Twelve doctors, wearing their white lab coats, stood in front of the North Carolina Legislative Building on Wednesday and implored their elected officials not to pass any further abortion restrictions. Dr. Amy Bryant, an OB-GYN from Durham, said she used up two hours of vacation time to be there.
North Carolina is one of the last states in the South that allows abortions. The number of procedures in the state increased 37 percent last year, after Dobbs v. Jackson Women’s Health Organization reversed the nationwide abortion protections under Roe v. Wade, the landmark Supreme Court case. That is the highest increase in the country.
“We’re going to see more women die in this state if we can’t provide standard of care,” said Dr. Alison Stuebe, a maternal-fetal medicine physician.
Prior to the Dobbs ruling, North Carolina effectively allowed abortion up to fetal viability, usually around 23 or 24 weeks of pregnancy. That changed late last summer, and North Carolina now does not allow abortion after 20 weeks of pregnancy. Republican legislators are currently debating cutting it further, likely to either 13 or six weeks, although no bills have been filed yet.
The state also has one of the longest waiting periods for abortions in the country and requires patients to have in-person visits for medical abortions. Both are seen as barriers by abortion rights advocates.
“We wanted to get ahead of the game and show our legislature that we, as healthcare professionals, do not accept or condone, in any way, any new abortion restrictions,” said Dr. Bryant.
She, along with over 1,000 colleagues from 54 counties, has signed the open letter, “Medical Professionals Against Government Intrusion into the Practice of Medicine,” a statement that the doctors plan to send to every N.C. legislator.
So far, Democrats in the legislature have united against further abortion restrictions, sponsoring bills in the House and Senate to codify the protections under Roe v. Wade. On the executive side, Governor Roy Cooper, a Democrat, has also signaled staunch support for defending access to abortion, joining the newly founded Reproductive Freedom Alliance of governors across the country.
Cooper is expected to veto any further limits on abortion. But given the Republicans’ near supermajority in the General Assembly, only one Democrat would need to flip to override the governor’s veto on a further ban.
“This was a purely organic endeavor,” Dr. Erica Pettigrew said of the letter. “We got together because we were worried. We put this out through word of mouth, and we have over 1,000 signatures, and we don’t even have a bill yet introduced.”
Unlike when Roe v. Wade was first reversed last year, the doctors don’t have to speculate about the effects of restrictions on their patients. Several of them are on text threads with colleagues in other states with more severe bans, said Dr. Pettigrew.
“They’re scrambling to find places that they can send their patients across state lines to get the appropriate care to save their lives, and we do not want that to happen in North Carolina,” she said.
A further ban on abortion would especially hurt North Carolinians with fewer resources and exacerbate existing health disparities, said Dr. Katie Borders, the current chair of the North Carolina section of the American College of Obstetricians and Gynecologists. She described those disparities as already “at crisis levels.”
The group of doctors said they are already experiencing the effects of the 20-week ban. One clause in the law allows abortion only to stop a patient from dying or if there is a “serious risk of substantial and irreversible physical impairment of a major bodily function, not including any psychological or emotional conditions.”
Dr. Stuebe told a story of her pregnant patient who developed a high-blood pressure disorder after 20 weeks.
“When I met the patient at the hospital, I said ‘Ma’am, I’m really sorry. Before the 20-week ban, I could offer you standard of care, which is to terminate this pregnancy, which will not result in a healthy child. But right now you’re not sick enough,” said Dr. Stuebe. She had to send the patient home, she said, and was checking her labs every six hours, waiting for her patient to be sick enough to meet the threshold of life-threatening.
Now, Dr. Stuebe said, doctors have to spend their time navigating calls to their legal departments rather than doing what’s best medically. She said doctors who provide abortions are wondering, “If I do the right thing for the patient, am I going to lose my medical license and lose the ability to practice?”
“We are hearing from colleagues where they are being told by their hospital lawyers that the patient needs to be closer to death,” said Dr. Pettigrew.
But waiting can be incredibly dangerous, Dr. Stuebe added. “When there’s an infection in the uterus, that can go from ‘I don’t feel great’ to ‘I am floridly septic in the ICU’ in hours,” she said.
Physicians in other states are experiencing a massive chilling effect on their ability to provide care, multiple doctors emphasized. Dr. Pettigrew said it’s not clear how doctors are supposed to deal with patients who have miscarriages or ectopic pregnancies — which can be life-threatening — and those diagnosed with cancer during pregnancies. “There is a lot of confusion and a lot of substandard care,” she said.
“There is no exception that can be written into legislation that covers all of the gray areas that come up in this world,” Dr. Stuebe said.
A further abortion ban would affect North Carolinians with planned pregnancies and unplanned pregnancies, the doctors said. It could also affect people who aren’t pregnant, but have health conditions that require medications that are also used to terminate pregnancies, they said.
“Methotrexate is a medication that is used to treat ectopic pregnancy. It is also used to treat a number of immunologic disorders, such as lupus, and people are afraid that a woman going into the pharmacy asking for methotrexate is getting an abortion, and so they’re refusing to provide it to her,” Dr. Stuebe said.
Beyond their home state, the doctors are concerned about another medicine, mifepristone. Mifeprisone is used in a two-step process for abortion and is the focus of a pending lawsuit in Texas that seeks to remove its FDA approval, stopping doctors’ ability to prescribe it.
If the lawsuit succeeds and mifepristone is banned, Dr. Matthew Zerden predicted that the effects would be “disastrous.” He said doctors would then move to only using the other drug in the current two-step regimen, misoprostol, which would be riskier for patients.
“It’s basically like if you went in to the doctor and you had high blood pressure or diabetes, and they said, ‘Well, the medicine I’d like to use is being restricted by the courts. A second-best works, but has additional side effects or you have to have more visits or take more medication. So it’s suboptimal care than what the medical evidence dictates,” he said.
Beyond individual patients’ safety, a shift in medication could spiral and affect an entire hospital system, Dr. Stuebe said, since a misoprostol-only process would mean patients would have to go to the doctor more frequently. “That means there are going to be fewer nurses to take care of your grandma when they’re in the ICU, because we are adding a burden to the healthcare system. I think we cannot underestimate the ways that this will resonate,” she said.
A further abortion ban, the doctors noted, would also affect the workforce in North Carolina health systems. Dr. Stuebe said she talked to a medical student who had crossed off all of the states with abortion bans from her list of future employers.
“We have one of the top residencies in the state at the University of North Carolina – Chapel Hill, and people won’t come if they can’t be trained in abortion. And that means that we’re not going to have good doctors coming to the state,” she said. “So this is going to affect every single human in North Carolina, and we need to stop it.”
Those humans in North Carolina include the doctors themselves. “We’re all really tired. It’s been a rough three years for everyone. For the medical system, it’s been a really rough three years,” said Dr. Stuebe.
“The moral injury of being asked to show up and provide care and then be told you can’t really do what you need to do. So, you have to watch the patient get sick. And then, oops, if they might be dying, then maybe you can take care of them. That’s incredibly real.”
Pictured above: Dr. Avanthi Jayaweera, a family medicine resident physician and board member of the American Medical Student Association, speaks in front of the North Carolina Legislative Building. Photo by Hana Stepnick — The 9th Street Journal