Understanding Reproductive Healthcare in a Post-Dobbs World: An Interview with Dr. Karen Davidson M.D., OB/GYN

Savannah Ko: In recent years, the topic of reproductive healthcare has become a highly politicized issue throughout the United States, causing rates of distress among both pregnant people and healthcare workers to sharply increase. A study conducted by Psychology of Women Quarterly in June 2024 showed that distress levels among 900 Americans who were assigned female at birth had increased after the Dobbs v. Jackson decision, particularly among people who were queer, low-income, or had a previous history of abortion.¹ I spoke with a practicing OB/GYN to gain more insight to what the medical field of reproductive healthcare looks like in a country where reproductive rights are not guaranteed nationwide.

SK: I’m here with Karen Davidson, an OB/GYN who has worked in the field for about 30 years. Can you introduce yourself a little bit, Karen?

Karen Davidson: I’m an obstetrician and gynecologist, and I specialize in high-risk pregnancies. I’ve been practicing for about 30 years, primarily working in Massachusetts at Brigham and Women’s Hospital, and doing occasional work up in New Hampshire as well. I do a lot of ultrasounds, I deliver a lot of babies, and do a lot of consultations for women who are deciding to become pregnant. During their pregnancies, I also help general OB/GYNs take care of their more complicated patients. 

SK: I’d like to jump straight into it and ask you about the overturning of Roe v. Wade in the summer of 2022, and what your hospital or your colleagues did in reaction to this. Were you aware that it might come, based on the Georgia heartbeat bill and Texas anti-abortion legislation that happened a few years prior? 

KD: We always knew that it was a possibility, but we thought it was a pretty unlikely possibility that it would be overturned. I really didn’t think that was gonna be the case. Fortunately, in Massachusetts, we are very spoiled by the fact that we do have ongoing protections. It hasn’t changed the patients that I see that live in this state, but we do have a lot of patients that come from other places to get care because of the things that are happening in their own states. 

SK: Tell me more about that. Tell me more about the out-of-state patients that you’ve received over the past few years. 

KD: I do a lot of prenatal diagnosis, so we do ultrasounds and we do genetic testing. We do have patients that come to us for second opinions, and also for ongoing care when the practices where they live do not allow for the possibility of termination of care, should we find an anomaly that is something they would not want to continue the pregnancy for. We don’t get a huge number of those patients, but we definitely do get an influx from other states.   

SK: Do you have any colleagues who work in red states or maybe purple states whose rights to abortion and rights to reproductive healthcare have changed somewhat in the past couple of years? Can you speak a little bit about those colleagues’ experiences?

KD: The people I know in other states are oftentimes people who have trained with us as residents or fellows, and then gotten jobs in places like Texas or other places where restrictions have occurred. It’s super hard for them to take care of patients in a way that they’ve been trained, and we have seen providers decide not to take fellowships in those states. It’s not possible to practice the medicine that we practice in Massachusetts; I know that the trainees are very much avoiding going to places like that for further training. 

SK: I imagine that might create a cycle. If there are fewer trainees and fewer OB/GYNs in those places with restrictive medical care, then the medical care in those places would get worse and more women would be at risk.

KD: I would say that that’s definitely a concern, that when high-risk obstetricians like myself are not willing to train or work in states where we can’t provide the care that we know we can, then it’s gonna be much harder for the patients to receive that care without going out of state. 

SK: If it’s appropriate, I’d like to talk about ectopic pregnancies and the issues and concerns around terminating them, especially in light of Dobbs v. Jackson Womens’ Health Organization. How do the roadblocks in terminating an ectopic pregnancy differ from blue states, like Massachusetts, and red states like Texas?

KD: So ectopic pregnancies are really a medical emergency, and they are a type of pregnancy that can lead to life-threatening complications, primarily because they can cause the [fallopian] tube to burst if they grow and grow and grow. They can cause the mom to lose a huge amount of blood in their belly. They are not viable pregnancies. In other words, no pregnancy can go past the very earliest stages, so they can only go to about eight weeks or so. The biggest complication is really not infection but bleeding. It’s never been a question of termination of a pregnancy, because it is not a viable pregnancy to start with and it is a pregnancy that cannot continue to grow past the very earliest stages without causing a surgical emergency for the patient. 

Dr. Davidson’s remarks of ectopic pregnancies are particularly important because several states severely restrict pregnancy care in the first eight weeks, which is when ectopic pregnancies occur and have a high chance of rupturing. Louisiana and Texas, two states with tight restrictions on reproductive healthcare, have reportedly failed to provide prenatal care appointments and promoted the use of dangerous surgical procedures for pregnant people suffering in their first trimesters.²³ 

Conservatives and pro-life individuals often justify methods like these through their worldview and the way they see life. Researcher Cara Muskmiller analyzed Roman Catholic bioethics in reproductive healthcare, and noted that “induction of labor and C-section represent forms of delivery that address the root cause of the problem, delivering the infected pregnancy and ending the threat to maternal life. Catholic bioethicists and secular pro-life OB/GYNs have both defended delivery in this case as a morally acceptable option.” ⁴ 

SK: Have you seen any changes in your patients since the overturning of Roe v. Wade? Do you think they have gotten more worried or anxious since that decision?

KD: I think patients are always anxious during a pregnancy, but I think that anxiety level has gone through the roof. Patients are just more focused on what I’m doing in ultrasounds – they’ll stare at my face, and I have to be very neutral in my face because I don’t want them to be nervous. I’d say “Everything we’ve seen looks good, but I’m just going to check on a couple of things” – I’m trying to decrease the level of anxiety at the very start. I joke that we need to have a bowl of Ataban in the waiting room, so when they do have things that should make anybody anxious, their responses are not quite so tough.

SK: Wonderful, I think that’s all the questions I have for you today! Lastly, in light of all the negative information about mental health and uncertainty over the future…what gives you hope as an OB/GYN practitioner?

KD: It’s still the best job to be delivering babies. It can be a very stressful and a very exhausting job, but I can’t imagine a better job than to help women create families and have babies – be able to be part of those patients’ lives when they’re having this most amazing experience of their lives. That’s always the thing that gets you excited about going to work.

SK: Dr. Davidson’s remarks on her work and industry paint a sobering reminder that inequities in reproductive healthcare across the United States are likely to worsen in coming years, as the politicization of a scientific issue continues to harm people seeking reproductive care. Political activism is needed more than ever to safeguard access to essential healthcare services, challenge harmful policies, and ensure that all individuals can make informed, autonomous decisions about their reproductive health. The fight for reproductive justice requires both immediate action and long-term advocacy to dismantle systemic barriers and defend the right to comprehensive care.

Buskmiller, Cara. “Ectopic Pregnancy as Previable Delivery .” Oxford Academic, April 26, 2024. https://academic.oup.com/crawlprevention/governor?content=/cb/article/30/2/120/7658845?rss%3D1.

“Criminalized Care: How Louisiana’s Abortion Bans Endanger Patients and Clinicians.” Lift Louisiana, June 2024. https://www.liftlouisiana.org/criminalizedcare?link_id=2&can_id=beefcf6cd46f1a79dd9e666d9f8c620c&source=email-la-legislative-session-begins-2&email_referrer=email_2247441&email_subject=lift-and-partners-release-criminalized-care-report.

Ko, Savannah. A Talk With Karen Davidson. Personal, November 24, 2024.

Watson, Laurel B., and Jacob M. Germain. “Reproductive Justice in the Post-Roe v. Wade Era.” Psychology of Women Quarterly 2024, Vol. 48 (2), June 2024. https://research.ebsco.com/c/4e4lys/viewer/pdf/vv6migkmt5?auth-callid=853e340b-b4f5-466c-892c-8c8c2f57ce81.

Westwood, Rosemary. “Standard Pregnancy Care Is Now Dangerously Disrupted in Louisiana, Report Reveals.” NPR, March 19, 2024. https://www.npr.org/sections/health-shots/2024/03/19/1239376395/louisiana-abortion-ban-dangerously-disrupting-pregnancy-miscarriage-care.