at home, and she wondered what would happen in that situation now.
"Would the police come instead of an ambulance?" she asked Nacke.
Amid the helplessness she and other health care workers have felt, they are embracing a moment of hope and empowerment: Missouri voters will have the chance to repeal the ban by voting for Amendment 3 in November.
The amendment would protect reproductive freedom, overturn the state's current ban and legalize abortion until fetal viability. More than 800 medical professionals have endorsed Amendment 3, and Missourians for Constitutional Freedom collected more than 380,000 signatures (more than twice the total required) to put it directly to voters.
Smith says there is a lot of misinformation circulating about the proposed amendment — that it will take away a patient's right to sue for bad care, for example, or allow an unqualified person to perform an abortion. She's heard fears that the amendment will nullify parental rights, force the state to pay for abortions and even promote sex traffickers.
"All these things are false scare tactics," she said. They are designed to get voters to go against their instinct to allow people to make their own health care decisions.
States with near-total bans or early gestational limits can affect women across the country — even those in blue states. Students may attend college in a prohibition state; others may be visiting family or traveling through for a work conference. If a pregnant person has a medical emergency in Missouri, or if a woman is raped here, her options are limited, Smith said.
But having the ability to vote to restore your rights is powerful, Nacke said. She said women have gotten hope from similar successful efforts in Ohio and Kansas.
"We do have this big opportunity now. That's real," she said.
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