On the front lines with OB-GYNs in the post-Dobbs world

When Roe v. Wade was overturned in 2022, the fallout poured gasoline on an alarming trend of burnout among obstetrician-gynecologists. 

But it also put OB-GYNs on the front lines of the abortion battle, as the decision led to a wave of restrictions and near-total bans on abortion in about half the states in the country. 

As president of the American College of Obstetricians and Gynecologists (ACOG), Stella Dantas wants to try to solve the burnout crisis while also supporting the work of physicians to advocate for themselves and their patients. 

“Without advocacy, we can't do what we do. Wherever you live, you're affected by current issues and legislative interference into the practice of medicine,” Dantas said.

For example, physicians in Oregon, where Dantas lives and practices, are trying to fill the gaps in care from neighboring Idaho, where abortion is almost entirely banned. Patients are leaving the state to get needed care, but so, too, are doctors who don’t want to work under threat of criminal penalties.

Dantas said in the aftermath of the Dobbs ruling, OB-GYNs are speaking out more, especially about their experiences living in states with abortion bans.

“You're seeing people get involved in their maybe their state medical society. They're working with ACOG, with the government affairs team. And they're going out to educate their patients,” Dantas said.

One of the most important educational aspects is to try to fit people's personal experiences into the bigger picture narrative, she said.

If people can’t get in to see their physician, maybe it’s because low reimbursement rates mean clinics are operating with smaller staff. Or maybe it’s because after the Dobbs decision, there are fewer doctors in the state.

"If you go upstream, where that problem actually is, it opens the eyes of friends, family and voters and people as they think about the issues,” Dantas said. “I think our clinicians are sensing they need to get out there and do this work themselves, which is going to help them in the long run. And that is why you see people willing to do whatever it takes out there in education, talking to people and getting involved in advocacy work.” 

The Supreme Court’s decision in Dobbs was years in the making, so Dantas said the ACOG could see the writing on the wall and was preparing for it. But it was still a massive blow. 

“That reality, I guess I would say, was hard to face,” she said. “When I was sitting here in Oregon, with that decision, you know, you feel helpless, because you just want to go and help people in Texas. You want to go and help people in Idaho.” 

Clinicians in states with severe restrictions just want something better than the current situation, Dantas said. 

“Boots on the ground, physicians and clinicians are taking care of patients. They are watching patients suffer because they can't take care of someone at 10 weeks, or they can't take care of someone at 15 weeks.” 

But there’s also the long game to consider, and allowing legislators to impose restrictions on abortion sets a precedent. 

“If you open up any door to legislative interference, what does that mean not just for abortion, but what does that mean for contraception? What does that mean for gender-affirming care? What does that mean for anything, you know, in the practice of medicine?” Dantas said. 

Dantas works full time seeing patients at Northwest Permanente in Portland, where she also serves as medical director of graduate and undergraduate medical education. 

She has been involved with the ACOG for most of her career and said her introduction to advocacy work came when she helped push Oregon to require mandatory licensing of all out-of-hospital birth providers, such as midwives.

Advocating for her specialty, she said, gives her a feeling of balance. 

“As a physician working, you feel the effects of what happens when someone legislates something in medicine, whether it's reimbursement, whether it has to do with education, whether it has to do with laws that that interfere with our practice of medicine,” Dantas said.  

“You feel it in a very different way, and to be able to do something about that, whether it's give a talk or help with legislation, being at the table of your medical society, it just makes you feel like you're doing something.” 

Abortion care advocacy is especially crucial, Dantas said, but it’s also intrinsically tied into the issue of burnout.

Practicing during the COVID-19 pandemic took a toll.  But coming out of the pandemic, instead of the situation getting better, it worsened.

COVID was stressful, “but everybody was working toward one goal, right? And patients, they were forgiving. They were banging pots and pans for us. They were supporting us, delivering meals to the hospital. They were they were all there supporting the health care clinicians and providers,” Dantas said. 

“Now, there's no patience. People want to get in for their care. They're tired of the surgical backlog. So you have that impatience, and that less forgiving, that takes its toll on health care providers.” 

And then, on top of it all, the Supreme Court overturned Roe, ending the constitutional right to abortion that had been in place for nearly 50 years.  

In some cases, patients need to travel hundreds of miles out of state to end pregnancies, even if their health is at risk. In other cases, including in Idaho, hospitals are transporting patients who need abortions, because doctors fear what will happen if they violate the law. 

Doctors are confused and frightened, and Dantas said that has led not only to an exodus of physicians from states with abortion bans, but also an exodus of practicing OB-GYNs in general. 

“Nobody goes into medicine to watch somebody get sicker before you can go in and save them or help them. So that that caused a lot of people to rethink, 'Is this what I want to do?' Especially if you're close to the age of retirement, or you can cut back or not work at all,” Dantas said.  

That makes the burnout problem worse, and it impacts patients. There will be more maternity care deserts, increasing the risk for poor outcomes in those areas. 

Dantas said the larger issues, such as abortion, aren’t going to be resolved quickly. But to help with burnout, she wants people to care for each other. 

“You stay for the people, you stay for your patients. And at least if we can have that still be a positive thing, to come to work every day, maybe we can help people not leave because of all the other threats and pressures and stress that's upon us.”