Consulting OB: How Indiana's abortion ban impacted management of vaginal bleeding in the emergency department.

Abstract

Objectives: This study examines how Indiana's abortion ban reshaped the provision of care for patients experiencing vaginal bleeding in two emergency medicine sites in the year following implementation.

Study design: Between August 2023 and August 2024, we conducted an ethnographic investigation, including observations and semi-structured, in-depth interviews with emergency medicine and OB-GYN clinicians at two clinical sites in Indiana that frequently serve patients with vaginal bleeding. We used a purposive sampling strategy to capture diverse perspectives across clinician types and demographics. Three team members carried out multiple rounds of content and thematic analysis using qualitative data management software, and the full team engaged in iterative discussion to refine interpretation.

Results: EM clinicians reported being largely insulated from the ban's effects through increased reliance on a small core of OB clinicians with specialized medical, legal, and socioemotional expertise. EM clinicians increasingly deferred abortion-adjacent care to OB specialists, including referrals, options counseling, and medications for ectopic pregnancy. OB clinicians welcomed expanded consultation roles while noting heightened fear among ED colleagues.

Conclusion: Reliance on OB providers appears effective short-term but raises concerns about sustainability, particularly given documented OB-GYN workforce shortages. Over-consultation risks narrowing ED competency with pregnancy-related care, potentially exacerbating barriers to care in rural or resource-limited settings.

Implications: In the year following Indiana's abortion ban, EM clinicians at two clinical sites grew reliant on a small core of OB providers, raising concerns about long-term sustainability and ED competency with pregnancy-related care.