Post-Dobbs Abortion Care: Insights from the NAF Annual Meeting

The WHEM team attended this year’s National Abortion Federation (NAF) Annual Conference, where we heard from independent clinics, advocacy organizations, research groups, and frontline clinicians who are collaborating to sustain abortion access and patient safety. National data demonstrate that post-Dobbs abortion access has shifted rather than disappeared, with telemedicine now accounting for a substantial proportion of care and interstate travel nearly doubling since 2020 (Society of Family Planning, 2025; Guttmacher Institute, 2025). Despite the advances in telemedicine, speakers also emphasized that fear and misinformation remain major barriers to care, particularly for marginalized communities. Experts noted sharp declines in abortion rates among undocumented patients, attributed to concerns about immigration enforcement and data privacy. At the same time, a recurring theme was the gap between lived patient experience and published evidence: data collection remains siloed, and research is struggling to keep pace with real-world abortion care practices. Conference discussions also emphasized the importance of safeguarding patient privacy, avoiding unnecessary documentation, and adopting trauma-informed approaches that reduce iatrogenic harm. Overall, the NAF conference reaffirmed for us how emergency clinicians have the potential to be a key point of contact for patients navigating complications, uncertainty, or gaps in care.

Clinical Pearls

• Protect Your Patients Privacy

  • “Health care providers reporting patients to government authorities is a main way people attempting self-managed abortion (SMA) become exposed to legal risks.”

  • Do not require patients to disclose use of abortion pills if it is not clinically relevant.

  • Management of medication abortion (including telemedicine or self-managed abortion) is clinically equivalent to early pregnancy loss (ACOG, 2024).

  • Document only what is necessary for clinical care: post-abortion care = miscarriage care.

• Do No Harm During Pelvic Exams & Procedures

  • Standardize pain and symptom management to reduce the influence of bias.

  • Create adequate time  = critical for patient comfort & procedure success

    • Schedule pelvic exams as procedures with dedicated time slots to streamline premedication and plan for patient discomfort.

    • Consider using CPT modifier 22 to reimburse your additional effort & time

  • Assume prior trauma and use a trauma-informed approach for every patient—this is the most universal way to prevent iatrogenic harm.

  • Example Minimal Sedation Protocol:

    • Ibuprofen 600 mg PO, 30–60 minutes prior

    • Lorazepam 2 mg SL, ~30 minutes prior

      • (1–2 tablets covered by Medicaid without prior authorization; may prescribe in advance)

    • Vaginal lidocaine (2%), ~10 minutes prior

      • May be self-administered if preferred

      • Uro-Jet lidocaine used for foleys can be used in SAFE/SANE exams

    • Adjunctive strategies: TENS units, music, presence of a support person, or phone-based distraction

• Remember, EMTALA includes abortion care

  • On June 25, 2025, NY Attorney General Letitia James reaffirmed that hospitals must provide emergency abortion care and may not refuse or inappropriately transfer patients with pregnancy-related emergencies, even amid changes in federal guidance.

  • Proposed legislation (NY Senate Bill S2165A, 2025) seeks to further codify hospitals’ obligations to provide stabilizing emergency care for all patients, including pregnant persons.

• Complex Cases to Keep on Your Radar

  • Placenta Accreta Spectrum (PAS)

    • Incidence up to ~1:272 pregnancies (ACOG, 2018)

    • MRI & Ultrasound have low sensitivity (Ultrasound PPV ~65% in some studies)

    • Placenta Accreta Spectrum (PAS) Score / Placenta Accreta Index can help stratify risk and guide multidisciplinary planning

  • Cesarian Scar Pregnancy

    • Increasing incidence (~1:1,800–2,600 pregnancies)

    • Can be endogenic or exogenic & requires careful ultrasound assessment of implantation depth and myometrial thickness

References 

American College of Obstetricians and Gynecologists. (2018). Placenta accreta spectrum. https://www.acog.org

American College of Obstetricians and Gynecologists. (2024). Self-managed abortion. https://www.acog.org

Centers for Medicare & Medicaid Services. (2025). CMS statement on EMTALA. https://www.cms.gov

Guttmacher Institute. (2025). State residence and travel for abortion care. https://www.guttmacher.org

Jauniaux, E., et al. (2023). Diagnostic accuracy of ultrasound for placenta accreta spectrum. Ultrasound in Obstetrics & Gynecology. https://pmc.ncbi.nlm.nih.gov

New York Office of the Attorney General. (n.d.). Abortion rights in New York. https://ag.ny.gov

Roberts, S. C. M., Zaugg, C., & Grossman, D. (2023). Health care provider reporting practices related to self-managed abortion. BMC Women's Health, 23(1), Article 136. https://doi.org/10.1186/s12905-023-02266-7

Society for Maternal-Fetal Medicine. (2022). EMTALA and pregnancy termination. https://www.smfm.org

Society of Family Planning. (2023). Medication abortion with misoprostol-only: Sample protocol. https://societyfp.org

Society of Family Planning. (2025). #WeCount: Abortion provision in the United States. https://societyfp.org