After Dobbs: Navigating Duty through Doubt

Last night as I was driving to the hospital, I called the legal team. Then I opened a Google search on my phone and typed in “Class V felony Indiana.” Why was I doing this? Because I am an obstetrician in Indiana, and I never had to worry about a felony conviction while taking care of my patients—before now.

Amber (whose name and circumstance I’ve altered to protect her identity) and her partner had already lost a baby to miscarriage, so they were excited when Amber became pregnant again—but it was a tough one from the start. She started bleeding at early in the second trimester and we never knew exactly why, although her care team and I had a few working diagnoses. But she and the fetus stayed stable, so things carried on. 

A few weeks later an ultrasound saw a short cervix, which raised the risk that Amber would deliver prematurely. We discussed options and went to the operating room for a cerclage—a stitch in the cervix to hopefully keep it stable and prevent preterm birth. She continued to bleed a little on and off, up until the day she arrived at the hospital bleeding a bit more briskly than before and having pain. An ultrasound showed the fetus was alive with a good heartbeat, but there was no amniotic fluid, which is necessary for survival and development.

Here are the things I was concerned about:

1. Her bleeding. Was her placenta separating? Would she need a blood transfusion? Would she have life-threatening blood loss? Was her cervix ripping or tearing around the stitch?

2. Was she getting an infection in her uterus? She was getting a fever—was it time to start antibiotics? Were her symptoms due to blood loss or sepsis? When should I send her to the ICU?

3. Did I have time to transfer her to Illinois? Would another doctor accept the transfer to do the work that I am perfectly capable of doing to save this woman’s life but has been made illegal for me to do? Would she be stable enough to make an ambulance ride of over an hour? How fair is it that I have to send her away from her state, her city, her hospital, her doctors? How is it fair that her trauma and grief will be expanded tenfold and her cost tenfold?

What would I do if I cut the stitch and the fetus still had a heartbeat? Would a nurse “turn me in” or “rat me out” and tell someone I broke the law by ending the life of a fetus in order to save the life of the woman bleeding to death in front of me? When can I say “This is life-threatening” instead of “Not yet, she can suffer longer, lose more blood, be exposed to more risk?”  

What would I do if Attorney General Todd Rokita decided to make an example out of me like he did Caitlyn Bernard, MD, and prosecute me, bring a case against me, take my medical license? What about a cross-examination? “Doctor, how can you be sure her life was in danger? How do you know she was going to be septic? Did you do everything in your power to avoid this?”

What would I do if I decided to cut the stitch and the fetus didn’t come out, but Amber was still bleeding more and more heavily, losing liters of blood on the pad beneath her while I activated the transfusion protocol and gave her back units of blood and platelets? Would I have to start medicine to force the evacuation of the uterus to stop bleeding and infection to save Amber’s life? Would my affidavit, my statement that I made these decisions, hold up in court? Or would I be prosecuted according to state laws, which carry the potential for one to six years of imprisonment?

Amber delivered her fetus. She lived, but her fetus did not. Amber was put on antibiotics and received a blood transfusion. 

A few days later, I took the elevator to the fourth floor to visit her and her partner. I wanted to check on them and see how they were doing after their loss. The elevator doors opened, and I burst into tears.  

I hadn’t realized how sad, angry, and defeated I was. I am a physician, and I have dedicated my life to the delicate balancing act of keeping a mother alive and healthy as a host for a cluster of cells that will eventually become a fetus—and with enough good fortune, a newborn baby. But that week, everything I’ve ever done was called into doubt.

Elizabeth Rutherford, MD, FACOG, Fellow of the Board of Obesity Medicine, is the site director for the laborist program at Northwest Health – Porter in Valparaiso, Indiana, and a director of obstetrics and gynecology residency education. She provides high-risk obstetric care for HealthLinc federal clinic in Valparaiso. She has 25 years of experience as a full-scope obstetrician–gynecologist in private practice. She is totally hopeless, helpless, terrified, angry, and destroyed at the state of reproductive rights in the United States.

Disclaimer: The thoughts and opinions in the Frontline Voices initiative reflect experiences of individual ACOG members and do not represent official organizational opinions of ACOG.