I’m a doctor: Once a patient is ‘sick enough’ for abortion, it’s often too late

Abortion policies may have become more restrictive in 14 states following the overturn of Roe v. Wade one year ago. However, taking reproductive health decisions away from patients and their doctors has not changed two fundamental, urgent truths about pregnancy.

The first is that pregnancy can be dangerous. That isn’t my conclusion; it’s empirical data. Even in a wealthy, developed country like the United States, more women are dying from pregnancy and childbirth than in the recent past.

The second truth is that restrictive policies are not eliminating abortions. They’re shifting where procedures occur. The Society of Family Planning has been tracking these trends. States with the largest drop in abortions provided by a clinician were Texas, Georgia, Tennessee and Ohio. Those with the largest increases include Illinois, Florida and North Carolina, so people are being forced to travel to obtain care. 

I’m seeing patients from abortion-restricted states in my New York-based practice and would build on the second truth: Lack of access to abortion services makes pregnancy more dangerous for some patients. 

Since last year’s Roe overturn, patients from abortion-restricted states are coming to us in New York. Already dealing with preexisting medical conditions and lethal fetal anomalies — not to mention heartache — they are coordinating flights and rides, hotel and family stays. They’re taking on the additional stress and risks of travel to legally find their way to safety. 

We’re saving these patients because doctors in their home states face, “the impossible choice.” Physicians are asking themselves whether patients are “sick enough” to terminate their pregnancies. 

When I train doctors to perform abortions, I tell them about a pregnant patient of mine whose water broke at 18 weeks, far too soon for the fetus to survive to viability. She did not want to end her pregnancy even though the complication placed her in grave danger. 

The following morning, she changed her mind. We booked the termination for her for that afternoon. A few minutes into the procedure, my surgical team and I saw that she had developed severe sepsis. The infection spread so rapidly and aggressively that, had she not been in our care at that moment, she could have died. It doesn’t take long for a patient’s condition to become deadly.  

That’s the medical truth about the concept of “sick enough.” It doesn’t exist. Doctors waiting for “sick enough” are pushing high-risk patients to the brink of death, and it’s possible — in some cases, likely — that we won’t be able to pull them back from that edge.  

Placing a stranglehold on safe medical and surgical options to terminate pregnancies keeps patients teetering on that edge. A year since Dobbs v Jackson, abortion restrictions and bans are confusing doctors in restricted states because legislators have used conflicting, non-medical terminology to write abortion policies. Some doctors are consulting legal teams before they make medical decisions, which can mean waiting for conditions to take that lethal turn. These limits interfere with the vital professional assessment of maternal risk in which outcomes can truly come down to timing. 

What about the supposed exceptions that restricted states have enacted to protect the life of the pregnant patient? They’re not working. 

“In practice,” the Kaiser Family Foundation says, “health and life exceptions to bans have often proven to be unworkable, except in the most extreme circumstances, and have sometimes prevented physicians from practicing evidence-based medicine.” 

Those last eight words haunt me.  

My response is to do what sometimes feels impossible. I insist on hope.  

Voters in Montana, Kentucky and Kansas who have organized people to vote against abortion restrictions in state referenda keep me going. So do the many states that have responded to the Dobbs v. Jackson decision by adding abortion protections to their state constitutions. These moves reflect the 6 in 10 Americans who say abortion should be legal in most or all cases. 

I’m not a policymaker; I’m a surgeon. My part is to nurture that hope by offering expert, evidence-based care in a compassionate environment. I’m also ensuring patients have full autonomy by training physicians to perform abortions. 

Throughout my 11-year career, I’ve trained more than 100 doctors to terminate pregnancies, manage miscarriage and pregnancy loss and become experts in contraception care. Today’s political realities make me feel uncertain about whether I’m doing enough, but I’m doing my best anyway. Hopefully, the doctors I train will train others. 

I know it could take 49 more years for abortion policies to change at the Supreme Court level, but I believe we doctors have the wherewithal to be the advocates our patients need. Each day, we can recommit to our patients and teach others how to save lives — without first pushing our patients toward death. 

The surgeon who taught me to perform abortions was in his 80s. Here I am, continuing his legacy, training the next generation of providers to ask the right questions and act when our patients need us.  

We’re not going anywhere.  

Elizabeth Schmidt, MD, MSCI, FACOG, FACS is the chief of Family Planning, Department of Obstetrics and Gynecology for Northwell Health, Ryan Program Director in the Department of Obstetrics and Gynecology and Assistant Professor of the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.