Frederica Freyberg:

Continuing our series on abortion, tonight, we hear from the medical perspective. Marisa Wojcik has this story.

Jenn Vollstedt:

When I got the results, I knew what I wanted to do. It was really hard emotionally. I was devastated. I wanted that baby and I wanted everything to be fine. I wanted her to be healthy, but she wasn’t and I knew that if I carried that pregnancy to term, I was putting my own health at risk and I also knew that my baby, if she survived to term, would only suffer and I didn’t want that, so I was very confident that I was making the right decision for my family.

Marisa Wojcik:

Jenn Vollstedt made her decision, while abortion was still legal. The cascade of events following the U.S. Supreme Court’s ruling on Dobbs v. Jackson Women’s Health Organization hit states like Wisconsin the hardest, creating a near total abortion ban in the state one year ago.

Christopher Ford:

We have yet to see what systemic consequences this law will have.

Kristin Lyerly:

We’re already seeing it. We’re seeing it at all levels.

Marisa Wojcik:

Wisconsin health care providers found themselves in legal limbo as a number of dated and conflicting laws remain in state statute. The default legal standing fell back to one law from 1849. It says destroying the life of an unborn child is a felony except to save the life of the mother.

Kristin Lyerly:

We didn’t even know that germs caused disease in 1849. This was 70 years before women even had the right to vote. You didn’t even often know you were pregnant until you actually could feel fetal movement.

Christopher Ford:

We are in a situation where that interpretation of a law from 1849 is really a gray area.

Jenn Jury McIntosh:

Now we’re operating this narrow channel of providing the best care and not committing malpractice and being careful not to break a law and so you think about things that you never had to think about before.

Marisa Wojcik:

Following the Dobbs decision, doctors Kristin Lyerly, Christopher Ford and Jenn Jury McIntosh put themselves forward as interveners in a lawsuit filed by state Attorney General Josh Kaul challenging the 1849 law. Prior to Dobbs, Dr. Lyerly counsel patients at the Sheboygan Planned Parenthood clinic, one of a small number of Planned Parenthoods in the state that provided abortions.

Kristin Lyerly:

To know that there’s a place where you can go where someone will listen to you and hear you and help you make a decision that you need to make within the context of your life, that was what we were doing in Sheboygan, and I was really proud of it.

Marisa Wojcik:

Dr. McIntosh works in maternal fetal medicine, teaches at the Medical College of Wisconsin and conducts research on pre-eclampsia, a serious condition she sees in many of her patients.

Jenn Jury McIntosh:

Those of us in maternal fetal medicine highlight our subset of obstetrics as kind of the highest of highs and some of the lowest of lows because when we have really great outcomes, it’s super rewarding but at the same time we help families through tragic outcomes as well. These pregnant people either have high-risk conditions themselves, so medical complications, but on the flip side, we also take care of fetuses, so get the most family-centered outcome that we can.

Marisa Wojcik:

Dr. Ford works in emergency medicine, with experience practicing in rural and urban settings.

Christopher Ford:

As an emergency medicine provider, I see women that are pregnant when, you know, things are going wrong most of the time. We are mandated as emergency providers to provide the most salient care we can to protect the lives of the patients in front of us. So inherent in that were capabilities of performing medical abortions, surgical abortions if that is required in the instance of instability of the patient for the life of the patient as well.

Marisa Wojcik:

Jenn Vollstedt worked as a labor and delivery nurse.

Jenn Vollstedt:

I really discovered during my career that those patients that were going through difficult times were my favorite patients to take care of because I felt like I made the most impact as a nurse on what their experience looked like.

Marisa Wojcik:

Prior to the Dobbs ruling, Wisconsin patients and physicians had more options when it came to making decisions about reproductive health care.

Kristin Lyerly:

We Kristin Lyerly would have conversations about what all their options were. We would talk about everything. Sometimes we would connect them with prenatal care. Sometimes we would connect them with adoption services. Sometimes they would go home and think about it and they just wouldn’t return for that second visit, but often they did, and it wasn’t unusual for people to thank us.

Jenn Jury McIntosh:

It was full scope care based on what the families and patients wanted. Sometimes a different understanding emerged and families that never saw themselves doing that couldn’t reconcile sort of what the after looked like, which is to interrupt the pregnancy and have an abortion, and those were always hard cases. Patients that we cried with, that I would go home and cry about.

Marisa Wojcik:

Now they’re managing realities much different than before.

Jenn Jury McIntosh:

We still provide the same information and similar counseling. If it becomes clear that they’re leaning towards a termination, I have to say, unfortunately, this is illegal in the state of Wisconsin, and if this is what you choose to pursue, then we’ll have to give you information on how to pursue this out of state, and it feels like I’m abandoning my patients in saying that.

Kristin Lyerly:

Today, I a Kristin Lyerly m not working in Wisconsin because of a lawsuit, because of the threat of criminalization for providing my patients with standard of care medicine. So I have the joy of working in rural Minnesota and northern Arizona on the Navajo reservation. So in a way, it’s very satisfying. But the truth is, I want to be home.

Man:

It’s become a huge distance, a huge problem. It’s not a situation that any of us want.

Marisa Wojcik:

A central issue physicians must now navigate is the exception to save the life of the mother.

Christopher Ford:

The law as written in the state of Wisconsin is still very gray. The next presentation of that patient may be in full-blown sepsis, may be something that is threatening for the life of the mother. We’ve heard reports in other states that have very strict abortion bans like we do here in Wisconsin in which we’ve had patients that have been told to wait in the car until they become even more unstable in order to present to the emergency department, so at that point in time, they can do something about it. Now, of course that’s an egregious example and it’s something that we don’t aspire to. However, that is someone’s interpretation of the law in states that have stricter abortion laws, such as Wisconsin. We see morbidity and mortality, specifically mortality go up by 60% plus for mothers as well as for their infants.

Jenn Jury McIntosh:

It’s intrinsically vague, which then causes physicians to potentially second-guess, like is this risky enough because everyone who practices medicine knows it can be very gray for a while and then become very black and white, and the longer you wait to intervene, the worse the outcomes are in general.

Kristin Lyerly:

There was a time when I was in Minnesota where someone presented in an emergency in an ambulance. She was bleeding. She was 21 weeks pregnant with a desired pregnancy but she was bleeding so much, she had to go to the operating room right away, and I had to perform an abortion, and I couldn’t help but to think to myself, if this was happening to me in Wisconsin, I would be terrified about what the next steps would be, about what the implications for my future, my career would be.

Christopher Ford:

There will still always be some providers who are very concerned about that, as they rightly so should be. There’s risk of prosecution up to six years as well as a $10,000 fine. There’s things that will likely be in the back of a lot of providers’ minds, especially those who are practicing in more rural locations.

Marisa Wojcik:

For Jenn Vollstedt having the procedure done without any additional barriers made all the difference.

Jenn Vollstedt:

Dealing with the grief and the stress to have to jump through those extra hoops while also dealing with that, I honestly don’t know how I would navigate it. So now when I look back, I feel so recovered and healed. I also wouldn’t have my son if I didn’t have this abortion because of the timing if I had to carry it to term. Julian, he is — he just turned six and he is one of the most joyful and curious people I’ve ever met. He just kind of is a ball of energy. He comes in here and runs and jumps over my couch and is very snuggly and tells me all the time how much he loves me. The more we try to focus on is that right or wrong or is that okay, the more we’re focused on making choices for other people when we’re not involved in their health care and we’re not medical professionals.

Marisa Wojcik:

Physicians worry not only about the consequences today, but those yet to come.

Jenn Jury McIntosh:

There’s certainly a domino effect.

Christopher Ford:

And what I’m seeing over and over and over again is this getting worse over time, and a lot of that has to do with the access of health care, with the access of, you know, care to obstetrics and gynecology. A lot of these women in these areas rely on their OB/GYNs as primary care, to be honest with you, and a lot of that mortality increase that we’re seeing is the lack of the ability to have follow-up, not only as we said before are we creating those health care deserts in rural settings, we’re doing that in inner city settings, too, which are already having a lot of issues inherent to access of care in general as well as health care outcomes, and so those are the things that for me personally, I take much stake in. It’s something that I will continue to fight for these patients because they need a voice. Everybody needs a voice in this fight and a lot of the voices that are at the table right now don’t see these patients and they don’t have any medical background, and they’re making these decisions.

Jenn Jury McIntosh:

I talk to recruiters all the time who are looking for doctors in states like Texas, and it’s nearly impossible to find doctors who are willing to go to states that have such hostile bans. So, yeah, I think this is the tip of the iceberg, and if we can’t turn this ship around, this dire physician shortage that we are already experiencing is going to get much worse. Not just OB/GYN doctors but family medicine doctors, who are the safety net in rural Wisconsin, where people are already suffering.

Marisa Wojcik:

Most of all, these health care providers want to go back to the law as it stood in Wisconsin prior to the Dobbs ruling.

Jenn Jury McIntosh:

I just want to do my job. The fact that politics are trying to be present in my exam room, present in the back of my mind as I’m looking at a patient and talking to her — to that patient and their family, that it’s impacting that at all feels crazy to me because, really, we should just be providing the best evidence-based medical care that we can that’s right for that patient and right for their family.

Marisa Wojcik:

Reporting for “Here & Now,” I’m Marisa Wojcik.

Frederica Freyberg:

As to the lawsuit challenging the Wisconsin abortion ban, Attorney General Kaul is seeking to expedite an injunction related to a recent circuit court decision in the case. The case is expected to end up before the state Supreme Court.

For more on this and our previous reporting on abortion in Wisconsin, including hearing from women who have had an abortion and pregnancy resource centers that discourage them, visit our website at PBSwisconsin.org and then click on the news tab.