As a fetal surgeon, Dr. Alireza Shamshirsa's job is to give a fetus the best chance of life. Shamshirsa said he works to "push the envelope" to increase life expectancy and quality of life — but of course, as with any job, there are limitations.
"We can't fix everything, we can't do everything," Shamshirsa told Salon. "In the cases that are complex, like fetal anomalies — the ones we know they will suffer for a lifetime — there is the option of termination."
In other cases, there's the possibility of "selective termination." Say there are identical twins — but one has a fetal anomaly, and a higher chance of passing away in the uterus. In this case, (especially if they are sharing the same placenta), if one twin passed away in the uterus, a sequence of events could kill the other twin. Or it could cause severe to moderate brain damage. In this scenario, selective termination might be the best course of action.
At the very least, termination of a pregnancy is an option that is often discussed in Shamshirsa's line of work, in the context of complex pregnancy cases — and it is often discussed as an option to save a life. But after a decade of working in Texas, the abortion restrictions became too much, as that option to terminate a pregnancy was taken away from these patients roughly a year ago.
"Many of these cases are complex, but the option of having a termination is an incredible option for the family, and we call it an option. We never push anybody to do it, we never force anybody to do it — you have it as an option," Shamshirsa said, adding that removing that choice made it "horrible" for the families he worked with. "When the rules and regulations came up, it pushed me to the point that I decided to move my family after 10 years being in Texas to Massachusetts."
Shamshirsa is part of a larger trend taking place, one in which female healthcare providers can no longer provide quality standard care for their patients because of statewide abortion restrictions. Last year's decision in the case of Dobbs v. Jackson Women's Health Organization upheld a Mississippi law that banned most abortions after 15 weeks of pregnancy. The decision gave each state the individual right to enforce their own abortion restrictions, many of which had so-called "trigger laws" with six-week abortion bans. As of July 1, 2022, abortion is completely banned in Texas with very limited exceptions — a fatal fetal anomaly is not one of them. Pregnant women whose fetuses are unlikely to survive childbirth are forced to carry their pregnancies to term or travel out of state for termination.
"It was horrible, we had to tell a patient, 'We don't have the option [to terminate]'"
In light of the one-year anniversary of the Dobbs decision, the American College of Obstetricians and Gynecologists (ACOG) highlighted stories of physicians who have made the tough decision to leave the red states where they built careers for years, sometimes decades. Shamshirsaz said it became "impossible" to not offer the best standard of care to patients in these complex cases. Due to the transient nature of Shamshirsaz's work, he never knew what happened to patients after he could no longer provide termination as an option, but in some cases, it's likely they were forced to carry on.
"It was horrible, we had to tell a patient, 'we don't have the option,'" Shamshirsaz said. "However, so and so in that state can do it for you, and that means they need to move to another state."
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Similarly, maternal fetal medicine physician Leilah Zahedi-Spung made the difficult decision to leave Tennessee after Dobbs.
"In the weeks that followed, I relived the decision with patients as they realized that the pregnancy they had put all their hopes and dreams into wouldn't result in a live child, but that wasn't a 'good enough' reason to end the suffering of their child in Tennessee," Zahedi-Spung wrote in her personal story shared on ACOG's website. "I cried with families, I took on the brunt of their anger, and I worked hard with colleagues across the South to find places for patients to get the care they needed. I've never backed down from a fight for patient access, but this felt insurmountable."
Zahedi-Spung said she knew that she struggled with the "guilt of leaving."
"But I first must do no harm to myself," Zahedi-Spung said. "I needed to be in a place where I could make a difference without putting my own safety and freedoms at risk."
Dr. Amelia Huntsberger worked as an obstetrician-gynecologist in Sandpoint, Idaho, and is currently in the process of relocating to Oregon. In a phone interview with Salon, Huntsberger said she always felt "called" to provide medicine in a small town with her husband who is also a doctor.
"Patients in rural areas deserve high quality health care, just like people do in other parts of the country, and it's really been our honor and our privilege to serve the community here for the past decade," Huntsberger said. "And it's pretty heartbreaking to us to now be in the position of being forced to leave a state that we thought would be our home, always."
"I crossed my fingers that I was going to be legally safe, saving these patients' lives."
Huntsberger gave her notice at a labor and delivery clinic a few days before it closed its doors. The hospital cited the "legal and political climate" as one reason for its closure. Following Dobbs, Idaho enacted some of the strictest abortion laws in the country, which initially included a complete ban. That first month, Huntsberger recalled having patients come in with ruptured ectopic pregnancies. In an ectopic pregnancy, the fertilized egg implants outside the uterus, where it has no hope of survival. Once ruptured, major internal bleeding can occur. It's a life-threatening condition.
"I crossed my fingers that I was going to be legally safe, saving these patients' lives by taking them to the operating room and treating their ectopic pregnancy and transfusing blood as needed," Huntsberger said. "It's very stressful. You're doing surgery where somebody's having an active, ongoing hemorrhage, inside their abdomen, that's a high stakes surgery that's already stressful. But then let's add on this nebulous, legal risk."
Since then, the Idaho Supreme Court has ruled that the abortion restrictions do not apply to ectopic or molar pregnancies. Still, Huntsberger said it's been "disturbing" to be put in a position where "instead of just focusing on my patient and what my patient needs, and the care that I've been trained to provide them — in the back of my mind, I'm thinking about my personal liability."
"That is not the position that I want to be in as a physician," she said. "And I think as a patient, I don't want my doctor to think about themselves; I want them to be thinking about me and my care and what I need. It's really uncomfortable."
It's not just doctors leaving — these states are also posed to face recruitment issues, too. According to an analysis from the Association of American Medical College, new doctors applying to residency programs are more likely to avoid practicing in states with abortion restrictions. Indeed, health care workers worry this will worsen maternal health care in these states. States with abortion restrictions already had the highest maternal and infant mortality rates.
"We will see a deficit in the next five to ten years," Shamshirsa said. "People don't want to go and work in these states. And these are states already had deficits of OBGYNs, even before these restrictions."
When asked about what Huntsberger wishes more people understood about being a female healthcare provider in a post-Dobbs world, she said that many things are "interconnected in health and healthcare."
"A lot of times people do not understand the complexity of pregnancy, and I don't think that they often understand medically, what abortion means. For instance, the term for a miscarriage is a spontaneous abortion," Huntsberger said, adding that medically, abortions happen frequently — and people choose to end pregnancies. "From my standpoint, a pregnant patient is in the best position to make decisions about their body, and to determine what level of risk they're willing to take on — that's a decision for a patient to make, there is no room for the government between a patient and their doctor."
about abortion and reproductive health