Iowa doctors say the new abortion ban has dangerously vague guidelines 

Iowa doctors explain why the Iowa Board of Medicine’s rules for the near-total abortion ban don’t help them.

Dr. Kaaren Olesen, an OB-GYN at Broadlawns Medical Center in Des Moines, doesn’t want to lose her license for taking care of patients—but she knows she might have to risk it.

In February, the Iowa Board of Medicine released its rules about how doctors should comply with Iowa’s new near-total abortion ban, but those rules still aren’t clear to physicians.

“It’s hard to make a rule for every scenario, but I think there needs to be more clarification of expectations,” Olesen said.

The board is responsible for enforcing the ban and determining whether physicians break it.

The near-total abortion ban isn’t in effect yet, but it could be in a few weeks. On Friday, June 28, four Iowa Supreme Court justices dissolved the injunction that has blocked the law since it was signed in July 2023.

Dr. Amy Bingaman, another OB-GYN at Broadlawns, said the ban and the lack of guidance for when doctors can act puts Iowans in more danger. 

“Pregnancy is the riskiest thing a woman in the United States of America puts herself through,” Bingaman said. “Women die because of pregnancy complications, postpartum complications. That’s why it should be a choice whether or not you want to assume that risk.”

Both Olesen and Bingaman said they know they might someday have to choose between a patient’s life and their medical licenses. Both said they’re going to continue doing what’s best for patients and hope their employer and the board of medicine support them.

The board of medicine’s rules don’t say much about discipline—simply, “Failure to comply with this rule or the requirements of [the ban] may constitute grounds for discipline.”

“We don’t have clear direction,” Olesen said. “Our whole livelihood is to provide care to pregnant persons, specific to this situation. [The ban and rules] just makes it all seem very vague and tenuous.”

The rules

The board of medicine’s rules define terms in the law and only provide additional guidance for the rape and incest exceptions. 

For both exceptions, physicians must get the following information: when the attack occurred and whether the attack counts as rape or incest. For rape, they also must note the age of the “woman”—which is defined as “a female individual regardless of her age”—and determine whether the reported rape was committed against the person seeking the abortion.

The rules say doctors do not have to verify any of the above information, but they have the option to ask the patient sign a form that their report is true. All of the reported information goes in the patient’s medical record.

The rules do not specify who must provide the above information, but both the information and the source will be included in the patient’s medical record.

Aside from the problem that the majority of rape and incest cases aren’t reported, especially not within a few weeks, doctors say interrogating patients can undermine patients’ trust in them.

“It’s not our job to gather the facts about ‘how did this happen,’” Olesen said. “We’re not an investigative body. We’re there to provide care for the patient.”

“It’s a terrible place to put women and pregnant persons in because they’re not going to get the benefit of the care,” she continued. “They’re not going to get the benefit of the doubt that they’re in need of help.”

Doctors said what’s more concerning is that the rules don’t mention medical emergencies.

Medical emergencies

“I don’t think they’re very clear on at what point are we allowed to intervene?” Bingaman said. “How close to death does a woman have to be?”

The law bans abortion after electrical impulses are detected in an embryo—misleadingly called a “fetal heartbeat” by anti-abortion figures, despite there being no physical heart and the pregnancy being in the embryonic stage. 

That can happen as early as six weeks after someone’s last period, and it essentially bans all abortions, because the majority of people don’t know they’re pregnant that early.

In states with similarly strict abortion bans, women who are in distress—or who are miscarrying—have been denied needed abortions because there was still a detectable “heartbeat.” 

Many Iowa doctors, including Bingaman, have said none of the ban’s exceptions work in practice.

The law mentions medical emergencies, which are defined in Iowa law as situations where abortion is needed to preserve the life of the pregnant person if they’re endangered by a physical disorder, illness, or injury—including those that happen because of the pregnancy—or when continuing the pregnancy risks a “substantial and irreversible” injury to major bodily functions.

No other conditions count, and there is no additional guidance from the board about how physicians should determine the level of threat to life or what specific conditions count, such as preeclampsia or hemorrhaging.

When a patient comes in losing blood—hemorrhaging—Bingaman said the course of treatment is obvious, but now doctors’ hands are tied.

“You have to intervene because they’re imminently life-threatened,” she said. “But that’s where the pickle comes in. Because what does the government deem as life-threatening versus how we look at a condition being life-threatening?”

Olesen has tried to get more guidance by asking the Broadlawns ethics board, but she said they’re still discussing how to handle those situations, which aren’t as rare as some may think.

“The priority is to the pregnant person that is having the emergency in front of you,” Olesen said. “It’s to take care of that person at that moment and save their life.”

If it’s possible to save both the pregnant person and the fetus, that’s the goal, she said. But when it isn’t possible, “then the life of the pregnant person has to take precedence over the heartbeat of the fetus within her.”