Dr. Laura Andreson hired a lawyer to be on retainer for the past year. In the beginning, Andreson called her nearly every day. Meanwhile, Dr. Nicole Schlechter, chief of women’s services at a local hospital, answers calls from clinicians almost daily to advise on whether a pregnant person is close enough to death to justify terminating a pregnancy to save their life.
Since a Supreme Court ruling overturned Roe v. Wade in June 2022 and Tennessee’s trigger law went into effect in August, physicians now have to weigh the risk of being convicted of a class-C felony under Tennessee’s near-total abortion ban.
“When I heard it was going to happen, I called people who run the hospital system at the national level and said, ‘I need to know where you stand on this because we are going to break the law and I need your help,’” Schlechter says.
At the legislature this year, a small exception was added for abortions in cases of ectopic pregnancies, a dead fetus or molar pregnancies. Still, a big barrier to OB-GYNs providing care to pregnant people is fetal cardiac activity, even at gestational ages that could never survive outside of the womb. Andreson and Schlecter both say they’ve sent pregnant people out of state for abortions for fatal fetal anomalies.
“Let’s say you come in and you’re bleeding, and you’re bleeding heavily to where you’re requiring transfusion and you’re 16 weeks pregnant, and that baby has a heartbeat,” Andreson says. “At this point, I would have to contact legal.”
Schlechter says she treated a patient who didn’t know she was pregnant and suffered a ruptured ectopic pregnancy that ultimately caused her death. She was in intensive care on the upper floor of the hospital, when another ectopic pregnancy came in the emergency room.
“Is it not a medical emergency?” Schlechter says. “I have a patient upstairs who’s in ICU who is brain-dead. It ruptured that quickly. Now I’ve got this other patient. Do I send her home? Do I keep her in the hospital until she ruptures and I can justify it? Hell no, we took her to the operating room and we took the tube out because it was the right thing to do.”
Without case law in place, physicians operate in a gray area and hold their breath until one of them is made an example. At both Schlecter and Andreson’s hospitals, more than one physician signs off on cases of terminating a pregnancy to save the life of the mother. Having more experts agree on a case could prevent litigation, but it could also put more people at risk of losing their jobs or facing jail time.
Nashville District Attorney Glenn Funk vowed not to prosecute women who seek abortions or doctors who perform them after the fall of Roe. But state law allows for Attorney General Anthony Skrmetti to appoint a special prosecutor in counties where a DA declines to enforce certain laws. The Metro Nashville Police Department has also provided a statement that it is “not the abortion police.”
“Don’t tell me it’s OK because they’ve said they aren’t going to charge anybody,” Schlecter says. “Somebody else can be in that job next week, and get pissed, or just not like me. That is no security for me.”
Local reproductive health care advocacy organization Healthy and Free Tennessee saw a win in the legislature this year: Senate Bill 745 repealed a Tennessee law that criminalized “attempted procurement of a miscarriage,” a law that landed one Tennessee woman in jail for a year as recently as 2015. The political will to decriminalize pregnancy wasn’t there before the fall of Roe, says Healthy and Free interim executive director Briana Perry.
“This criminalization language really resonated with a lot of people, including legislators,” Perry says. “Even conservative legislators don’t want pregnant women to be criminalized. It was a huge win.”
The organization inched forward, introducing a resolution that clarified that contraception should be accessible in the state, which failed. Despite public support of exceptions to the abortion ban in cases of rape and incest, a bill that would have allowed that failed in the legislature this year. Even so, exceptions rarely benefit the people they seek to help, Perry says.
“There are so many barriers to go through the legal process as a survivor of sexual assault, especially communities of color who are more often not believed in these circumstances,” Perry says. “We are not pushing for exceptions — we are pushing for abortion access to be available in Tennessee again.”
The road to abortion access will be long and arduous, but OB-GYNs anticipate a more immediate effect on the field. Andreson currently serves people from surrounding counties and out of state because of a scarcity of providers.
“I think we need to provide some sense of normalcy for the providers in this state, or I think our attrition rate will be remarkable,” Andreson says. “I’m at a point in my career, I could probably practice another 10 to 15 years, and I just don’t know — if I am in this type of setting — that I could keep doing that. I think it’ll make people retire earlier. I think it’ll make people go to just GYN only or maybe consultative work.”
“What I take care of every day are people who really want a pregnancy and something’s wrong,” Schlechter adds. “Please let me do my job.”
Schlechter and Andreson’s views do not reflect the views of their employers.
