By Rose Hoban
As lawmakers met Wednesday morning to give the public an opportunity to weigh in on abortion restrictions proposed late Tuesday, one group predominated in the gallery of the hearing room — health care providers. Many wore their white coats or scrubs.
Some had been up all night delivering babies and gave up sleep to drive to Raleigh. Others had rearranged clinic schedules or asked colleagues to cover their patients so that they could be present as lawmakers debated enacting a bill that would restrict abortions after 12 weeks of fetal development.
Most had not had enough time to read the entire 46 pages of Senate Bill 20, which was posted to the General Assembly’s website after 10 p.m. Tuesday. Still, the health care providers had received emails, texts and phone calls from friends, lobbyists and advocates keeping them up to date on developments.
“The requirements proposed in this bill are not evidence-based or in any way beneficial to patients, but rather create further barriers and hoops for patients and providers alike to have to jump through,” Jenna Beckham, an obstetrician-gynecologist from Wake County, said Wednesday morning during a meeting of the Joint Committee of Rules, Calendar and Operations. “We went to medical school and completed years of rigorous training to do our jobs caring for our patients. Please let us do our jobs.”
Doing their jobs the way these doctors see fit is something that would change if SB 20 becomes law. Abortion currently is available in North Carolina until 20 weeks gestation. The bill that Republicans are moving through the General Assembly would limit abortion after 12 weeks to victims of rape or incest or if the pregnant person’s life were in danger. There also would be exceptions if the fetus has a condition incompatible with life.
The bill is opposed by the North Carolina Medical Society, the North Carolina Obstetrical and Gynecological Society and the North Carolina Academy of Family Physicians. Nearly 1,500 providers from across the state have signed an open letter opposing any abortion restrictions beyond the current 20-week limit.
But with Republican supermajorities in each chamber, posing a large possibility that any veto by the governor could be overridden, providers are frustrated. Some have said that SB 20 could have a detrimental impact on their willingness to remain in the state.
‘Full scope of training, full scope of care’
Standing outside the Legislative Office Building where the morning’s committee meeting took place, a group of resident OB-GYNs looked grim.
One resident, Kristen Carillo-Kappus grew up in Texas, where a six-week abortion ban is in effect. Further complicating medical care in the Lone Star state, lawmakers there adopted a law that allows anyone to file a civil lawsuit against anyone found to have provided an abortion, or helped a woman obtain one. Carillo-Kappus said that despite wanting to be closer to family, she did not want to complete her medical residency training there.
“I knew I wanted to go somewhere where I thought I was going to get an opportunity for the full scope of care, the full scope of training, and not limit myself,” said Carillo-Kappus, who is in the third year of her OB-GYN residency.
“I wouldn’t go back to Texas because of the restrictions that are there, but now that map is growing, and it’s now including North Carolina,” she added.
Carillo-Kappus said she might be inclined to dig in and fight the proposed restrictions in North Carolina, but in the next breath she said that to do that could jeopardize the career she’s worked so long for. “I’m risking myself and my livelihood.”
Others, too, have said they would be hesitant to work in a state with stringent abortion restrictions. Recent data from the Association of American Medical Colleges found a 10.5 percent drop in medical school graduates applying for OB-GYN residency programs in states with abortion bans.
When medical school seniors are applying for their residency programs, they choose programs they are interested in matching with and rank those choices. New medical school graduates are bound to the training location of their match.
“Applicants are preferentially ranking places that are friendlier to abortion higher than they might have otherwise previously,” Carillo-Kappus said.
Her colleague Jenny Wu did her medical school training in North Carolina and now is doing her OB-GYN residency here.
“Having been here over the course of eight years, I have seen the change, and I’ve seen how it’s impacted my training,” Wu said.
OB-GYNs who are already in practice said they were frustrated that some of the assumptions baked into the bill infer that they’re not already counseling their patients and helping them make their best decisions.
Duke University Associate Professor Beverly Gray talked about new paperwork requirements in the bill that dictate what information must be sent to the state, as well as what OB-GYNs can and should say to their patients as they come for an abortion.
“There’s just this assumption that physicians aren’t counseling their patients adequately, and that needs to be mandated. … [T]hey’re not in the exam rooms with us, they have no idea what conversations that we have,” Gray said. “There’s no way to script out what’s exactly going to happen for every single possible case.”
Some physicians who support the bill spoke at the lawmakers’ morning meeting, but critics such as Beckham, the Wake County OB-GYN, were in the majority.
“Never did I imagine when I decided to go to medical school that I would be up at 4 a.m. as I was today trying to digest a 46-page document that’s telling me how I can and cannot do my job,” Beckham said.
People seeking an abortion would only be able to obtain one in a setting that comes up to the standard of a freestanding surgical center or a specialized surgical clinic. Instead of obtaining consent over the phone or by telehealth, physicians would be required to sit down in person with someone seeking an abortion to discuss the procedure and obtain consent. The bill also requires that an ultrasound be performed and has new paperwork requirements to be filled out and sent to the state Department of Health and Human Services. Then patients must wait three days before the procedure can proceed.
“This is really unlike anything else in medicine,” Beckham told NC Health News after the meeting was over. “There are no other medical procedures that require in-person consent legally, that require a certain waiting period legally and that require follow-up appointments legally. There’s nothing else in medicine that is dictated so strictly by legislators and politicians.”
Up all night
After a lunchtime rally near the legislative complex in Raleigh, six certified nurse midwives stood in line to get inside the Legislative Building.
“I happened to have an indirect day with meetings, and I skipped them. I brought my teen daughter and niece and a friend because I’m just infuriated,” said Estela DiFranco-Field, who also is the associate medical director of the Duke University Hospital Birthing Center.
DiFranco-Field was in line with colleagues wearing scrubs and hospital cover-ups.
“She was in clinic. She left clinic with another nurse practitioner, who covered her patients,” DiFranco said, pointing to midwife Carleen McKenna. “She left early from the hospital because we covered each other to be able to have a presence here, because we’re outraged.”
Another midwife at the Duke birthing center, Penni West, had been up all night attending a birth. Instead of heading home to sleep, she thought it was more important to come to Raleigh to represent her profession.
One section of the bill gives certified nurse-midwives something they’ve worked toward for decades — more autonomy in their practice after completing 4,000 hours of supervised work at the conclusion of their training.
Emily Joubert is a certified nurse midwife who sees patients at Duke hospitals and at the Durham County health department. She said that even before she completed midwifery school a dozen years ago, she was coming down to the General Assembly and talking to legislators about a pathway for independent practice for nurse midwives. Instead of feeling elated that her requests might soon be realized, she’s frustrated.
“It’s horrible that this bill is being pushed as improving women’s health care, because we know it’s not,” Joubert said. “’It’s really insulting.”
Reporter Rachel Crumpler contributed reporting to this story.
Tell us your story about abortion access
NC Health News will be continuing to cover the effects of increased abortion restrictions in the months ahead and the best way for us to do that is with your help — hearing concrete examples of how you are navigating the new law. Have you been affected by new abortion restrictions as a medical professional or a patient? NC Health News is interested in hearing your experience.