KANSAS CITY, Mo. — Dr. Betsy Wickstrom understands where some of the voices opposed to abortion are coming from.
She used to be one of them.
The Kansas City OB-GYN specializing in high-risk pregnancies is a Republican and a Christian, but her more than three decades in maternal-fetal medicine have moved her away from the “pro-life” movement and into abortion advocacy.
The past two-and-a-half years practicing under an abortion ban in Missouri have strengthened her resolve.
Wickstrom’s job has always been one of joy-filled highs and heart-breaking lows for families navigating complicated diagnoses.
But the experience of walking an expectant mother through a nonviable pregnancy diagnosis now includes new hoops to jump through that can delay care. Sometimes, she’s not even able to be with her patients when their pregnancy ultimately ends, forced to send them to Kansas where a ban was never implemented and hospitals are more willing to perform second-trimester abortions.
It’s why Wickstrom knocked doors in support of Missouri’s abortion-rights amendment and celebrated last month when a majority of voters chose to unravel the state’s near-total ban.
“The best possible outcome is that we will once again be able to care for people in the most compassionate way,” she said.
But her excitement over the amendment wanes when she talks about what the future may hold. State lawmakers are vowing to overturn some of Amendment 3’s protections, and the threat of a national abortion ban after Republicans take over Congress and the White House looms.
As Wickstrom waits to hear how Missouri hospitals will advise doctors like herself to proceed once Amendment 3 goes into effect after Dec. 5, she continues to hold her breath.
“Missourians want choice. They want personal freedoms, and they don’t want their civil rights restricted, and that gives me hope for the future,” Wickstrom said. “But I know we’re not even close to done yet.”
A Republican in the abortion-rights movement
Wickstrom wasn’t “liberalized” while attending the University of Nebraska Omaha. When she started her medical residency in Missouri, Wickstrom said she believed “the only God-honoring and American patriotic thing to think is that you have to save this fetus and this embryo at all costs.”
While she did vote for President Barack Obama because she supported the Affordable Care Act after seeing patients without insurance struggle to access prenatal care, Wickstrom remains what she calls an Eisenhower Republican, seeking a balance between fiscal responsibility and a basic safety net.
But when it comes to abortion, she sees no option other than choice.
Shortly after graduating from her fellowship and going into the medical practice in the early 1990s, Wickstrom had to perform an abortion for a woman who came into the hospital with a partial molar pregnancy, which is both nonviable and can be life-threatening to the mother.
The patient was 15 weeks pregnant and had such high blood pressure that she was delirious.
While abortion was legal and Wickstrom would typically refer patients to abortion clinics in such cases, this was the middle of the night, and the patient was dying. Wickstrom performed a dilation and evacuation procedure, a type of surgical abortion done in the second trimester, and saved the woman’s life.
More than three decades into her practice as an obstetrician, the nuance of the patient stories she watches unfold every day have carved out a new perspective.
She had a patient diagnosed with brain cancer 14 weeks into pregnancy who chose to terminate the pregnancy rather than wait for the fetus to die inside her during treatment. She had a patient whose fetus’s brain didn’t develop properly who chose to continue the pregnancy so she could meet her child before they died shortly after birth.
Both outcomes were different ways of honoring life, Wickstrom said. What matters most, she added, was that the families got to choose.
That choice became murkier on June 24, 2022, when the U.S. Supreme Court overturned the constitutional right to an abortion and Missouri became the first state to enact a trigger law banning the procedure except in cases of medical emergencies.
‘Care delayed and care denied’
Wickstrom had just taken a new position at a Kansas City area hospital when the Supreme Court’s decision was announced.
“As of 4 p.m. on June 24 of 2022,” Wickstrom said. “We were receiving emails from our hospital attorneys saying: ‘You cannot offer abortion. You cannot refer for abortion out of our hospital, because we’re not going to take on that liability and that responsibility.’”
Instead, Wickstrom said she was advised to email the hospital’s legal team if she had any concerns that a pregnancy could not continue. If the situation was dire, she was given a legal hotline to call, staffed 24/7, for advice on how to proceed.
Ever since the ruling, when she enters an ectopic pregnancy diagnosis into the electronic medical record, a large red banner pops up asking if she’s sure the diagnosis is accurate. If the embryo or fetus has a heartbeat, she has to consult an attorney. In the case that the mother is already starting to bleed, Wickstrom said, “time is life.” Sometimes, she has to refer the patient to a provider in Kansas.
This is one example of “care delayed and care denied” that Wickstrom said she’s experienced since abortion became illegal in Missouri.
Some physicians across the state have said the abortion ban hasn’t affected their protocol for treating nonviable pregnancies or miscarriages.
Wickstrom said that’s likely because most obstetricians can perform a dilation and curettage procedure to remove any fetal remains in the first trimester once a heartbeat is no longer detected. But the more complex cases that occur later in pregnancy that require abortions are usually referred out to specialists like her.
But, she said, she’s not allowed to treat most of those cases anymore.
Now, when women come in with ruptured membranes in the second trimester of pregnancy — months sooner than their water should be breaking — she has to send them to Kansas for care.
“Bleeding, infection, labor, all of those things can happen with or without that heartbeat stopping inside the womb,” Wickstrom said. “The answer is, you’ve got to stop the pregnancy and empty the uterus. You have to take care of this woman, or she potentially dies not being able to raise her other kids, potentially loses her uterus.”
She’s still allowed to talk about evidence-based care with patients, she said, but as soon as the words “you may want to consider termination” leave her lips, she’s required to hand the patient Missouri’s 23-page informed consent booklet.
“But the pamphlet begins with the phrase ‘The life of each human being begins at conception,’ which is not medically true,” Wickstrom said.
Instead, she keeps a water bottle on her desk. On it, above a sticker of Taylor Swift, is an adhesive with a list of national abortion hotlines.
It’s her way of showing the words she doesn’t always feel she can speak aloud.
A few weeks ago, Wickstrom had three other words tattooed into her forearm that she’s been speaking aloud for the better part of a decade.
The words remained her mantra as she watched maternal mortality and morbidity rates rise, as she heard stories of women who said their pain was ignored or downplayed, and as she watched abortion access fade for huge swaths of the population across the country, including her own backyard.
They remain at the heart of her work today:
“Listen to women.”
This story from the Missouri Independent is published on KSDK.com under the Creative Commons license. The Missouri Independent is a nonpartisan, nonprofit news organization covering state government, politics and policy.
