After Kaitlyn Kash delivered her baby daughter at Austin’s Ascension Seton Medical Center in July 2023, she began hemorrhaging. Her doctor told her that her placenta had not come out of her body as it should have after the baby was delivered and that she would need a D&C—a procedure that removes the contents of the uterus.
Kash consented, but then, she told me, nothing happened. “Are we going to the operating room?” Kash kept asking. She started shaking and vomiting. Hospital staff took her newborn daughter off her chest.
After about 45 minutes, Kash was wheeled to the OR—where, she said, she faced more delays. “People were running around, and there was slamming of cabinets,” she told me. The staff didn’t seem prepared. Kash remembers thinking that she was going to die, that she would never get to name her daughter. She struggled to speak, then passed out.
When she awoke after the procedure, a nurse told her that she was lucky she still had her uterus. She’d bled so much, she ended up needing a transfusion.
Kash didn’t understand what had happened, nor, she says, did the hospital tell her. Only after being discharged and speaking with a nurse-practitioner friend did she realize that her experience was not typical of a D&C. The procedure does not typically take hours, involve significant blood loss, or risk the loss of a uterus.
It is, however, commonly used for first-trimester abortions. The words of the hospital social worker Kash spoke with before she was discharged stuck out to her: “We don’t do D&Cs anymore,” the woman said, according to Kash. Of course, emergencies during delivery can be chaotic anywhere. But Kash began to suspect that, because Texas had banned virtually all abortions in 2022, following the Supreme Court’s Dobbs decision, either the equipment to perform the D&C was not ready, or the hospital was struggling to justify performing one, even for a placenta. Soon, she joined a lawsuit against the state of Texas over its abortion laws. (Kash provided medical records that support that she had a D&C and lost blood. The hospital did not respond to a request for comment, and it is not part of Kash’s lawsuit.)
I found Kash’s experience particularly unnerving because my husband and I are planning a move to a state that bans abortion after six weeks. After hearing and reading stories like hers, we are wondering if our move means that we should not have another child. Kash’s experience is representative of the kinds of delays, confusion, and other substandard care that some pregnant women now experience in the 19 states that enacted significant abortion restrictions after Dobbs. Pregnancy and childbirth are risky no matter where you live, but the grim stories and maternal-health statistics coming out of abortion-restrictive states have made me consider how safe it is to have a baby in one of them.
Today, Kash doesn’t blame the doctors or staffers at the hospital; she blames Texas’s abortion laws for causing unnecessary confusion. She wishes she could have been pregnant and delivered her baby somewhere else. But at the same time, her best friends live in Austin, and her close family lives in Dallas and Houston. “It’s not easy to leave,” she said. “Texas is my home.”
Every year, of course, hundreds of thousands of people safely have babies in Texas and other states with near or total abortion bans. But some women with pregnancy complications do encounter doctors who are afraid to act quickly to provide life- or health-preserving terminations, according to interviews I did with legal and medical experts, patients, and 15 doctors who practice in these states. Though the bans make exceptions to protect the mother’s life, they contain so much uncertainty that some doctors, fearing prison time or the loss of their license, try hard to avoid providing abortions, even when they are medically indicated.
Sometimes, a doctor may be too scared to give the patient an abortion and so point her to a neighboring state. The delays involved in travel can push inevitable abortions later into pregnancy, when they can become more complicated. Other times, the fear manifests as doctors choosing a more invasive or less-effective procedure instead of one that might be considered an abortion. Sarah Osmundson, an obstetrician in Tennessee, offered me the example of an ectopic pregnancy, in which an embryo implants outside the uterus. Ectopic pregnancies are almost never viable, and if left untreated can be fatal for the mother. The safest and simplest way to address an ectopic pregnancy is to give the patient methotrexate. But this drug can be seen as an abortifacient, so some doctors in restrictive states might opt to remove the patient’s fallopian tube instead, according to Osmundson, which could impair her future fertility. “We’re requiring a patient to undergo a surgical procedure as opposed to a very safe medical treatment that we have,” she said. This nearly happened to Representative Kat Cammack, a Florida Republican, when she went to an emergency room with an ectopic pregnancy in 2024 and where, she said, doctors resisted giving her methotrexate because they were worried about losing their medical licenses or going to jail for doing so.
Even if a doctor is comfortable providing a medically indicated abortion, they need to find scrub techs, nursing staff, and anesthesiologists who are, as well. And they might not be able to. “Abortion care doesn’t happen individually in a hospital,” says Leilah Zahedi-Spung, an obstetrician in Colorado who previously practiced in Tennessee, where abortion is completely banned with very limited exceptions. “I anticipated a lot of trouble finding people who felt safe participating in the care.” Tennessee’s abortion laws contributed to her decision to leave the state.
The most consistent concern I heard raised by the providers I spoke with is that the new bans cause unacceptable delays in patient care. In abortion-restrictive states, some hospitals have created task forces and committees of lawyers to help doctors figure out how to comply, which can slow down the process of treating at-risk patients. “There sometimes are delays while there’s this sussing out of like, ‘How do we take care of this?’” Lara Hart, an obstetrician in Georgia, where a six-week abortion ban went into effect in 2022, told me. Though Hart praises her own hospital’s processes for dealing with tricky cases, she said her job now requires more paperwork and calling around to different departments. She told me that she sometimes wonders, “Is some overzealous district attorney gonna come and arrest us or something?” She remembers arriving at work at her previous practice to find a patient in the ICU with sepsis and on a ventilator. The woman had come in with previable PPROM (preterm premature rupture of membranes), a condition in which a woman’s water breaks too early in pregnancy. The other doctors were reluctant to offer her an abortion, which is a standard treatment. She began hemorrhaging so much that Hart had to perform a hysterectomy. Hart remembers feeling angry. “I shouldn’t be here doing this,” she thought. “This should have been taken care of a week ago before she was so sick.”
Certain states’ bans say an abortion can be performed to avoid “death or substantial and irreversible impairment of a major bodily function,” but some doctors say this guideline is unclear because many situations can go from reversible to irreversible within minutes. A recent study of post-Dobbs obstetric care in states with abortion bans highlighted this problem. It concluded that, because abortion laws tend to focus on the patient’s current health status, doctors in these states are often unable to consider the likely future health of a patient—including life-threatening emergencies that are all but certain to arise. “In obstetrics, there is an inch of black and an inch of white and, like a thousand yards of gray,” Hart said. This regulation also contradicts typical standards of care, according to Dawn Bingham, an obstetrician who is currently suing South Carolina over its abortion ban. “There’s nothing else in medicine that we wait for people to get sicker,” she told me.
Quantitative and qualitative evidence suggests that the delays created by abortion restrictions are having an effect on health care. A recent report from the Gender Equity Policy Institute, a nonprofit that advocates for women’s equality, found that, although the overall risk of dying from pregnancy is low, mothers living in states where abortion is banned were nearly twice as likely to die during pregnancy or childbirth compared with mothers living in states where abortion is accessible. In states with abortion bans, Black mothers were more than three times as likely to die as white mothers. ProPublica found that when Texas banned abortion after six weeks in 2021, rates of sepsis increased by more than 50 percent for women hospitalized with miscarriages in the second trimester, likely because women were being made to wait until either there was no fetal heartbeat, leaving them at higher risk for an infection, or their infection became life-threatening. ProPublica also found that after Texas banned abortion, blood transfusions during emergency-room visits for first-trimester miscarriages increased by 54 percent, suggesting that doctors were avoiding performing D&Cs. At least four women in states with near-total abortion bans have died because they were denied an abortion, according to news reports. In a 2023 survey from KFF, a health-care nonprofit, four in 10 ob-gyns in abortion-ban states said the Dobbs ruling made providing care during miscarriages or other pregnancy emergencies harder.
A qualitative study involving anonymous doctors in abortion-ban states offers quotes such as “The way our legal teams interpreted it, until they became septic or started hemorrhaging, we couldn’t proceed.” In another study, a doctor described a patient who came in 15 weeks pregnant and hemorrhaging, with “blood everywhere, bleeding through her clothes.” But because the fetus had a heartbeat, the doctor had to talk to the hospital’s risk-management department before performing an abortion. “There’s less evidence-based health care that is provided for everyone that needs it in those states,” Nikki Zite, an obstetrician in Tennessee, told me. When I asked Nicole Schlechter, another Tennessee obstetrician, about the higher mortality rates in abortion-ban states, she put it more simply: “People are dying from being pregnant.”
Supporters of abortion bans deny that conditions are dire. Ingrid Skop, the vice president and director of medical affairs for the Charlotte Lozier Institute, a nonprofit that advocates against abortion, said in an email that “all pro-life state laws allow doctors to exercise their reasonable medical judgment to treat women with pregnancy emergencies, and no law requires certainty or imminence before a doctor can act.” She also pointed out that “no doctor has been prosecuted since Dobbs for performing an abortion to protect the life of the mother.” Christina Francis, the CEO of the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) and an obstetric hospitalist in Indiana, told me her practice has been unaffected by her state’s near-total ban on abortion. She says any hesitation of doctors to act in emergency situations is a result of hospitals failing to adequately prepare their physicians. “The problem is not the law,” she told me, “but rather either the guidance or the lack of guidance that physicians are receiving.”
Some states are aiming to clarify their abortion bans. In June, Texas passed the Life of the Mother Act, which clarifies when the state’s near-total abortion ban allows for the procedure, saying explicitly that physicians do not need to wait until a patient is in imminent danger of dying to perform an abortion. In Tennessee, a new law clarifies that abortions can be performed in cases of previable PPROM and severe preeclampsia. In Kentucky, a clarification law added conditions under which doctors can legally perform an abortion, such as hemorrhage and ectopic and molar pregnancies.
Some Texas doctors I interviewed support the clarification law. Todd Ivey, an obstetrician in Houston, told me he thinks it “is going to help us some.” He said he wishes the law had exceptions for fetal abnormalities, rape, and incest, but that Texas doctors shouldn’t “let the perfect be the enemy of the good.”
But some experts say the clarification bills don’t offer doctors much security, because some obstetric emergencies may not meet the laws’ precise legal language. For instance, John Thoppil, an obstetrician in Austin who supports the Texas clarification law, once had a patient whose fetus had a fatal anomaly. He diagnosed the condition at 12 weeks, but the woman was not able to travel out of state for a termination until she was 18 weeks along. In the intervening time, her placenta began to invade her scar from a previous C-section, something that would not have happened, Thoppil told me, if he had been able to perform the abortion at 12 weeks. The patient was hospitalized after the abortion and had to have another procedure, almost losing her uterus in the process. The Texas clarification law, he told me, would not have changed her situation.
This confusion may get worse now that the Trump administration has revoked Biden-era guidance saying hospitals in abortion-ban states must provide abortions if the procedure would stabilize a woman experiencing a medical emergency.
Hector Chapa, an obstetrician in south-central Texas and a member of AAPLOG, told me that this revocation didn’t matter, and that doctors could and should still treat patients in an emergency. “EMTALA still stands,” he said, referring to a federal law that hospitals must stabilize patients. “EMTALA has never gone away.” But Andreia Alexander, an ER doctor in Indiana, told me that patients should not want a doctor who hesitates to save their life. “If somebody is dying in front of me,” she said, “I can’t be thrown off my game to think for a minute about whether or not my actions are going to cause me to be thrown in jail, lose hundreds of thousands of dollars, or lose my medical license.”
The horror stories I heard during my reporting are shocking but rare. In one study, the most common scenario that physicians said they struggled with, post-Dobbs, was PPROM in the second trimester. The risk of previable PPROM is extremely low: less than 1 percent. But in pregnancy, small percentages matter. Osmundson told me her hospital sees a previable PPROM patient about once a month. In my own pregnancy, I had multiple complications that occur very rarely. Complications seem unlikely until they happen to you.
I asked every provider I interviewed whether having a baby in their state is safe, given the current abortion restrictions. Almost all of them said yes. But almost all of them also qualified their answer. They said they, personally, would take appropriate care of a pregnant woman, but they couldn’t say the same about every provider in the state now that the abortion laws have made administering emergency care so much more complicated. They said pregnancy had become “less safe” or “scarier” or “safe, if you have resources.” There’s a new charge to what were previously purely medical conversations with patients: Thoppil said patients ask him “every week” if having a baby in Texas is safe, and Emily Briggs, a private-practice family-medicine doctor in New Braunfels, told me that patients have asked her if they should leave Texas. Hart told me she’s had patients who “get on contraception because they say that they are scared to be pregnant in Georgia.”
The future of obstetric care in abortion-ban states also seems murky because fewer medical students are applying to residencies in states with abortion bans. Zite says she’s not able to train her obstetric residents in the same ways she was before Dobbs, and she’s not sure what’s going to happen with the next generation of doctors after hers retires.
I spoke with some women who aren’t willing to risk having a child, or another child, under these circumstances. Jessi Schoop Villman, who lives outside of Houston and has a history of miscarriages, decided not to try for a second child after Texas banned abortions. “I couldn’t stand the thought of something happening and leaving the baby we already have without a mother and my husband without a partner,” she told me.
Nisha Verma, an obstetrician who works in both Georgia and Maryland, told me she recently saw a patient who was eligible for an abortion in Georgia because she was less than six weeks pregnant. The woman said that she would consider having the baby, “but I am scared to be pregnant in this state as a Black woman,” Verma remembers her saying. “If I developed a complication like I did in my last pregnancy, I wouldn’t be able to get care and I could die.” The woman did something that crafters of abortion bans likely would not have wanted: Just days before it would have been too late to do so, she terminated the pregnancy.
*Illustration by Akshita Chandra / The Atlantic. Sources: Jacobus Johannes van Os / Fine Art Photographic / Getty; Getty.
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