Editor’s note: This essay is part of CNN’s “America’s Future Begins Now” opinion series, in which people share how they’ve been affected by the biggest problems facing the nation and experts offer their solutions. . Dr. Mae-Lan Winchester, an obstetrician-gynecologist and maternal-fetal medicine specialist, is an assistant professor at Case Western Reserve University and a member of Physicians for Reproductive Health. The opinions expressed here are his own. They do not represent the views of Case Western Reserve University. Read more reviews on CNN.
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Life for pregnant patients who come into my Maternal Fetal Medicine clinic in Cleveland, Ohio is never easy.
Because I specialize in diagnosing and treating high-risk patients, people who come to see me are already dealing with something they could not have foreseen. I constantly think of them: The mother carrying twins, faced with the abortion of a fetus or the risk of losing both. A scared 21-year-old girl with a life-threatening infection that developed two days after her waters broke too soon.
I live in a state where the realities of abortion are raw and politicized. Since the Supreme Court’s June 24 decision in Dobbs v. Jackson Women’s Health which overturned Roe v. Wade, I’m haunted by what will happen – and has happened – to patients like mine.
Tara and Justin, whose story they allowed me to share (we all also spoke with CNN), were forced to leave their home country because hospital lawyers disagreed with my medical opinion that the risks of her blood clotting disorder and autoimmune disease significantly outweighed the potential benefit of carrying a fetus with life-threatening abnormalities. Tara was finally able to get the care she needed in Michigan, but with a heavy emotional burden, financial costs, and delays. If, God forbid, something had gone wrong for Tara medically during the days she had to wait to terminate her pregnancy, I don’t know what I would have done.
As a doctor specializing in maternal-fetal medicine, my daily job is to navigate the delicate balance between the pregnant woman and the fetus. I cannot consider one without the other; I’ve spent my entire career caring for pregnant patients who struggle in morally charged and emotionally draining gray areas that many anti-abortion politicians either seek to ignore or pretend doesn’t exist. It is therefore like a slap in the face that lawyers have told me, after more than 11 years of postgraduate medical training and expertise, that my medical opinion is not sufficient for the law to allow me to provide the care for which I am trained.
Like many doctors, I also have more than one job. My other office — where I work as a board-certified obstetrician-gynecologist, not a maternal-fetal specialist — is in a clinic that routinely provides abortion care to all kinds of patients. . Their lives are never simple either.
They are the graduate student who must complete her meticulous experiments before the scholarship money runs out, the new mother of twins who had been misinformed that breastfeeding was a surefire form of contraception and cannot take a third child, the rape victims, the newly pregnant hotel worker who lost her job due to the Covid-19 pandemic, the patient whose escape plan from her abuser did not include being tied to her for always by a child, the patient for whom pregnancy was not an objective at that time.
Patients sometimes drive more than 12 hours to seek treatment at this clinic. Just as I am honored to care for my high medical risk patients, I am also proud to ensure that patients who need abortion care for these other reasons have access to it. I am proud to support them in their choice to live their life as they had imagined.
In the more than 100 days since Roe’s fall, people in my position — abortion providers and those who care for pregnant patients — have aged 10 years. Many of us feel like pawns in a game over which we have no say. As naive as it sounds, most of us never imagined that our careers would become the political collateral damage they are now – torn between caring for patients, losing our medical licenses or going to jail.
The nastiness of the patients who need care and of my colleagues who can provide that care, the constant misinformation about abortion, the prolonged trauma of the endless hoops that patients have to walk through, all weigh heavily on us.
The legal reality of abortion changes frequently and unexpectedly in my home state of Ohio. In 2019, Governor Mike DeWine (who is up for re-election next month) signed legislation banning abortion after early heart activity is detected, usually about six weeks into a pregnancy (even before many women do not know they are pregnant). That law, which was blocked by a federal judge who said it would likely be ruled unconstitutional, came into effect after Dobbs struck down Roe v. Wade.
Already, since Tara and Justin’s experience, this law which required them to travel out of state has been suspended by a preliminary injunction from a judge, which means that it will not be applied until the litigation in his subject is still ongoing. But the hotly contested races in the midterm elections are likely to have a powerful impact on what comes next. I also have to keep up to date with the laws of our neighboring states, as I often coordinate out-of-state abortion care.
It’s hard to practice medicine when you’re always preparing for the next legal crisis that could harm your patients. I speak to hospital lawyers more frequently than any doctor should, begging and pleading on behalf of patients, frustrated that patients cannot receive the same care as they would in a different state.
Every time I’m forced to turn down a patient, that candle burning inside me, once a roaring, passionate fire in a young college student excited to embark on a career of helping others, swells. fades slightly. This serious breach of my duty as a doctor is not easily recoverable, even when I am powerless to do otherwise.
I worry about my community – providers and patients. I think of how scared my patients must be of traveling to another state, how quickly their finances run out, how lonely they must feel. I’m afraid they think I didn’t fight hard enough for them, though I know they can hear crackles in my voice when I tell them the hospital said they weren’t quite sick.
But above all, I fear that the next lawyer with whom I will discuss a complex case will not understand, and that the patient who needs an abortion will be refused. I fear they will lack the time, money, transportation and support to get the care they need. And this denial, which is not in accordance with my medical opinion or the wishes of the patient, will forever change his life. I fear they will die.
But I still feel joy in my work sometimes. The shaking hands of a college student, suddenly motionless after swallowing the first pill of his medical abortion regimen, whispering with growing confidence, “It’s going to be okay.” A transplant recipient’s tears dry up when she knows she won’t have to go back on the transplant list when her already fragile kidney fails again in another pregnancy.
The enormous weight on a single mother’s shoulders lifts, now that she can focus on the family she has and the career she wants, freed from the constraints of an unwanted pregnancy. I take comfort in knowing that the broken hearts of Tara and Justin – who desperately wanted the baby they were meant to say goodbye to – can finally begin to heal now, knowing that they did what was right for Tara’s health and spared their baby, who might not have lived, a short life of pain.
It is these moments of hope, often masked by sorrow, that help those of us weary from dogfighting in the political trenches to rise once again. Our veils are lifted by the outpouring of support from the general public, from our colleagues in other specialties who are stepping up to organize and mobilize on our behalf, and from our governing bodies – such as the American College of Obstetrics & Gynecology and the American Medical Association – who unequivocally oppose banning abortion.
But this battle has a high cost for all of us. Patients seeking abortion care and providers of such care should not be exploited as political pawns or pushed to the fore in national elections.
Patients should be allowed to just be patients, to make medical decisions that fit their faith, family needs, and health, without government interference. They should be able to receive accessible and compassionate care, regardless of the state in which they live. And doctors should be allowed to just be doctors. I should be allowed to care for my patients without fear of reprisal or legal action.
When the prohibition of abortion exists, this simple objective becomes impossible.
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