On Point submissions are individual member viewpoints and not North Carolina Medical Society policy.

Amy Bryant MD                      At Large Member of the Executive Committee, NCOGS


I always ask my 3rd year medical students when they start Ob/Gyn:  “What are you most excited about?” They invariably say “delivering a baby.” At the end of their rotation, they write essays about what has impacted them most.  Someone, usually more than one, writes about how unexpectedly difficult pregnancy could actually be.  They learn the truth that has become clear to me over almost 2 decades in Ob/Gyn: pregnancy is not always a joyous condition.    

The Dobbs decision overturning Roe vs. Wade, which has protected the right to privacy between a patient and her doctor for almost half a century, turns the ability to make laws regarding abortion back to states.  In North Carolina, the right to abortion exists for now, but could be rolled back if the state legislature decides to ban or restrict abortion. If this happens, there will be unintended consequences for women’s health.  Pregnancy is not always a joyous condition, and in some cases can lead to severe morbidity and mortality, not to mention poorer outcomes for existing children, greater poverty, and less educational attainment (see turnaway_study_brief_web.pdf (ansirh.org)_ 

 North Carolina has unacceptably high levels of maternal mortality, particularly among the most marginalized women populations.  Racism and structural inequity are two of the drivers that deprive many Black, Indigenous and other people of color access to quality healthcare, including  abortion,  prenatal, and maternity care. These communities have higher rates of maternal and infant death and are more likely to be investigated, prosecuted, and punished for their pregnancy outcomes.  The impacts of restricting abortion will fall hardest on people who already face discriminatory obstacles to health care—particularly Black, Indigenous, and other people of color, people with disabilities, people in rural areas, young people, undocumented people, and those having difficulty making financial ends meet. 

 Restricting abortion will not stop people from seeking abortion. Evidence of this has been seen around the world.  When faced with obstacles to getting a safe abortion under the guidance of a trained physician, people will travel or seek other means of obtaining abortion.  When a pregnant woman experiences a medical emergency, without consulting a medical expert, it may be impossible to tell whether they are experiencing an induced or spontaneous abortion, which could, under the new federal law, put a patient in jeopardy of criminal referral.  Furthermore, physicians will need to make decisions not based on what is best for the patient, but on considerations of criminal liability.  This is not an optimal way to practice medicine.  

Every person and every pregnancy is different, and not every patient decides to continue a pregnancy. Our patients’ lives are complex, and full, and nuanced and beautiful. As physicians, we have the responsibility to care for our patients with dignity, respect and support, using shared decision making to come to the outcome that best serves each patient, who is the expert in her own preferences and values, without undue interference by outside parties. 

Amy Bryant is North Carolina Ob/Gyn and a NC Ob/Gyn Society At-Large Member from Durham