Iowa clinics rushed to squeeze in abortions before a new 6-week ban. How they managed it

As the implementation of Iowa's new "fetal heartbeat" bill loomed, staff at abortion clinics across the state scrambled to get as many patients seen as possible.

Earlier in the week, Paige Bergholtz, a patient services navigator for Planned Parenthood North Central States, called patients to get as many appointments as possible scheduled before Friday, when Iowa Gov. Kim Reynolds signed the six-week abortion ban into law.

One woman Bergholtz spoke to lived a couple of hours away from the nearest health center. She had two hours to get to a clinic if she wanted to receive an abortion before Iowa outlawed it, Bergholtz told her.

Could she be there?

She made it in time, Bergholtz said.

"I can't imagine what that would be like to get a call that says, 'We can't see you in the state of Iowa for abortion care unless you come in today, within a couple of hours,'" she said.

That scene played out at abortion clinics throughout the state last week as the Iowa Legislature debated, and then approved, one of the strictest abortion bans in the country on July 11.

Now signed into law by Reynolds, the "fetal heartbeat" bill bans abortion when cardiac activity is detected during an abdominal ultrasound, which medical providers say occurs around six weeks of pregnancy.

The ban includes limited exceptions, such as to preserve the life of the mother or for pregnancies that result from rape or incest.

During the uncertainty of the week, some of Iowa's abortion clinics paused patient appointments, then rescheduled them. Others placed holds on appointments, anticipating that they could be banned from providing abortion care.

Meanwhile, clinic officials discussed contingency plans as they waited to find out whether a judge would block the new law from going into effect.

Update: Iowa's 'fetal heartbeat' abortion ban temporarily blocked by judge amid court challenge

Physicians who provide abortions in Iowa say they are used to the uncertainty, especially while working in a state whose elected leaders have worked for years to restrict the procedure.

But with this new ban, which comes a year after the U.S. Supreme Court overturned Roe v. Wade, Iowa's current situation feels more desperate, they say.

“Without the protection of Roe and with the Iowa Supreme Court decision last summer about the 24-hour rule, we are much less optimistic that the protections we thought would be there for us will continue to help keep abortion accessible," said Dr. Abbey Hardy-Fairbanks, the medical director of the Emma Goldman Clinic in Iowa City.

Abortion advocates have filed a lawsuit in an attempt to block the law. As providers waited Friday to find out if a temporary injunction would be issued, their efforts to provide care while they still could emotionally drained providers and other staff, Bergholtz said.

"It has just been breaking my heart the past couple of days to hear all of these patients, all of their stories, and just to be the bearer of bad news that we can't see you 30 minutes from your home anymore. You have to travel six hours," she said.

"No, it's not an easy time or an easy conversation."

As lawmakers debated, hundreds of Iowa patients were thrown into flux

Early in the week, word came that the ban could go into effect as soon as Wednesday morning.

Since the bill prohibited most abortions at about six weeks of gestation, or about six weeks from the first day of the pregnant person's last menstrual period, it essentially amounts to a total ban on abortion in Iowa, because many women don't realize they're pregnant that soon, said Dr. Emily Boevers, an OB-GYN that provides abortion services with Planned Parenthood North Central States.

"There’s no way for people to actually get the care they need before six weeks on a regular basis for a majority of patients," she said.

The 200 patients who were scheduled for abortions across the state last week and into this week were thrown into flux, according to the lawsuit challenging the new ban. Most of these patients, who were set to be seen at Planned Parenthood clinics or the Emma Goldman Clinic, had pregnancies past the six-week cutoff.

Iowa law had allowed abortion up to 20 weeks of pregnancy.

As the Legislature worked to push through the new 6-week ban, doctors who spoke to the Des Moines Register, part of the USA TODAY Network, said their clinics worked to see as many patients as possible early in the week. But Iowa's law requiring a 24-hour waiting period before an abortion made that difficult.

“We had to refer some patients out of state because we didn't think we could get them in before both the gestational age cutoff and the 24-hour waiting period. We didn’t know what was going to happen with the ban," Hardy-Fairbanks said.

It was a heart-wrenching moment for clinic providers and other staff, who felt powerless to help their patients, Hardy-Fairbanks said.

“Patients were really understanding, but that was actually harder than them being upset," she added. "I think the removal of access and the removal of rights has become something that has become expected — not accepted but expected.”

Governor's announcement prompts a scramble to reschedule appointments

When Iowans awoke Wednesday, the Legislature had passed the new ban, but abortion remained legal for up to 20 weeks — for the moment.

Reynolds promised to wait until Friday to sign the bill, during a conservative event, opening a brief window for clinics to continue to provide abortion services.

Clinics across the state moved quickly to reschedule patients' appointments for Wednesday and Thursday, said a Central Iowa-based abortion provider for Planned Parenthood, who asked to remain anonymous for safety reasons.

Abortion providers at Emma Goldman and Planned Parenthood worked into the evening Thursday to see a full roster of patients seeking care, they said. With that extra time, Planned Parenthood clinics saw nearly two-dozen patients for both surgical and medication abortions, one physician said.

"So it was kind of all hands on deck, and people were willing to jump in and come in on short notice to help out," the physician said. "Everyone was just so focused on getting as much access as we can before Friday."

"It's only one more day, and we still don't know what's going to happen with the injunction on Friday, but for each patient that we're able to see, it's a really huge deal for them," the central Iowa OB-GYN said. "So I'm really grateful to be able to be there for them."

Iowa's six-week ban has been felt outside abortion clinics, said Dr. Amy Bingaman, a Des Moines-based OB-GYN. More of her patients asked about long-acting birth control options last week.

One young patient inquired about getting her tubes tied, she said.

"I've had a lot of patients that are really angry," Bingaman said. "I think there's a fair amount of anger out of it, for losing our bodily autonomy, which is frankly what it feels like."

Are Iowa patients able to find abortion care out of state?

For those who couldn't be seen in Iowa last week, Bergholtz said she and other Planned Parenthood staff worked to schedule appointments in other states.

That includes Minnesota and Nebraska, where laws make the procedure more accessible.

For subscribers: Illegal abortions shaped these Tennessee doctors' careers: 'Pre-Roe v. Wade was not easy'

However, providers in Iowa say the growing list of states enacting strict abortion bans has put a severe strain on the health care providers in states where abortion remains legal as more patients travel for procedures from other parts of the country, Hardy-Fairbanks said.

Even if patients can find an appointment, they have to wait weeks before they're seen by a physician.

"It's going to be a hot mess," Bingaman said. "The problem is that people who have money will probably still be able to access abortion, but the poor and the marginalized are not going to have that availability and those economic resources. So I think it's going to be very limited in what we can do to help people."

Still, those that work at abortion clinics across the state say they are committed to continuing to provide services for patients, including those who are eligible for abortions under the six-week ban.

"There are people in the world that believe and that will fight to keep access to this care open and accessible," Bergholtz said.

Michaela Ramm covers health care for the Des Moines Register. She can be reached at mramm@registermedia.com, at (319) 339-7354 or on Twitter at @Michaela_Ramm.

This article originally appeared on USA TODAY NETWORK: Iowa abortion ban legislation caused rush in clinics