How two ob-gyns are practicing among rapidly changing abortion laws

In the four years since the Dobbs decision overturned Roe v. Wade, ob-gyns have had to navigate an ever-changing landscape of laws and regulations for abortion care.

Thirteen states have enacted total abortion bans, seven have placed gestational limits of up to 18 weeks, and 21 ban abortion at a point after 18 weeks, according to research and policy firm Guttmacher Institute. And more legal changes could come as a handful of states are expected to have ballot measures either restricting or protecting abortion rights in the upcoming November midterm elections.

Healthcare Brew talked to two ob-gyns about navigating these changes and how they’ve kept up with evolving rules on care access.

Ob-gyns share their experiences

Erin Stevens, an ob-gyn practicing in Minnesota, told Healthcare Brew that when the Dobbs decision first took place, many of her patients were hesitant to become pregnant. They were afraid they wouldn’t be able to access care if there was an issue in their pregnancy, such as a miscarriage or fetal anomaly.

Minnesota currently has no gestational restrictions for abortion care and is a shield law state, meaning both people who travel from states with abortion restrictions to Minnesota to receive care and clinicians providing the abortion services in the state are shielded from legal repercussions.

“We’re very lucky in Minnesota that this is a very reproductive health care-friendly state, that we’ve enshrined abortion rights in our Constitution, and that this ends up being a safe haven overall,” Stevens said. “But that could really change depending on who’s in charge.”

Despite this, though, Stevens has seen an influx of patients taking permanent birth control precautions out of fear of future legal changes, she said. “People ended up getting a tubal ligation or getting long-term birth control when [it was] something that they were not absolutely planning to do at all,” Stevens said.

The rapid changes in legality across the country have left patients confused on what kind of care is available, she added, so she has had to spend time explaining to patients things they’ve heard about abortion and dispelling myths.

“There’s confusion, hesitancy—there’s fear. There’s a total reconsideration of life plans, where they live, how they live, what their future families are going to look like,” she said. “It’s really unfortunate to have to consider these types of federal policies to decide who can I be where and…can I live the life that I want to live?”

While Minnesota has largely protected abortion rights, other states, including North Carolina, have put more stringent restrictions in place.

Clayton Alfonso, an associate professor of ob-gyn at Duke University School of Medicine, told us that when North Carolina passed a law in 2023 restricting abortions past 12 weeks of pregnancy, it “significantly changed the landscape of how [providers] practice abortion care.” The law has since been updated to specify that abortions after 12 weeks will be allowed only in cases of rape or incest, or if the pregnant person’s life is in danger, and can only be performed in a hospital.

The hospital where Alfonso practices had to move its abortion clinic since the law stated it could no longer be attached to a hospital, he said. The law also caused a lot of confusion among providers as to whether providing abortion services to people who had bleeding during pregnancy or a possible miscarriage was legal, he added.

The latest struggles

One of the biggest challenges ob-gyns are navigating today is the legality of mifepristone.

The medication is one of two drugs—the other is misoprostol—typically used together in a medication abortion. In 2023, the FDA allowed mifepristone to be prescribed via telehealth, making it accessible via mail or retail pharmacy, even for patients living in abortion-restricted states.

But in October 2025, the state of Louisiana filed a lawsuit against the FDA, claiming the agency had violated the law when it allowed mifepristone to be prescribed via telehealth. A federal appeals court on May 1 ruled in Louisiana’s favor, putting a nationwide restriction on telehealth mifepristone. But then on May 4, the US Supreme Court blocked the ruling, allowing access while the case moves through the court system.

Even so, Alfonso said providers are preparing for a future where mifepristone prescriptions may no longer be allowed via telehealth and strategizing backup plans in case only one medication is available. This includes asking questions like: “How do we adapt quickly so that patients still can get care [to] the best of our ability while at the same time not doing anything illegal that gets us shut down from being able to provide care to other people?” Alfonso said.

Another potential challenge in North Carolina is a recently proposed bill that would define life as starting at the moment of conception and classify abortion as first-degree murder, with no exceptions for rape, incest, or threat to the pregnant person’s life. If it’s passed, it would “completely eliminate” abortion access in the state, according to Alfonso. However, the bill is unlikely to pass, as it would modify the state’s Constitution and require support from a majority of voters.

“If that law were to be passed, I’d have to seriously consider whether staying in North Carolina is the right thing for me because having the skills to do something and not being able to do it and watching patients suffer is not why I went into medicine,” he said.

Keeping up with changes

With states changing and passing new regulations on abortion frequently, ob-gyns are having to stay up to date with the legal changes on top of their clinical and administrative work.

Stevens said she does so in part by monitoring social media and “seeing what people are seeing, and then trying to find confirmatory reports of that or not.”

“I just do my best to read and stay informed, and then also help try to spread that awareness,” she said.

Alfonso said he and his colleagues consult with their institution’s legal counsel every time there’s a new executive order or federal or state legal change to determine how the rule should be interpreted and how they can “stay within the confines of the law but continue to provide excellent evidence-based patient care to the most patients we can.”

“It’s kind of scary to have to be practicing medicine knowing that any day, if there’s a court case pending, you could get a ruling that completely upends the practice you do either that day or the next day,” Alfonso said.