Last week, the Nation reported that a woman in Texas received a c-section to deliver a stillborn pregnancy, in place of abortion care, revealing the chilling measures being taken to navigate abortion restrictions which do not always outline the details of legal exceptions to the law.

The influx of abortion bans since the Dobbs decision has led to a wave of confusion and a shift in how some Americans experience pregnancy. The limitations enacted by some states attempting to prohibit abortion have also impacted how pregnancy-related care, including prenatal testing, miscarriage, and even fertility treatments can be safely and legally carried out.

Though most states with abortion bans have exceptions to save a pregnant person’s life, what exactly that means is often subjective. Confusing or vague laws have left both doctors and patients unsure of what could land them in legal trouble, and in some cases have caused delays or refusal of treatment. This has left pregnant people to be discharged or pushed out of emergency rooms until the lines questioning whether they are receiving life-saving care cannot be debated.

The ramifications have even impacted people’s desire to be pregnant, even in states where abortion is legal. According to a 2023 polling by nonpartisan civic education organization All In Together, 34% of women between the ages of 18 and 39 said they or someone they know personally has decided not to get pregnant due to concerns about managing pregnancy-related medical emergencies.

From emotional, to economic, to medical, Americans’ perception of and experiences with pregnancy are shifting. Here are 5 ways abortion bans are changing pregnancy care:

Unnecessary c-sections

A C-section is a major invasive surgery, and though it is a common procedure, it’s used as an alternative option when a baby cannot be delivered vaginally. Last week, a report by the Nation revealed that a Texas doctor substituted c-section in place of an abortion to deliver a stillborn, presumably to protect themself against potential legal threats. Though c-sections are considered safe, they carry a risk of health complications including infection, hemorrhaging, and blood clots, and should not be used as an alternative to abortion, according to medical experts.

“I want to emphasize that this is not what’s in the best interest of the patient,” an unnamed New Orleans OB-GYN told NPR, after a report released in March revealed c-sections were being used on abortion patients in Louisiana. “This is what’s in the best interest of…the physician in protecting themselves from criminal prosecution.”

Delayed miscarriage care

Miscarriage management often uses similar procedures to abortion. With abortion bans, doctors might hesitate to provide timely treatment for miscarriages, causing physical and emotional distress for the patient and potentially leading to complications.

For example, D&C, dilatation and curettage, is a surgical procedure in which the cervix is expanded to scrape the uterine lining of abnormal tissue, used in both miscarriage and abortion. Because of the dual-usage of a procedure like D&C, some doctors have been hesitant to provide timely treatment, in fear of being accused of facilitating an abortion.

In 2022, a Texas woman was denied a D&C during a miscarriage, even though the New York Times reported she had the same procedure done for an earlier miscarriage a year prior in the same state.

“Even in these straightforward cases of basic OB/GYN practice, the laws leave providers questioning and afraid,” Wisconsin OB-GYN Dr. Carley Zeal told the New York Times. “These laws are already hurting my patients.”

In December, Brittany Watts made national headlines after being sent home from the hospital while experiencing a miscarriage, eventually passing the pregnancy in the toilet, and being arrested for attempted abuse of a corpse. Approximately 26% of all pregnancies end in miscarriage, and Black women are 43% more likely than white women to have a miscarriage, according to WebMD.

Increased and/or limited prenatal testing

With strict abortion laws reducing the time in which a pregnancy can legally be terminated, patients are desperate to test for abnormalities and identify prenatal abnormalities to be able to have a legal abortion if necessary, prior to reaching the gestation limit. According to a PBS Newshour report published in February, earlier ultrasounds and testing do not always provide the most accurate depiction of a pregnancy because it’s too early to see many details of the fetus, like limbs and heart defects; genetic diagnoses cannot be done until 10 weeks or later.

Additionally, some prenatal tests, such as amniocentesis, carry a small risk of miscarriage, according to academic medical organization Mayo Clinic. Doctors might be discouraged from offering these tests due to fear of being seen as performing an abortion, potentially leading to missed diagnoses of genetic abnormalities.

Restricted treatment for life-threatening pregnancies

An ectopic pregnancy is a life-threatening condition where the fetus implants outside the uterus, and treatment often involves procedures similar to abortion. States with exceptions to save the mother’s life, or with conflicting abortion restrictions, what is considered medically necessary is up to interpretation.

In Oklahoma, because the laws do not explicitly define what is considered life-saving, the state’s Attorney General Gentner Drummond issued an updated guidance on Nov. 2023 clarifying that the ban does not apply to ectopic pregnancies, fertility treatments, or emergency contraception.

Last month NPR interviewed Dr. Nicole Freehill, a New Orleans OB-GYN, about how abortion bans endanger patients.

“There are going to be deaths that didn’t have to happen. There are going to be severe complications that didn’t have to happen,” she said.

Increased cost of care

Abortion bans are expensive. With more complex procedures to work around bans, for example having a c-section instead of an abortion, and potential legal battles, the overall cost of pregnancy care could rise.

This could disproportionately impact low-income women, creating further barriers to accessing safe healthcare. Additionally, the cost of raising a child in the United States is much greater than having an abortion, and has lasting costs. A 2018 USCF study found that women who are denied abortion experience financial hardship that lasts for years.

“Laws that limit abortion access have a huge economic impact,” said Kate Bahn, director of labor market policy at the Washington Center for Equitable Growth told NBC in 2021. “It’s not just the year-over-year financial hardship associated with having children, but it also affects people’s career trajectories.”

A study released in January by the Institute for Women’s Policy Research found that abortion restrictions cost the US about $173 billion annually, up from $146 billion in 2020 by reducing the labor force, earnings levels and increasing turnover and time off from work among women employed in the private sector. According to the report, the loss is greatest in states with the strictest abortion restrictions, such as Arkansas, Idaho, and Missouri.