When the U.S. Supreme Court overturned the federal right to abortion in 2022, the legal status of abortion was left up to individual states to decide.
Since then, Wisconsin doctors have had to interpret and follow the state’s 19th century law that effectively bans abortion in the state. But according to a new study, hospitals across Wisconsin interpret the law differently.
Led by Dr. Abigail Cutler, a practicing OB-GYN at UW Health, the new study intended to document changes in clinical practice among Wisconsin doctors as a result of the Dobbs v. Jackson Women’s Health Organization decision.
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Cutler, who also teaches at the University of Wisconsin-Madison, said she wanted to know how doctors managed pregnancy complications.
“It was really alarming to see how it impacted patients depending on where they lived in the state,” Cutler told WPR’s “Wisconsin Today.” “I think this study illustrates the dangers in legislating medical care without consideration for the individual patient in front of us.”
The study hit home for Dr. Kristin Lyerly, an OB-GYN who moved her practice from rural Wisconsin to Minnesota after the U.S. Supreme Court overturned Roe v. Wade.
Lyerly, who unsuccessfully ran for Congress in Wisconsin, said she will bring her practice back to Wisconsin if the state Supreme Court recognizes a right to an abortion in the court decisions it is set to make in the coming months.
“We need politicians to back off and stop practicing health care,” Lyerly said. “We know what to do for our patients. When politicians interfere, that’s what our patients suffer.”
After the U.S. Supreme Court’s decision and before a 2023 ruling in Dane County that recognized the right to abortion, Wisconsin doctors were unable to train in and learn abortion-related health care services, Cutler said.
“Emergency doctors need to know how to manage these complications,” Lyerly said. “Family medicine doctors need to know. Pediatricians need to know. This affects the entire care team.”
Cutler and Lyerly shared more specifics about their experiences as practicing OB-GYNs experiencing the pressure of balancing vague legal requirements with the needs — and lives — of their patients.
The following was edited for clarity and brevity.
Kate Archer Kent: In Minnesota, abortion is legal. Dr. Lyerly, how different does it feel for you to practice in Minnesota versus in Wisconsin?
Dr. Kristin Lyerly: There was one case in particular that I remember where someone quite literally would have died if I hadn’t been able to completely respond to her needs. And I took just a minute to reflect on how differently I would have thought and approached this case if I was in Wisconsin. But because I was in Minnesota, I didn’t have to worry about any of the political considerations. All I needed to focus on was my patient, and that’s exactly what she needed so that I could save her life.
KAK: Dr. Cutler, what did people in your study say about applying the pre-Civil War law to their medical practice?
Dr. Abigail Cutler: The law was described by our participants as vague and uninterpretable. Physicians needed guidance from hospital legal teams. What were they to do when they had an individual patient in front of them in need, potentially, of abortion care? Was this patient at death’s door enough to warrant safe intervention? And by “safe,” I mean legally protected.
KAK: What does a supportive hospital system look like to you in this context?
AC: We saw really wide variation in what that support and guidance looked like — interestingly, often around the same pregnancy complication.
For instance, we heard a lot from participants about how they struggle to manage PPROM [preterm premature rupture of membranes], when the amniotic sac ruptures in the second trimester way too early, before neonatal survival is possible. Staying pregnant in those situations can be really risky because developing a severe, unpredictable life-threatening infection can happen very quickly.
When we asked participants about how they managed this pregnancy complication post-Dobbs, some made reference to guidance they received from their institutions that allowed them to offer the standard of care. In cases of PPROM, this [standard of care] includes abortion, even before the patient becomes clinically unstable.
However, other participants said their institutions prohibited them from providing pregnancy termination unless the patient really appeared to be at death’s door — showing signs of a really serious infection or hemorrhage.
KAK: How do these inconsistencies compare to your experience treating patients?
AC: It was evidence of what we had seen on the ground, too: that pregnant Wisconsinites facing the same unfortunate pregnancy complication were receiving really different care with potentially completely different outcomes, all because they found themselves at different hospitals in our state.
KAK: Dr. Lyerly, what’s coming up for you as you hear about the differences between hospital systems and the support from those hospitals?
KL: What we really need to do is educate the people of Wisconsin so that they understand what this means. I can’t tell you how many folks I’ve talked with who don’t understand that a miscarriage, in medical terms, is a spontaneous abortion. From our perspective, it’s very similar. But when someone sees that in their patient record, it’s shocking to them. It takes on a whole other set of meanings and feelings and emotions because of the politicization of our health care here in this country.
KAK: Dr. Cutler, what legal clarity would you like to see that would enable you and your colleagues to have more confidence in performing abortions as part of obstetrical care here in Wisconsin?
AC: Our ability to access needed health care cannot come down to something as arbitrary as your ZIP code, whether that’s the state or the county you happen to live in.
I would like it to be clear that abortion is considered to be part of normal health care that a patient who is pregnant might need or want for any number of reasons, and that it really cannot be legislated because every individual patient comes with their own set of needs.
