Not actively dying: An inductive categorization of obstetric cases negatively affected by post-Dobbs abortion bans

Abstract

Objectives

This study aimed to document categories of patient scenarios wherein the timing of pregnancy-related care in the United States has been negatively affected despite the risk of health harms by post-Dobbs abortion laws.

Study design

Between November 2022 and October 2024, we conducted semistructured phone interviews with 36 health care professionals in the United States who were involved in care for a pregnant patient who did not receive the standard of care due to post-Dobbs laws. We analyzed the interviews using a flexible coding approach and grounded theory.

Results

We identified three categories of patient scenarios wherein care that clinicians judged necessary to prevent or reduce future health harm was delayed or denied: patients who had an existing health condition whose severity was exacerbated by pregnancy; patients for whom the pregnancy itself was the health condition clinicians anticipated would lead to medical endangerment or death; and serious fetal health conditions that would result in inevitable fetal or infant death. In all three, the absence of a current life-threatening emergency — even when one was near certain in the future — prevented clinicians from offering abortion care and increased the risk of health harms.

Conclusions

Restrictive post-Dobbs laws’ inflexible focus on the patient’s and/or fetus’s current health status prevented clinicians from using their knowledge and experience to prevent future health harms, turning clinical care for pregnancy into an exclusively reactive practice. These laws reorient care for pregnant patients to only allow interventions based on present health and, in effect, prohibit care that will prevent or reduce future harm.

Implications

Restrictive post-Dobbs laws change the practice of obstetric medicine and constrain clinicians’ ability to offer pregnant patients care that will prevent or reduce future harm, illustrating a concerning policy outcome and highlighting the health dangers of these laws.