Maternal fetal specialists should see abortion care as a “core component” of their practice in states where laws restrict abortion, according to a new special statement from the Society for Maternal-Fetal Medicine (SMFM). Some 41 states ban abortion at some point in pregnancy, and these legal restrictions make it difficult or impossible for clinicians to practice “standard-of-care, evidence-based medicine”, the report, released on Tuesday, says. The Dobbs decision made it even more challenging for patients to access abortion care in the US, as more restrictions went into effect in some states.
Deaths from ectopic pregnancies nearly doubled between 2020 and 2025, a ProPublica analysis found, and later-abortion providers in haven states report that patients are showing up “later and sicker”. In July 2021, Kate Dineen was about 33 weeks pregnant and giddy with excitement. Her husband was finally able to join her for his first ultrasound of their second child, after Covid restrictions were loosened.
But then the room went quiet; the silence stretched on as the ultrasound tech lingered over images of the baby’s brain. Soon, after an MRI and consultation with a pediatric neurologist, they learned that their son had suffered a catastrophic stroke in utero, and his chances of surviving even the pregnancy were poor. Dineen remembers asking, “What are my options?” One of the specialists said, “You may still be able to explore termination – if you’re able to travel.” Dineen was stunned.
She lived in Massachusetts, where abortions were banned after 24 weeks except in specific cases – and her case didn’t qualify for an exception, she learned. The maternal fetal team at her hospital offered to link her to a later abortion clinic in Washington DC, Dineen said. She and her husband rushed to find childcare for their 18-month-old son and made the long drive to Maryland, where they stayed multiple nights, to receive care.
If she’d been able to get the abortion in Massachusetts, it would’ve been much easier to grieve and find closure, she said. That’s why guidance from professional societies on supporting abortion is key, so providers may expand their roles and “continue to provide as much care as possible” said Lappen. The statement highlights what can be done on the individual level when it comes to caring for patients, and it points to the role that specialists play in “institutional advocacy” to make sure their health systems have plans to support patients ahead of time, he said.
That way, they can create the most comprehensive and expansive systems to provide care, he argued. It’s imperative to set guidelines now, before emergencies arise, Lappen said. That means understanding the exceptions to those laws and how providers may offer care in those scenarios, which can often be complicated to interpret but are no less important, Lappen said.
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