OF: NATANYA FRIEDHEIM

Physician David Mehr addressed a dozen voters gathered Saturday morning at the Columbia headquarters of Missourians for Constitutional Freedom, the coalition behind a proposed amendment that would enshrine abortion rights in the Missouri constitution.

Meanwhile, doctors welcomed volunteers to St. Louis and more gathered in Kansas City as part of the coalition’s final get-out-the-vote campaign before the Nov. 5 election.

“I’ve taken care of women my whole life,” Mehr told the group of volunteers in Colombia. “It’s important to keep this decision between a woman and her doctor.”

Mehr works at University of Missouri Health Care, but spoke as an individual and not on behalf of the hospital.

An hour later, he was navigating a thicket in a northwest Columbia neighborhood, looking for the right door to knock on. By the end of the day, he and his canvassing partner had knocked on 44 doors.

Like other states with abortion bans, Missouri state law provides exceptions “in cases of medical emergency.” Doctors who perform abortions deemed unnecessary can be found guilty of a Class B felony and have their license revoked or suspended.

“There is no definition of what a medical emergency might be,” said Betsy Wickstrom, a high-risk obstetrician who works in Kansas City. “So if my patient is bleeding and the cervix is ​​open, there’s still cardiac activity, how long should I let her bleed?”

Wickstrom preferred not to disclose his hospital affiliation. Her reluctance was shared by doctors who gathered Saturday at St. Louis and reflects a broader trend of doctors keeping their jobs hidden when talking about abortion, identified in a 2023 study.

Last month, a group of 800 medical professionals in Missouri, including 500 doctors, signed a letter of support for the abortion rights amendment, which appears on the ballot as Amendment 3.

No doctor in any state has been prosecuted for performing an abortion during a medical emergency, according to an article published last month by the Association of American Medical Colleges. However, doctors across the country have warned that the lack of clarity about what constitutes a medical emergency is compromising their ability to provide emergency abortions.

In August, a group of Missouri OB-GYN medical residents anonymously published an article in the Journal of Graduate Medical Education describing their shock and fear at entering the profession in a state with a strict abortion ban.

“Because the law’s text reads so punitively, it has caused fear among clinicians and caused life-saving care to be needlessly delayed or flagrantly denied,” the authors wrote.

Since abortion became illegal in Missouri in 2022, the state has seen a more than 25 percent drop in applications for OB-GYN medical residencies, according to a May report by the Association of American Medical Colleges.

In a widely publicized case from 2022, two hospitals, including one in Missouri, turned away Missouri resident Mylissa Farmer when she sought care after her water broke just 18 weeks into her pregnancy. Last year, the Centers for Medicare and Medicaid found that the two hospitals — Freeman Hospital West in Joplin and the University of Kansas Health System in Kansas City, Kansas — violated federal law when they denied Farmer care.

Numerous other examples of women being denied emergency medical care have been in the news since the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization ended the constitutional right to abortion.

Health professionals who oppose abortion say media reports promote an exaggerated narrative that abortion bans jeopardize women’s access to emergency care.

“All state laws allow maternal-fetal separations to be done (by any means necessary) to save the life of the mother,” Christina Francis, an obstetrician-gynecologist and executive director of the American Association of Pro-Life Obstetricians, wrote in testimony for a US Senate Finance Committee hearing in September.

Decisions in medicine are rarely black and white. When a woman’s water breaks early enough that fetal viability is removed, abortion is the standard of care, Wickstrom said. When a woman approaches 20 weeks, factors such as bleeding, signs of infection and the amount of amniotic fluid in the uterus are taken into account.

Some women want to wait, and a doctor guides the patient through this choice.

“Of course we do that, because the point is choice. The idea is that her body is determining what’s right for her, and we’re coming alongside her and supporting her and guiding her through what’s right for her,” Wickstrom said.

If a woman does not want to continue the nonviable pregnancy, the fetus has a heartbeat and her condition is not considered an emergency, she must leave the state for an abortion, Wickstrom said. In Kansas City and St. Louis, women can reach clinics that provide abortion care in Kansas and Illinois more easily than those in mid-Missouri.

Wickstrom brings his metal water bottle to work at a Kansas City hospital. He keeps it displayed when he talks to patients so they can see the stickers that adorn it: Just above a cutout of Taylor Swift is a sticker that says “ABORTION RESOURCES,” followed by a list of phone numbers and URLs of websites.

Wickstrom said she struggles to talk honestly with women who have high-risk pregnancies about their options.

“You have to dance a lot more,” she said, “because the waters are muddy.”

This story originally appeared in Columbia Missourian. May be republished in print or online.