How Dobbs Changed Maternal-Fetal Medicine: Colorado Physician Describes the Impact on Hospitals and High-Risk Pregnancy Care
As abortion laws continue to reshape American medicine, Leilah Zahedi-Spung, MD, examines the lasting impact on hospitals, physician practice, and high-risk pregnancy care.
When the U.S. Supreme Court overturned Roe v. Wade in 2022, hospitals across the country found themselves navigating an unfamiliar landscape. Policies had to be rewritten. Physicians had to interpret rapidly changing state laws. Risk managers and hospital attorneys became part of conversations that once centered almost exclusively on patient care.
For maternal-fetal medicine specialists—physicians who care for the most medically complex pregnancies—the changes were immediate and deeply personal.
Leilah Zahedi-Spung, MD, a maternal-fetal medicine physician in Colorado who previously practiced in Tennessee, said the changes hospitals experienced after Dobbs varied considerably depending on the state’s abortion laws, the hospital’s existing practices, and how much abortion care the institution had provided before the Supreme Court’s decision. Some hospitals had already begun preparing for the possibility that Roe would be overturned, while others had to rapidly adjust policies and referral systems as new restrictions took effect.
“A lot of it was really dependent on where you were and what your law actually said,” Zahedi-Spung said.
While practicing in Tennessee, Zahedi-Spung said one of the first operational challenges was determining which patients qualified under the state’s legal exceptions and identifying where patients who no longer qualified for local care could be referred. As Tennessee’s restrictions became increasingly stringent, physicians found themselves weighing legal consequences alongside medical judgment in ways they never had before. Decisions were no longer based solely on what represented the best medical care, but also on whether providing that care could expose physicians to criminal liability.
“It became a really impossible situation for a lot of people, and there was a lot of conversation about like how sick does someone have to be to be sick enough to meet these criteria initially after the Dobbs decision,” Zahedi-Spung said.
She said providers were effectively caught between competing legal risks. Delaying treatment could expose physicians to negligence claims if a patient’s condition deteriorated, while intervening too early could create the possibility of criminal prosecution under state law. That uncertainty raised the threshold for intervention in many pregnancy complications and forced physicians to constantly evaluate how sick a patient needed to become before treatment clearly fit within legal exceptions.
The legal uncertainty also fundamentally changed documentation practices.
Zahedi-Spung said she worked closely with a criminal defense attorney throughout much of her time practicing under Tennessee’s abortion ban. Medical records became more detailed and increasingly incorporated language drawn directly from the state’s statutes in an effort to clearly document why physicians believed abortion care met the legal standard. Rather than serving only as clinical records, documentation also became part of physicians’ legal protection should their medical decisions come under scrutiny later.
Those consultations became a regular part of her practice. Difficult cases often required discussions about both the medical facts and the legal implications before treatment decisions could be made, reflecting how criminal law had become intertwined with everyday patient care.
Zahedi-Spung also questioned whether hospitals were fully prepared to help physicians navigate this new reality. Hospital legal departments traditionally focus on malpractice and institutional liability, she said, while abortion bans often place legal responsibility directly on individual physicians. That distinction left many providers carrying personal legal risk that hospitals themselves could not eliminate.
“The issue is that hospital attorneys are not in the business of criminal defense,” Zahedi-Spung said. “That is a very different type of law.”
The effects extend beyond legal documentation and hospital policy.
Zahedi-Spung pointed to physician training as one of the longer-term consequences of Dobbs. Because many obstetrics and gynecology residency programs now operate in states with abortion restrictions, some residents are graduating with less experience performing procedures used for both abortion care and miscarriage management. Since the same procedural skills are often required for both types of care, she expressed concern that future physicians may have less experience managing complex pregnancy complications than previous generations.
She also discussed how abortion restrictions are affecting the physician workforce. Some physicians with specialized reproductive healthcare training have relocated from restrictive states to places where they can practice the full scope of maternal-fetal medicine. Although the total number of physicians leaving may appear relatively small, she said the loss of even a handful of highly trained specialists can significantly affect hospitals and communities that already struggle to recruit obstetric providers. She pointed to states like Idaho, where physician shortages have contributed to maternity ward closures and reduced access to obstetric care.
For physicians themselves, the changes have carried an emotional toll.
Zahedi-Spung described caring for patients while knowing legal restrictions prevented physicians from consistently providing what they considered the standard of care as creating profound moral injury. Ultimately, those circumstances led her to leave Tennessee and relocate to Colorado, where she now practices in a legal environment that allows physicians to make decisions based on medical judgment rather than criminal statutes.
She also believes the public often misunderstands the role maternal-fetal medicine physicians play. Specialists routinely care for patients facing severe fetal anomalies, life-threatening maternal illnesses, pregnancy loss, and medically complex abortions. Because of that unique position, they often navigate both routine obstetric care and abortion care simultaneously. Public attention, she said, frequently centers on the most tragic pregnancy complications while overlooking the broader range of patients whose reproductive healthcare also depends on these physicians’ expertise.
More than three years after Dobbs, Zahedi-Spung believes the most significant operational change inside hospitals has been the incorporation of legal risk into clinical decision-making. Physicians caring for the most medically complex pregnancies must now balance medical judgment, professional ethics, and legal uncertainty in ways that were largely absent before the Supreme Court’s decision, fundamentally changing the practice of maternal-fetal medicine in many parts of the country.