GREEN BAY, Wis. — The three women seated around a table in a busy lunch spot share a somber camaraderie. It’s been over a year since an 1849 law to criminalize abortion in Wisconsin went back into effect. Now these two OB/GYNs and a certified midwife find that their medical training, skill and acumen are limited by state policy.

“We didn’t even know germs caused disease back then,” said Dr. Kristin Lyerly, an OB/GYN who lives in Green Bay.

Like undertakers and garbage collectors, obstetricians see the nitty-gritty of human existence that can be gruesome and grotesque. A fetus with organs growing outside of its body. A woman forced to give birth to a baby without a skull in order to open its cervix.

Dr. Anna Igler, an OB/GYN, regularly performed abortions for medical reasons before the Supreme Court struck down abortion rights last year. She is beyond fed up.

“I’m on a different level now,” he said. «Part of me is so upset with people for sticking their heads in the sand.» With her world inside a Green Bay hospital in crisis, she said, she can’t imagine people can ignore the government’s incursion into their health care.

“A lot of people I’ve talked to have no idea what our laws are in our state,” he said.

Even now, a year later, Igler said, parents-to-be come to her office with the assumption that if their fetus has a lethal genetic disorder, such as anencephaly or trisomy 13 or 18, they can safely terminate the pregnancy.

«They’re surprised when I tell them they can’t,» Igler said, «and they’re surprised when I tell them we’re following the 1849 law.»

She’s referring to the state’s original abortion law, which was passed before the Civil War, when women couldn’t vote or own property. The law makes it a felony to perform an abortion at any stage of pregnancy, unless it prevents the death of the pregnant person.

More on the impacts of the Dobbs decision

It had been some time since these women had been together and they were eager to compare notes. The certified midwife spoke on condition of anonymity because she is not authorized to speak to the media and is concerned about losing her job at a local health system. “My biggest problem right now is getting medication to end a pregnancy that’s already passed,” she said. «I’m finding out locally that pharmacists just don’t dispense the medicine.»

She offered a summary: A pharmacist told her patient that the drug, misoprostol, which causes cramps to expel pregnancy tissue, had expired. Another, at Walgreens, simply canceled the order. A third said she needed a prior authorization, noting, «It’s a $3 pill and we’re not going to get a prior authorization on a weekend.»

The midwife said that she and her medical colleagues in her practice have half-joked that they would send a gift basket to a pharmacist in town that she found would fill her prescriptions.

Now, when a patient miscarries, the midwife said, “we warn patients that this could happen, and they say, ‘But my baby is dead,’ and I say, ‘I’m sorry. I don’t know why, but a lot of pharmacists in Green Bay think it’s their job to police this.’”

A year into this new era of mandatory childbirth for most pregnant women, the dismay and disorientation of those first few months have turned, if not into acceptance or resignation, into a kind of chronic fear. OB/GYNs are afraid to practice medicine as they are trained.

A recent survey by pollsters at KFF of OB-GYNS in states with abortion bans found that 40% felt limited in treating patients for miscarriages or other pregnancy-related medical emergencies since the Supreme Court decision Dobbs v. Jackson Women’s Health Organization last summer. Nearly half of them said their ability to practice standard medical care has worsened.

The specter of felony charges and the loss of a medical license has led to futile exercises.

Under Wisconsin’s abortion ban, and bans in at least 13 other states, doctors who cannot detect fetal heart activity should, in theory, not face criminal charges for prescribing abortion pills with medication or performing abortion procedures. But doctors here in Green Bay, and others interviewed in Madison, said they, and the litigation-averse hospitals they work for, require patients whose pregnancies are no longer viable, or who have gestational sacs that do not contain an embryo, to return for multiple ultrasounds, forcing them to carry non-viable pregnancies for weeks.

Dr. Eliza Bennett, left, and Dr. Abigail Cutler, OB/GYNs at the University of Wisconsin-Madison, refer patients who need out-of-state abortion services rather than risk criminal prosecution, fines or losing their licenses. “It’s heartbreaking not being able to care for patients myself,” Cutler says.Sarah Varney / KFF Health News

Before Wisconsin’s abortion ban, Igler typically used the ultrasound machine in his office to detect when a patient’s pregnancy had ended. There he would break the news to the intended parents. In some cases, a patient wanted more ultrasounds and referred them to the fetal imaging department. She could help with her grief, and «she was happy to do that for them,» Igler said.

But her bedside ultrasound can’t record and save the images Igler would now need to prove her medical judgment was reasonable during criminal proceedings, so she is forced to send all her patients for additional imaging.

«It seems cruel to show a woman her dead, non-viable baby and then say, ‘Well, now I have to bring you into fetal imaging so we can record an image and you have to look at it again,'» she said.

In March, Rep. Ron Tusler, a Republican who represents a rural fringe of Wisconsin south of Green Bay, posted on Facebook, «Thank God for Dobbs’ decision!» In response, a local resident asked, “If my 14-year-old daughter who doesn’t speak or walk is assaulted, should I force her to carry?”

The exchange turned into a confrontation. «Is your health in danger?» Tusler asked. “Are you unable to leave the state? Can you give your consent?

In the torrent of vitriol, certain moments stand out. Igler was outraged by the insensitive response and jumped on, writing: “Are you a monster Ron Tusler? Do you know what compassion is? Come the next election, you will feel the backlash from his inhuman and outdated views. Take your hands off the bodies of the women and leave the exam room. I am an obstetrician. I am the expert, not you.

Tusler responded that Igler was «mad that she can’t kill babies until and occasionally after birth» and asked if «I’m a monster for stopping her.» She wrote: “Honestly, how many babies have you aborted? How much money have you made with that? Did your hospital collect the bodies to obtain stem cells?

The lunchtime bustle at the Green Bay restaurant had died down, and the women were staring at the Facebook post on Igler’s phone.

She shook her head in puzzled amusement. “This doesn’t even make sense,” she said. “It is a conspiracy theory. I make a lot more money if people really have their babies and if i No give birth control, I would make a lot more money.”

Those who were sitting at the table laughed at the absurdity.

The salad bowls were empty. They had all told their own abortion stories. Igler was forced to travel to Colorado after her 25-week-old baby girl was ravaged by a viral infection; Lyerly had miscarried at 17 weeks and did not want to endure the trauma of a vaginal delivery.

Some 22 million women living today have had an abortion. It doesn’t take much effort to find some of them.

Igler has found a community to grieve with other women in a Facebook group called «Ending a Wanted Pregnancy.» There are untold numbers of other groups online.

«Politicians would like to believe that we live in a perfect world where these things don’t happen,» he said.

The Wisconsin Legislature is one of the most manipulated in the country, according to the Gerrymandering Project at Princeton University. Republicans hold a majority in the state Senate and Assembly, and last month Senate Republicans voted unanimously to uphold the 1849 abortion ban.

But a judicial alternative to restoring the right to abortion has begun to develop. In April, Janet Protasiewicz, a Democrat-backed abortion-rights supporter, won a seat on the Wisconsin Supreme Court, giving liberal justices a narrow majority and paving the way for a ruling on the legitimacy of the 1849 law. On July 7, a Dane County Circuit Court Judge Diane Schlipper appeared to doubt the validity of the pre-Civil War-era ban, leading allowed a lawsuit from Attorney General Josh Kaul, a Democrat, to proceed.

For now, Lyerly crosses the border to work in rural Minnesota. “I want to practice medicine here,” she said, “but first we have to get rid of this law.”

KFF Health Newsformerly known as Kaiser Health News (KHN), is a national newsroom that produces detailed journalism on health issues and is one of the central operating programs of KFF — The independent source for health policy research, surveys and journalism.

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