LLast week, family physician Dr. Maya Bass was on the phone with the medical director of Trust Women, one of four abortion clinics in Oklahoma. They were scrambling to figure out how to keep their doors open after a leaked draft notice signaling the Supreme Court’s intention to overturn Roe v. Wade and the Oklahoma governor’s signing of SB1503, barring the abortions in the state after six weeks of pregnancy.
“With my colleagues, there’s a lot of anger,” Bass says. “As a medical professional, it’s really difficult to spend your life studying to become an expert in a certain field and then have a politician with no medical expertise and not even a womb take away your power to offer patients safe medical care.”
About once a month since 2017, Bass has traveled from her home in Camden, New Jersey, to moonlight Trust Women Oklahoma City to help ease the shortage of abortion providers in the center of the country. Staff at the small clinic had been stretched thin since September, when neighboring Texas banned abortions beyond six weeks of pregnancy, forcing about 6,000 Texans to Oklahoma.
But Oklahoma will no longer be a haven for sick Texans. A near-imitator of Texas law, Oklahoma’s new ban would allow any private citizen to sue anyone – doctors, nurses, pharmacists – who “aids or abets the performing or inducing of an abortion” after signs of fetal heart activity. And following a Roe reversal, Oklahoma is one of 13 states that would immediately ban nearly all abortions.
“The staff is exhausted,” Bass said. “They are amazing and resilient and are probably some of the most creative humans I have ever met in that they have come up with every new legal hurdle different plans to serve as many people as possible. “How can we legally accommodate patients with a 72-hour waiting period and a six-week ban? How can we achieve this?
They considered options to fight back. Perhaps they could serve patients better by offering consultations and screenings at their clinic in Oklahoma City, then sending them to their sister clinic in Wichita, Kansas, two and a half hours away, for the procedure. abortion itself – but would that somehow put them at risk of being prosecuted for “aiding and abetting” an abortion? Would that involve the Wichita clinic? Could Oklahoma City staff serve more patients if they moved to Kansas to practice?
After his call with the medical director, Bass canceled his next trip, which would have been in June. The Oklahoma City clinic — which receives some 500 calls a day — has temporarily suspended new appointments. “Patients were too nervous to make an appointment with us,” says Bass. “We couldn’t promise that we would be able to see them.” The facility is now referring patients to Wichita. Appointments for the Kansas clinic are all currently full.
“We have planned this”
“Pregnancy is tough,” Bass says. “You are tired and nauseous. People have hyperemesis – they vomit continuously. Mental health disorders tend to worsen, especially during an unwanted pregnancy. There are so many stories of people coming in saying, “I can’t function, I can’t do my job, I’ve taken too many sick days.”
After an abortion, the negative side effects of pregnancy disappear. But trigger laws that require patients to travel out of state to access care are forcing more patients to stay pregnant longer. “That’s four more weeks of suffering,” Bass says. “And that’s definitely something that’s going to get worse because even if a person has resources, clinics that exist after Roe’s fall will see greater volumes and wait times.”
For doctors nationwide, the struggles of patients and providers in Texas and Oklahoma offer a glimpse of what will come after Roe’s likely fall.
“I feel sad and I feel tired and I feel angry and incredibly motivated,” said Dr. Katherine Farris, chief medical officer at Planned Parenthood South Atlantic in Raleigh, North Carolina. “It’s breathtaking and heartbreaking, but we’re not surprised. We have planned for this.
In so-called sanctuary states like North Carolina, much of that planning involves figuring out how already overwhelmed clinics can serve even larger waves of aborted “refugees.”
Even with efforts to bolster staff, clinics expect wait times to increase, which will force more patients to carry pregnancies beyond the medical abortion limit, driving demand for more procedural abortions in the second trimester. “So people who say they’re so upset about subsequent pregnancy abortions are creating a scenario where more will happen,” Farris says.
In a landscape plagued by misinformation and stigma, where searching Google for “how to get an abortion” often results in misleading advertisements for anti-abortion “crisis pregnancy centers,” providers are prepare to educate more patients about safe and affordable reproductive health care options. Even though Women’s Trust Oklahoma City is completely prohibited from providing in-house abortions, they plan to remain open, offering informational consultations and other reproductive health services.
“Our patients need us more than ever as resource guides,” says Bass. “If someone calls me, it’s not enough for me to say, ‘Here is the number of the nearest clinic.’ I need to say, ‘Here is the clinic, here is the number of an abortion fund in this area if you have money problems, here is the free emotional counseling hotline.’ Healthcare providers need to serve our patients now by giving them clear resources, websites with up-to-date information. »
Preparing for a post-Roe America also means providers discovering how to legally and ethically counsel patients on how to safely procure and self-manage abortions.
In a pre-Roe landscape, before the advent of abortion pills, self-management posed serious risks of injury or death. But now, “because of medical abortion, there are safe ways to manage at home,” Bass says. “I hope more suppliers recognize the safety of [self-managed medication abortions] so that we can support our patients through this.
Patients can self-manage in other ways, such as contacting the loose underground networks of women trained to provide safe home abortions outside the law, using devices such as hand aspirators made from mason jars or herbal abortifacients, such as pennyroyal tea or black cohosh.
“I have friends in the more natural herb world who talk about going back to the old days of using different herbs,” Farris says. “Other patients will return to physical induction attempts. And these will be dangerous.
Even as they plan how best to handle this latest blow to reproductive health, these doctors expect their efforts won’t be enough to stem the devastation of a Roe reversal. Providers are increasingly forced into interactions with patients that seem rude and absurd.
“I’ve had patients sitting in front of me sobbing, saying, ‘Please, please, I need you to do this today’, but they didn’t get their consent. 72 hours,” Farris says, referring to the state-mandated time between counseling and abortion. “Or their 72-hour consent time doesn’t expire for five more hours, and I have to say, ‘I’m sorry, I need you to wait five more hours before giving you your pill in order to be in accordance with the law.'”
She says she needs to explain to patients that although it breaks her heart, she cannot make an exception because it would put her at risk of being able to treat thousands of other women who need her care every year. She knows her work will continue to be sought after, likely with growing desperation and dire prospects. Research suggests that a total ban on abortion would lead to a 21% increase in pregnancy-related deaths.
“There will be a lot of forced deliveries. People’s lives will be devastated. People are going to be emotionally and financially traumatized. People’s futures are going to be derailed,” Farris says. “I will be amazed if people don’t die. And it shouldn’t be up to people dying for us to reconsider autonomy.