A year before the U.S. Supreme Court overturned Roe v. Wade and most abortions became illegal in Oklahoma, a pregnant patient came into an Enid hospital with her water broken weeks before the baby had a chance at survival. 

Dr. Rebecca Lewis, a family physician practicing obstetrics at St. Mary’s Regional Medical Center, and her patients were left to decide between inducing delivery early, or waiting until the baby died in the womb or the patient went into septic shock. 

The patient wasn’t facing medical complications, but they decided to start labor early, which Lewis said she believes prevented the woman from experiencing the further psychological harm of a potential life-threatening emergency. 

“If that came in tonight, would I be able to make that same decision legally?” Lewis said. “It’s still such a gray area.” 

The Oklahoma Supreme Court has ruled twice in recent months to overturn state laws that only allow for abortions during life-threatening medical emergencies, stating that requiring doctors to wait doesn’t serve a compelling state interest.

But an Oklahoma law from 1910 that outlaws most abortions is still in effect. That law says abortions are allowed only when necessary to preserve a mother’s life. Otherwise, medical professionals can be charged with a felony and face up to five years in prison.  But doctors still aren’t certain when they can perform the procedure. Other states that have banned most abortions including Utah, Georgia and Louisiana have laws with more specific language, permitting terminating a pregnancy  to prevent serious, irreversible damage to a life-sustaining organ, but Oklahoma’s law contains no specifics or clear definitions.

The Frontier interviewed three medical providers who said a lack of consensus on how to interpret the recent state court rulings makes it difficult to make decisions while treating patients. 

Lewis said many of the doctors she knows interpret the law to mean that abortion is appropriate if the mother’s life will be at risk in the next 24 hours, but that leaves out lots of situations that could be detrimental to patients’ health and wellbeing. 

Oklahoma Attorney General Gentner Drummond said before the most recent state Supreme Court ruling in May that doctors should be given “substantial leeway” in deciding when abortion is appropriate. 

Phil Bacharach, a spokesperson for Drummond’s office, said in an email that staff are reviewing and potentially updating guidance based on the most recent Supreme Court decision, and they could include definitions for preserving the life of a mother. 

Neither the Oklahoma Board of Medical Licensure and Supervision or the Oklahoma State Board of Osteopathic Examiners have guidance published on their websites based on the most recent state court rulings, though Board of Osteopathic Examiners executive director Michael Leake said he’s working to develop some.  

The American College of Obstetricians and Gynecologists’ official position is that abortions can be medically necessary. The organization opposes efforts to impede access or criminalize health care providers. But Molly Meegan, general counsel for ACOG said doctors can only follow the organizations’ guidance as far as state laws will allow.  

ACOG can’t offer individual doctors legal advice, but Meegan said the organization encourages hospital administrators to help doctors navigate their work. 

“A lot of institutions haven’t provided enough guidance,” Meegan said. “Most doctors are operating in what feels like a very scary and chaotic environment.” 

Oklahoma Call for Reproductive Justice, an abortion access group, was the plaintiff in two lawsuits that struck down narrow exceptions for medically necessary abortions in the state. Board member Priya Desai said the organization has tried to push back on what they see as the highest impact laws, and they saw similar bans in states like Texas cause spikes in out-of-state abortions. 

The organization worked together with Physicians for Human Rights and the Center for Reproductive Rights on a study of Oklahoma hospitals, which found that almost none have clear policies on when to perform emergency abortions. 

Desai said her group believes that hospitals should outline clear emergency abortion policies for doctors, but she thinks the liability associated might prevent some from creating them.

Oklahoma City OB-GYN Dr. Dana Stone asked that her hospital not be named because she isn’t authorized to speak on the organization’s behalf. She said hospital attorneys created broad guidelines for doctors after Roe v. Wade was overturned. But black-and-white rules often don’t work for a subject as gray as medicine, she said. 

At her facility, Stone said decisions to perform a medically necessary abortion are made with a team that includes an anesthesiologist, a nurse and other hospital staff. Team members have always been able to refuse to participate in the procedure for any reason.

But if a team member expresses concerns for a legal reason, it often halts medical plans for a patient, Stone said. 

Lewis, the physician from Enid, said she doesn’t perform abortions herself, but if she believes one is necessary, she refers the patient to a gynecologist at her hospital. She said hospital administrators have clarified that doctors’ priority should be saving the life of the mother when they can, which she said has been clearer guidance than some hospitals. 

Dr. William Po, an OB-GYN who also serves as the vice chair of Oklahoma’s ACOG section, asked that his hospital not be named because he wasn’t authorized to speak on its behalf. Po said his hospital hasn’t given doctors guidelines to interpret the law, and administrators have also said that they’d give physicians legal support in a civil case but not if they face criminal charges. 

In cases where he believes an abortion is medically necessary, he will refer patients to a medical professional outside the facility, where they receive extra counseling before they decide whether to end the pregnancy. 

The most helpful outcome would be for legislators to write clearer laws outlining what doctors can and can’t do, Po said. 

“Medical standard of care is not being done when you’re faced with substantial criminal penalties,” Po said. “We all want to do the right thing. We all want to follow the law. We all want to save our patients and give good medicine. And when you have a law with such a blanket statement, it’s difficult to navigate those waters.” 

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