New guidance says abortion care is inseparable from high-risk pregnancy medicine

The Society for Maternal-Fetal Medicine has issued a formal special statement asserting that abortion care and counseling are not peripheral services but core components of maternal-fetal medicine practice. The guidance, published in the journal Pregnancy and endorsed by the Society of Family Planning, argues that the subspecialty’s mission of protecting maternal and fetal health cannot be meaningfully separated from the ability to counsel patients about all pregnancy options and, when medically appropriate, to provide or facilitate abortion care. The statement arrives at a moment when the American landscape of reproductive healthcare has been dramatically reshaped by state-level legislation, leaving physicians, hospitals, and patients navigating a patchwork of conflicting rules and uncertain legal boundaries.

The document, titled SMFM Special Statement: Considerations for management of high-risk pregnancies when abortion care is restricted, was released on September 15, 2026, and addresses four interlocking domains: patient counseling, patient transfer and referral, institutional collaboration, and the training of obstetrics and gynecology residents as well as maternal-fetal medicine fellows. Its central premise is that maternal-fetal medicine subspecialists, physicians who complete additional fellowship training beyond obstetrics and gynecology to manage complicated and high-risk pregnancies, possess a distinctive combination of clinical expertise and institutional leadership that positions them to safeguard patient access to evidence-based reproductive healthcare even under restrictive state laws.

The impetus for the statement traces directly to the 2022 Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, which overturned the federal constitutional right to abortion established nearly five decades earlier. In the aftermath of that ruling, many states enacted bans or severe restrictions, forcing a growing number of patients to travel across state lines for abortion care. The society notes that these restrictions have generated confusion and uncertainty among physicians and institutions, particularly in high-risk pregnancy situations where the medical stakes are highest and the clinical timeline may be unforgiving. Conditions such as severe preeclampsia, placental abnormalities, preterm premature rupture of membranes, and serious fetal anomalies can evolve rapidly, and delays in decision-making or care can translate directly into worsened outcomes for patients.

Justin R. Lappen, MD, chair of the SMFM Reproductive Health Committee, framed the guidance in terms of the day-to-day realities faced by high-risk pregnancy physicians. According to the society’s release, Lappen stated that restrictions on abortion care hinder the ability of maternal-fetal medicine specialists to provide compassionate, evidence-based healthcare for their patients. He described the new guidance as a tool for specialists to use their expertise, experience, and leadership to build reliable and collaborative systems so that pregnant patients receive the very best care without unnecessary delay. The emphasis on systems, rather than individual heroics, reflects a recurring theme throughout the statement: that safe care in a restrictive environment depends on pre-established institutional processes, not improvised solutions at the bedside.

At the level of clinical counseling, the society’s recommendations are unambiguous. All patients with an increased risk of medical complications during pregnancy should be provided with accurate, evidence-based information about the health risks they face and about all available treatment options, including abortion care. The statement further emphasizes that accurate, unbiased, evidence-based counseling about treatment and prognosis is critical for pregnant patients who receive a fetal anomaly diagnosis, and it affirms that all patients should have the option of abortion care. This position grounds counseling in the same standards of informed consent and shared decision-making that govern other areas of medicine, in which patients are expected to understand their diagnosis, their prognosis, and the full range of interventions available to them before making consequential decisions about their own bodies and families.

One of the most technically significant recommendations concerns the legal ambiguity that has come to characterize abortion-restrictive states. The society calls for organizing interdisciplinary discussions among institutional, community, regional, and state-level stakeholders to achieve consensus on the legal interpretation of abortion restrictions. The goal is to minimize uncertainty about what constitutes legally permissible healthcare in medical emergencies or in the legal grey zones that restrictive statutes have created. In practice, this means bringing together clinicians, hospital administrators, legal counsel, and public health authorities to define in advance which clinical scenarios fall within permissible care, so that a physician facing a hemorrhaging patient at two in the morning does not have to improvise an interpretation of state law while the patient deteriorates. The statement treats this kind of prospective consensus-building as a patient safety intervention in its own right.

Because some patients will inevitably need care that cannot be provided where they live, the guidance also addresses transfer and referral infrastructure. Lappen stated that collaborative partnerships with institutions and clinics in surrounding states that provide abortion care should be developed so that patients can be quickly and safely transferred for care. The statement additionally urges maternal-fetal medicine specialists to be aware of existing resources such as hotlines, abortion funds, and practical support networks that provide funding and travel assistance for patients. In a healthcare system where interstate travel for abortion has become increasingly common, the difference between a well-organized referral pathway and an ad hoc one can be measured in days of delay, and in restrictive settings those days can determine whether a patient receives care before or after a complication becomes catastrophic.

The training dimension of the statement carries long-term implications for the workforce. Obstetrics and gynecology residency programs and maternal-fetal medicine fellowships are tasked with producing physicians competent to manage the full spectrum of pregnancy complications, and the society’s attention to training goals and competencies for fellows signals concern that restrictions may erode the clinical experience available to trainees in affected states. A subspecialist who completes fellowship without exposure to the management of abortion care, including for patients with serious comorbidities or complex fetal diagnoses, enters practice with a gap precisely in the procedures and counseling skills that the society considers central to the field. The statement’s inclusion of training among its four core domains suggests that SMFM views workforce preparation as inseparable from immediate patient access concerns.

The society is candid about the barriers that make abortion care difficult to access for many people in the United States, identifying judicial, legislative, and institutional obstacles as the principal drivers. It also acknowledges that although existing data demonstrate harm created by abortion restrictions, the evidence base remains incomplete. The statement identifies several priority areas for future research, including patient outcomes in cases of severe obstetrical complications, data on maternal morbidity and mortality as well as fetal and infant mortality, the definition of training goals and competencies for maternal-fetal medicine fellows, and patterns of patient volume and transport to states without restrictions. Framing these as research priorities is notable: it positions the society not only as an advocate within clinical walls but as a scientific body committed to measuring the real-world consequences of policy on pregnancy outcomes.

Founded in 1977, the Society for Maternal-Fetal Medicine represents more than 6,500 members who care for high-risk pregnant patients, providing education, promoting research, and engaging in advocacy aimed at reducing disparities and optimizing outcomes for high-risk pregnant people and their families. The new special statement, published with the DOI 10.1002/pmf2.70376 in the journal Pregnancy, extends that mission into a contested policy environment by insisting on a straightforward clinical proposition: that the management of high-risk pregnancy includes honest counseling about every option, reliable pathways to care when local services are unavailable, and institutions organized in advance so that legal uncertainty never becomes a substitute for medical judgment. For the subspecialists who care for the most medically complicated pregnancies in the country, the society’s message is that abortion care is not an adjacent issue to be delegated or deferred, but an integral part of what it means to practice maternal-fetal medicine at all.

Subject of Research: Clinical guidance on abortion care and counseling within maternal-fetal medicine practice under state abortion restrictions

Article Title: Abortion care and counseling is core to the practice of maternal-fetal medicine, says new SMFM guidance

Article References: Abortion care and counseling is core to the practice of maternal-fetal medicine, says new SMFM guidance. (n.d.). Original publication

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Keywords: maternal-fetal medicine, SMFM, abortion care, Dobbs decision, high-risk pregnancy, patient counseling, reproductive health, state abortion restrictions, patient transfer, medical training, maternal morbidity, Pregnancy journal