For Tennessee-based obstetricians like Laura Andreson, work has become a lot more complicated since June 2022.

Andreson, who began practicing as an obstetrician over two decades ago, currently works at a private practice in a suburb of Nashville. Since the landmark Supreme Court decision Roe v. Wade was overturned in June 2022, Andreson’s work has become difficult—and dangerous.

“There’s not a lot of drive for [OB/GYNs] to stay here,” Andreson said in an interview with The Beacon.

In Dobbs v. Jackson, a 2022 Supreme Court ruling colloquially called the Dobbs decision, the court ruled that the U.S. Constitution does not include the right to an abortion. This ruling had a near-immediate effect in many states including Tennessee, where state legislatures had already developed “trigger bans” on abortion.

Following the overturn of Roe v. Wade, these trigger bans went into effect, outlawing most abortions with a few exceptions in the event the pregnant patient’s life is at risk. In many cases, however, a pregnant person’s life can only be spared if they are near death, which can cause many complications for doctors and patients alike.

“There’s no clear definition for how sick someone needs to be,” Andreson said. “Do you have to be in the ICU before I can do an abortion or do I need to wait for that to happen, even if I know that’s where it’s going, before I can progress?”

These strict abortion bans can be devastating for patients and doctors alike, changing the patient-doctor relationship and leading some OB/GYNs to question whether Tennessee is the right state for them, Andreson said. In some cases, doctors have left altogether; in others, they are continuing their work in a constant state of confusion about what is legal amid fears of being prosecuted.

“There are specific exceptions [to abortion bans] but it’s hard and risky, and you have to get it signed off by another physician,” Andreson said. “At any given point we can have a patient walk in the ER that needs an emergency abortion. If someone decides that was inappropriate or that we were overreacting, both of those physicians would potentially be held criminally accountable.”

Abortion bans are not only a source of stress for practicing doctors, but play a role in the decision-making process of medical students and future physicians. In a 2023 study of more than 2,000 doctors and med students, almost 80 percent of respondents said they would not want to work or train in states with restrictions on abortion.

Kristen Beierealtes, an OB/GYN resident at Nashville General Hospital, began her residency after Roe was overturned. Early in her training, Beierealtes’ program director asked her cohort if they wanted to opt into abortion training. Everyone in her program said yes.

“Abortion training is something that if you opt into it … you have to do a certain number of abortions to meet the minimum requirement to be able to perform that service after residency.” Beierealtes said. “I’ve found that people want education on how to do abortion procedures.”

Beierealtes said she’s seen an increase in teen pregnancies since Roe was overturned, since limited access to abortion means a higher need for prenatal and maternal care, and trafficking bills directly threaten the health safety of pregnant patients. She said the things she’s seen have gone directly against the Hippocratic Oath all doctors swear by, which ensures fair treatment and the best possible care for all patients.

“They’re not being served the way they should be served,” Beierealtes said. “The Hippocratic Oath swears to give patients autonomy and justice. Right now, physicians can’t uphold that end of the bargain. You’re not giving anybody the option to do what’s right for them.”

As a resident, Beierealtes also recruits candidates for future residency and shares her experiences with prospective residents. She said an overwhelming majority of people she’s spoken to have asked about abortion training—and when they’ve heard what’s available, most have said they don’t plan to complete their residency or practice in Tennessee. 

Data shows that doctors who decide to leave the state post-Roe will not be adequately replaced, leaving many pregnant Tennesseans without adequate access to reproductive care including abortions, prenatal care, and maternal care. In Tennessee, just 46.6 percent of physicians who complete residency training in the state end up practicing there, compared to a nationwide average of about 54 percent, according to the Association of American Medical Colleges.

Andreson said this “watered-down” care is a very real threat to patients.

“We already have really large obstetrical deserts in Tennessee,” she said. “This will lead to more maternal death, more fetal death, and it’s all preventable. It’s going to take a lot of deaths for something to change.”

Forthcoming legislation may make abortions even more difficult to obtain—and raise the stakes for patients and healthcare providers. A newly introduced travel ban in Tennessee attempts to make it illegal for anyone to cross state lines to get an abortion and penalize anyone who helped along the way, focusing on adults who help minors.

Briana Perry, the interim executive director of the reproductive justice organization Healthy and Free Tennessee, said the vague language in these bills leaves room for just about anyone to be persecuted. Perry also said the bills are blatantly targeting young people, who are less likely to be able drive out of state to get an abortion or may have more trouble affording one.

“It’s this wedge that legislators are trying to drive between young people and their caregivers under the banner that parents should have rights,” Perry said.

The proposed travel ban will introduce civil penalties for people supporting a young person traveling to get an abortion, Perry said. However, there is no clear definition of “support”—meaning civil penalties could potentially be applied to a person who got an abortion, a person who drove them to get the abortion, a doctor who recommended a clinic, a support group that helped the patient, or a number of other roleplayers. As a result, Perry said, many healthcare providers worry about providing any kind of counseling or support, and those that do may fear for their jobs.

To combat this, Healthy and Free Tennessee is currently working on a “clarification bill” which will help define the criminalization proposed in the recently introduced trafficking bill. The organization is also part of a regional coalition that is developing an abortion bill to “think about a vision for achieving abortion care in the state again,” Perry said.

Andreson said this work is essential to keeping reproductive rights at the forefront of Tennesseans’ minds, and sharing information about new laws and changes is the best way to keep folks fired up and fighting for change.

“They can only tell us we’re overreacting for so long,” she said.