When Jessica Bernardo found out she was pregnant, it was reason to celebrate. Bernardo and her husband had struggled for two years to conceive, and when their fetus was diagnosed with Down syndrome, they continued to celebrate, naming her Emma, which means “whole.”

Emma’s health continued to deteriorate until it became clear she would not survive birth. Bernardo, too, was at risk—she was in danger of developing mirror syndrome, a rare condition in which the fetus has an abnormal buildup of fluid, and the pregnant person has high blood pressure, or preeclampsia. The diagnosis comes with a high fetal mortality rate and maternal morbidity rate.

In discussions with their doctor, the word “abortion” was never uttered. The couple lives in Texas. A request for care under Texas’ “medical emergency” exception in the state’s abortion ban was denied without explanation by the hospital’s ethics committee, entities that are notoriously averse to undertaking legal risk.

The couple tried to get care in Colorado next, but the wait times were too long. Finally, Bernardo was able to get an abortion in Seattle, where, according to the Center for Reproductive Rights, she was told she was their third patient from Texas that week.

Now, represented by the Center for Reproductive Rights, Bernardo is one of 13 women suing the state of Texas over its restrictive abortion ban. The plaintiffs seek clarification of the “medical emergency” exception—they argue that the exception is vague and, coupled with the extreme legal risks that hang over physicians, qualifying for care under the current law is nearly impossible.

Current Texas law says abortion care may be provided “when there is a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy that poses a serious risk of substantial impairment of a major bodily function.” So, too, if a physician provides abortion care and is found to have done so outside of that criteria, they risk being charged with a first-degree felony, which could result in life imprisonment.

Recently, exceptions to abortion bans have begun to attract more attention, mostly due to a growing public awareness that the exceptions are difficult for patients and physicians to navigate.

“I do not think that exceptions are effective broadly—in fact, they seem like something that you would think on face value would be helpful to make sure that, in particular circumstances, people can get care,” explains Dr. Kristyn Brandi, an OB-GYN who practices in New Jersey. “In real-life practice, exceptions are often unclear, confusing, and create delays in care because physicians have to talk to a lawyer to interpret these laws. It doesn’t translate to medicine at all.”

Since the fall of Roe v. Wade, about half of all states have enacted abortion bans. Exceptions—often for rape, incest, life of the pregnant person or some combination of the three—serve as an illusory promise of humane care in disastrous circumstances.

Twenty-two states with abortion bans have exceptions for the life of the pregnant person, making it the most common exception. The language, however, can vary from state to state. For example, Arizona, Florida, Ohio, Wyoming, and Indiana have exceptions for “when there is a serious risk of substantial and irreversible impairment of a major bodily function.” Georgia’s exception is “to prevent substantial and irreversible physical impairment of a major bodily function.” Utah says there can be an exception “when there is serious physical risk of substantial impairment of a major bodily function.”

To be sure, in the chaotic post-Dobbs legal landscape, uncertainty reigns supreme. Abortion bans in most states are accompanied by heavy penalties for physicians who perform the procedure—gargantuan fines, loss of medical license, and, in some cases, criminal conviction and imprisonment. Katrina Kimport, a research sociologist focusing on reproductive health and author of No Real Choice: How Culture and Politics Matter for Reproductive Autonomy, says that the laws twist physicians’ role from provider of medical care to gatekeeper of medical care.

“These are people who are working inside institutions, and those institutions have legal teams, administrators, ethics boards, and all of those entities are really designed and are incentivized to not bring risk on to the institution, on to the hospital, on to the individual practice,” Kimport says.

Most medical providers, Kimport points out, are not lawyers. “Interpreting the law is not their specific skill set,” she says. “So they may very reasonably be cautious and conservative about offering these kinds of care, because the consequences for offering abortion care outside of these narrow exceptions can be so severe.”

Brandi, too, says the bans, coupled with their muddy exceptions, directly affect the ability to practice medicine. For her, it’s very simple: if she has the skills and the tools, it’s her responsibility to ease suffering immediately. Making a patient wait while she consults a lawyer is unconscionable. “It goes against our oath in medicine to wait until someone is sick enough—and what is ‘sick enough’?— to intervene,” Brandi says.

It’s also simply unrealistic to expect the law to cover something as complex as the human body. “There’s a heartbreakingly large number of ways pregnancy can go wrong,” Kimport says. “Those are going to keep coming up; there is not a way to make a list of all of them.”

Of course, there are other exceptions besides cases in which abortion is necessary to save the life or physical functions of a pregnant person, including mental health of the pregnant person, lethal fetal abnormality—both of which are open to the same sort of problematic interpretation that Brandi and Kimport speak of—or rape or incest.

The main barrier to obtaining a sexual assault exception is because sexual assault victims often fear shaming or belittling by law enforcement. Some victims may also fear retaliation from their rapist. According to RAINN, for these reasons and more, only 310 in every 1,000 sexual assaults are reported to begin with, meaning that more than 2 out of 3 assaults go unreported in the U.S. In order to qualify for a sexual assault exception, victims must file a police report, which often includes invasive questioning. In some states, fetal tissue is subject to a DNA test to prove the veracity of the assault victim’s claim.

“It’s just too much for people to go through after having a sexual assault—these requirements create shame, stigma, and re-traumatization that people don’t want to go through. So they not end up getting an abortion because of all of that, and that’s really a shame because people should be able to make that healthcare decision and not have to go through these onerous processes,” Brandi says. “And it’s creating this false narrative that care will exist for these people with no problem.”