Medical uncertainty in the shadow of Dobbs: Treating obstetric complications in a new reproductive frontier

Abstract

Recent changes to United States medical practice following the U.S. Supreme Court's decision in Dobbs v Jackson Woman's Health Organization have led to new forms of medical uncertainty arising from the interpretation and implementation of state law. Post-Dobbs legal restrictions are particularly challenging because they entail multiple forms of uncertainty that intensify when combined, with risks to pregnant patients and to the clinicians who care for them. In this article, we identify and describe three distinct types of uncertainty that obstetrician-gynecologists (OB-GYNs) in states with abortion bans encounter when caring for patients with an obstetric complication known as preterm prelabor (or premature) rupture of membranes (PPROM, i.e., ‘water breaking’). PPROM represents a paradigmatic case in which prognostic, legal, and existential uncertainty coalesce, leading to stress and discomfort for both patients and the clinicians caring for them. Focusing on OB-GYNs, we describe each of these forms of medical uncertainty in turn, and then elaborate a case study to show how they operate in tandem over time. In doing so, we add to a growing body of literature highlighting the relationship between structural conditions shaping medicine and uncertainty in practice. Whereas evidence-based medicine is organized around the logic of reducing uncertainty, we find that doing so is far more difficult when the uncertainty arises from politics as opposed to clinical factors.