How the Reversal of Roe v. Wade Has Impacted Labor and Delivery Nurses
Written by Melissa Schenkman, MPH, MSJ
For women in their 20s, 30s, and 40s in the United States, the only life we have ever known was one where abortion was a legal treatment option for us if we had an unwanted pregnancy–whether for health, personal, financial or other reasons.
That was up until about a year ago. Since then, the Supreme Court’s decision to overturn Roe v. Wade and end the protection of a woman’s right to choose to have an abortion or to severely restrict her options in multiple states, has led to a win for those who have long been against the medical procedure in general and a host of medical and financial challenges for women of child-bearing age–mainly millennials and Gen Z–seeking to end a pregnancy safely and on their own terms.
For labor and delivery nurses nationwide, the decision has led to uncharted territory for providing patients the medical care that is in the best interest of their own health.
Jessica Woon is one of them. A high-risk labor and delivery nurse at Duke University, whose early nursing career has been overshadowed by the COVID-19 Pandemic and the overturn of the once landmark Supreme Court decision, now must care for pregnant patients facing unprecedented challenges to their care. She believes (and many people would wholeheartedly agree with her, me included) that there is a massive lack of education out there around reproductive healthcare and rights.
“I am a person of faith who grew up in the Christian church, where many people are pro-life. So, it can be extremely difficult to navigate the crossover between religion, politics, and healthcare as someone who’s in the healthcare field, who loves science,” Woon said. “I do not fit within any box though as I love evidence and there is a lot of evidence around birth that has led me as a labor and delivery nurse to be pro-choice, recognizing that every woman's body is so different, and every baby is so different.”
She and her fellow labor and delivery (L&D) nurses have a unique role in providing care for pregnant women, Woon pointed out. They provide patients with many different treatment options, giving them the pros and the cons, but ultimately the decision is the patient’s individual decision to make.
“As a nurse, I see my role as needing to honor that decision and respect it. I have to be an advocate for that decision,” Woon said. “Birth, life, and death are all so intertwined, and it's such a thin line. As labor and delivery nurses, we have patients who are having the best day of their life and patients who are having the worst day of their life. You have to show up for both.”
By doing so, you ultimately show up for women’s health and well-being. It’s what Woon does every time she walks into a patient’s room, what happened when the Roe v. Wade decision was made in 1973, and what we do at YMyHealth, value and empower women about their healthcare.
Pre-Roe v. Wade Era
Women in pre-Roe v. Wade America lived in a very different world. The kind of place that is foreign to today’s millennials and Gen Z (with the exception of this past year) because it was commonplace for women’s autonomy over their own health decisions to take a backseat to laws and politics.
Women who became pregnant before marriage were likely to have a “shotgun marriage,” marrying the child’s father before birth. Contraceptives were not readily available or even known about by some women because of bans on advertising them. Some states, like Massachusetts, even had laws prohibiting the distribution of contraceptives, specifically to unmarried women.
Another shocking fact: Did you know that the hormonal birth control pill, which millions of millennial and Gen Z women take a form of every day, was not even first approved by the FDA until 1960? Then, its use was banned for five years after that. Hard to comprehend, but all true.
Given that options for preventing pregnancy were so limited in the United States in the 1950s, 1960s, and early 1970s, many women had no other option but to turn to illegal abortions, which put them at risk for serious health complications and even death.
That’s because women would have to travel hundreds of miles from their homes to get to a state offering them a safe, legal abortion – one carried out by a method recommended by the World Health Organization, appropriate to the pregnancy duration, with the use of quality medications, and performed by trained healthcare workers.
When women had no choice but to turn to unsafe means of performing abortions, it included inserting implements, objects, or caustic substances into the vagina or cervix or undergoing an abortion performed by an untrained healthcare provider.
In either case, women risked sustaining life-threatening complications–hemorrhage, injuries to their pelvic organs, dangerous infections, and sepsis–and even death, all because they did not have the treatment option they needed to preserve their own health.
Between 200,000 and 1.2 million women had an illegal abortion in the US each year in the 1950s and 1960s, with many taking these risks in doing so.
All of these events led up to the case of Roe v. Wade, when “Jane Roe,” the name used to protect the plaintiff, Norma McCovey’s identity, challenged Henry Wade, a Dallas, Texas, district attorney with federal action after Wade denied Roe her right to terminate her pregnancy based on a Texas law criminalizing abortion in most cases.
In a landmark ruling, the US Supreme Court ruled that the set of Texas statutes was unconstitutional as they “violated a woman's constitutional right of privacy, which it found to be implicit in the liberty guarantee of the due process clause of the Fourteenth Amendment.” As a reminder, the Fourteenth Amendment prohibited all US states from depriving any person “life, liberty, or property, without due process of law” and from “denying anyone within a state's jurisdiction equal protection under the law.”
The Impact of Roe v. Wade
For women’s health in America, the landmark decision to legalize abortions as a result of Roe v Wade led to many positive changes for women’s health and well-being, including:
Increased access to safe abortions
A reduction in maternal mortality rates (deaths of mothers after delivering a child)
A decreased risk of cardiovascular disease for women who would have experienced preeclampsia (high blood pressure that can damage the kidneys and other organs), gestational diabetes, preterm delivery (birth before the 37th week of pregnancy) or have had a baby with low birth weight (less than 5 pounds) had they not undergone an abortion for an unintended pregnancy
An increase in the number of female high school graduates being enrolled in college
An increase in the number of women in the labor force
For L&D nurses like Woon, legalized abortions–medical and surgical–give them the ability to provide pregnant women optimal medical care. This includes providing procedures, such as a dilation and curettage (also known as a D & C), in a timely manner, preventing patients from having the very common complication of hemorrhage instead of spending time-fighting political red tape to get the types of procedures and treatments their patients need.
Both during and after recovery from abortion procedures, L&D nurses play a key role in providing care to patients, but recovery is made much easier with a far lower risk of complications when nurses can offer patients the treatments their bodies need when their bodies need it.
A Labor and Delivery Nurse's Experience
Like many things in life, timing can be everything when it comes to preserving a woman's health, especially in the face of pregnancy–something Woon has witnessed firsthand in the post-Roe v. Wade era.
She had one patient who lived two hours away from her closest clinic in North Carolina. When she finally arrived, they saw she was five centimeters dilated at just 21 weeks (10 centimeters is fully dilated and ready for delivery). Sadly, she had to have this whole horrible and very difficult conversation with the doctors and nurses there, Woon recalls her telling her. They told the woman that she had two options: to have an abortion or to wait and see, but that either way, her body was almost definitely going to go into labor, and she would lose her baby.
After the repeal of Roe v. Wade, the state of North Carolina required all women to wait 72 hours after having an in-person visit with a medical professional before being allowed to have an abortion procedure.
“Because this woman had to wait 72 hours to schedule an abortion, she ended up going into labor and showed up in our triage fully dilated with a 21-week-old baby that was very much wanted, and then had to have what was a very traumatic delivery. I remember we had to take her back to the procedure room and do a D&C right after she had just delivered her baby, and it passed away in her arms,” Woon recalled.
A D&C is a procedure in which the cervix is dilated and an instrument (the curette, which the “C” stands for) is used to scrape the uterine lining to remove small pieces of placenta after childbirth or used during or after an abortion or miscarriage to prevent heavy bleeding an infection. As such, D&Cs are a very important procedure in treating or making a diagnosis when women are experiencing abnormal uterine bleeding caused by polyps, fibroids, or uterine cancer.
The complication of hemorrhage in labor and delivery is so common, Woon explained because the placenta doesn’t want to detach from the uterine lining, even more so in a pre-term baby.
“While the uterus can’t clamp down because the placenta is still inside the human being, you’re bleeding. So, if that woman was able to do a D&C prior to going into labor, she would have avoided a hemorrhage and a traumatic delivery,” Woon said. “On the other hand, she did get to hold her baby in her arms, but it was dying.”
“Abortion is such an individual decision. I still do not understand how someone can generalize a set of rules to such an individual decision, and it frustrates me to no end,” Woon said.
Jessica Woon, RN
The Repeal of Roe v. Wade
The political landscape leading up to having Roe v. Wade overturned may have been one of division when it comes to a woman’s right to an abortion, but the evidence-based research on the potential consequences of the repeal on women’s health–reproductive rights and healthcare access–which Woon strongly believes in, was and still is crystal clear, especially for vulnerable populations (including Black, Hispanic, and Native American women).
One large piece of evidence: The Turnaway Study. Conducted at the University of California, San Francisco, the study looked at what happened to women who wanted an abortion and were denied one. It included 1000 women from clinics in 21 US states, resembling the population of women seeking abortions nationwide.
What did researchers find? They found that restricting abortion access caused women to experience harm with far-reaching implications in multiple areas of their lives: their health, safety, and financial well-being.
In the study, women who gave birth after being denied an abortion reported:
More chronic headaches, joint pain, and gestational hypertension (high blood pressure after 20 weeks of pregnancy) than women who received an abortion.
It’s also important to note that two women in the study died after being denied an abortion, but no women died from having an abortion.
Some other key findings about restricting abortion access were that women denied a wanted abortion:
Had an increase in household poverty lasting at least four years compared to women who received an abortion.
Lacked enough money to cover basic expenses like food, housing, and transportation, even years after the experience.
Had an increase in the likelihood of staying with an abusive partner.
For women’s mental health, unintended pregnancies mean a greater risk of substance use disorders, depression, and physical abuse.
Advocacy and Support
Woon and her fellow L&D nurses around the country have a huge role in advocating for women’s reproductive rights and their comprehensive healthcare as a whole. To that end, she wants women in their 20s, 30s, and 40s to remember these key takeaways for their own medical care as we live in this post-Roe v. Wade era:
Make it a priority to get your Pap Smears
Find a healthcare provider who makes you feel seen and heard. It’s important to be able to go every year and to see the same person for your visits. You want someone who you can feel comfortable with and be able to ask them hard questions. “While they may be restricted in the care that they can physically give you, it doesn’t mean they are restricted in the resources that they can provide you,” Woon said.
Birth control is very important. Find the right method for you and make sure you use it consistently and as directed to protect yourself from the possibility of getting pregnant if you do not want to. This will help you to avoid the possibility of getting pregnant and contending with abortion restrictions.
Jessica Woon, RN, with one of the many babies she has delivered.
“I so deeply value a choice that a mom makes because it’s never easy. It’s always hard. Sometimes parenting your child, even if it's not born yet, looks different for different people. Sometimes being able to treat yourself for metastatic breast cancer is vastly more important,” Woon said. “It really irks me to know that some people think that people are just flippantly getting abortions. No woman flippantly puts herself through a difficult surgery or thinks of life that way.”
Sadly, in our post-Roe v. Wade country, not only do many people not recognize the difficulty of this decision or the procedure, but as Woon points out, they do not see the bigger picture for women’s lives long term.
“There's not this safety anymore of knowing that you could get the health care that you need.” A need that Woon chose to pursue a career path in women’s health to fulfill.
If you are someone you know is pregnant and looking into their treatment options, here are some organizations and resources that can be helpful to them and their healthcare professionals during this challenging time:
The National Abortion Federation’s “Find a Provider tool and Referral Line
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