The Society for Maternal-Fetal Medicine released a special statement this month to assist physicians treating patients with severe pregnancy risks in states where abortion is prohibited. The guidance addresses the legal and clinical uncertainties that have emerged since 2022.
Dr. Justin Lappen, an Ohio-based maternal-fetal medicine specialist who chaired the committee drafting the document, noted that high-risk patients require specific reproductive health services, including abortion care, to prevent morbidity and mortality.
Fragmented Legal Landscape
The United States currently operates under a divided regulatory framework. Ten states and the District of Columbia permit abortion without gestational limits, while 13 states enforce total bans at all stages of pregnancy. Since the Supreme Court’s June 2022 decision in Dobbs v. Jackson Women’s Health Organization, hospital systems and clinics have struggled with inconsistent interpretations of what constitutes legal jeopardy.
This confusion has resulted in delayed treatments for women experiencing pregnancy complications. The new guidelines urge providers to establish cross-state referral networks, clarify permissible actions under local laws, and counsel patients on their options. They also recommend that medical teams consult with legal experts regarding the federal Emergency Medical Treatment and Labor Act and undergo training for basic termination procedures.
Rising Complication Rates
The statement cites research demonstrating the health consequences of restricted access. In cases involving premature rupture of membranes—a condition where the amniotic sac breaks before fetal viability, posing a risk of deadly infection—complications were significantly higher in states with abortion bans.
Data referenced by the specialists showed that 57 percent of such cases in restricted states resulted in serious outcomes, including blood transfusions, intensive care admission, or severe infection. In contrast, comparable research from states without restrictions indicated a complication rate of 33 percent. In every cited instance of premature rupture of membranes under these conditions, the fetus did not survive.
Texas provides a notable example of these outcomes. After passing Senate Bill 8 in 2021, which banned abortion at an early gestational stage, waiting to treat patients under those restrictions led to increased negative health results.
Divergent Medical Standards
The Society for Maternal-Fetal Medicine and the American College of Obstetricians and Gynecologists maintain that access to abortion and counseling constitutes standard care, allowing for conscientious exceptions by individual physicians. However, some doctors align with the American Association of Pro-Life Obstetricians and Gynecologists, which provides alternative guidance that includes termination in certain scenarios.
The pro-life association partners with the Alliance Defending Freedom, several anti-abortion organizations, and the Alliance for Hippocratic Medicine. The latter group previously filed a lawsuit seeking to revoke federal approval of one of two drugs used to terminate pregnancies or treat miscarriages. A representative from the American Association of Pro-Life Obstetricians and Gynecologists was unavailable for comment.
Dr. David Hackney, another Ohio maternal-fetal medicine specialist, published a book in August detailing the challenges of navigating high-risk pregnancy care post-Dobbs. He observed that healthcare systems initially implemented patchwork policies that heightened confusion among staff. Since then, providers and administrators have developed informal agreements to determine which actions remain comfortable within the bounds of state abortion bans.