The Society for Maternal-Fetal Medicine released new clinical guidelines this month to assist physicians treating high-risk pregnancies in states with abortion restrictions. The statement addresses the legal and medical complexities providers face when managing patients at risk for severe complications or mortality.
Dr. Justin Lappen, a maternal-fetal medicine specialist in Ohio, chaired the committee that drafted the guidance. The organization noted that individuals facing high risks of pregnancy-associated morbidity have unique needs for reproductive health services, including abortion care.
The guidelines emerged as the legal landscape for reproductive healthcare remains fragmented across the United States. Currently, ten states and the District of Columbia allow abortion access without gestational limits. Conversely, thirteen states maintain bans on abortion at all stages of pregnancy.
Since the implementation of various restrictions following the Supreme Court’s Dobbs decision in June 2022, hospital systems and clinics have reported confusion regarding legal boundaries. This uncertainty has led to delays in treatment and varying interpretations of what constitutes permissible medical action under state law.
The new recommendations encourage healthcare facilities to establish cross-state referral networks. Providers are advised to reach agreements on actions allowed by their specific state statutes and to counsel patients thoroughly on available options. The guidance also instructs providers to collaborate with legal teams to understand the federal Emergency Medical Treatment and Labor Act and recommends training for basic termination procedures.
Data from Texas illustrates the potential health impacts of delayed care. After the state passed Senate Bill 8 in 2021, which banned abortion at an early gestation, complication rates rose significantly. Research indicated that 57 percent of cases involving premature rupture of membranes resulted in negative health outcomes, such as blood transfusions, intensive care admissions, or serious infections. In comparable research from states without such restrictions, the complication rate was 33 percent. In all cited cases involving premature rupture of membranes under the ban, the fetus did not survive.
The Society for Maternal-Fetal Medicine and the American College of Obstetricians and Gynecologists maintain that access to abortion and counseling represents the standard of care, with allowances for conscientious objections by some physicians. However, other medical professionals affiliate with the American Association of Pro-Life Obstetricians and Gynecologists, which provides its own guidance permitting termination in certain situations.
The pro-life organization partners with the Alliance Defending Freedom, several anti-abortion groups, and the Alliance for Hippocratic Medicine. The latter group filed a lawsuit seeking to revoke federal approval of one of two drugs commonly used to terminate pregnancies or treat miscarriages. A representative from the American Association of Pro-Life Obstetricians and Gynecologists was not available for comment before publication.
Dr. David Hackney, another Ohio-based maternal-fetal medicine specialist, published a book in August on navigating high-risk pregnancy care under the current legal framework. He noted that after the Dobbs ruling, healthcare systems implemented patchwork policies that increased confusion among providers. In some institutions, administrators and clinicians have reached informal agreements regarding what procedures they are comfortable performing within the bounds of abortion bans.