A group of maternal-fetal medicine specialists is urging hospitals and clinics in states with abortion bans to agree on how they will handle pregnancy complications, prepare referral networks and tell patients about their options—including abortion care that may not be available in their home state. The Society for Maternal-Fetal Medicine published the guidance this month for clinicians caring for patients with conditions such as cancer, diabetes, high blood pressure and serious fetal anomalies. The recommendations address both medical decisions and the legal uncertainty providers face when state bans carry potential criminal or professional penalties. The group recommends that health care systems work with legal teams to understand when federal emergency-care requirements may apply, train clinicians in basic termination procedures and expand abortion care as far as state law allows. It also calls for providers and administrators to establish shared interpretations of their state’s restrictions and referral connections within and beyond state lines. Dr. Justin Lappen, an Ohio maternal-fetal medicine specialist who chaired the committee behind the statement, said specialists can help push health care leaders to provide clearer direction. A common framework, he said, could give clinicians more confidence in addressing difficult cases. The guidance comes amid differing interpretations of abortion-ban exceptions among hospitals and clinics. Those conflicting policies have contributed to confusion and delays in care since bans took effect after the U.S. Supreme Court overturned Roe v. Wade in 2022. The risks can be acute when a patient’s water breaks before a fetus can survive outside the womb. If untreated, the condition can lead to a potentially fatal infection. Research cited in the statement found complications including blood transfusions, intensive care admission and serious infection in 57% of cases involving delayed treatment under Texas’ 2021 abortion law. Comparable research in states without restrictions found complications in 33% of cases. The fetuses did not survive in either group. Dr. David Hackney, a maternal-fetal medicine specialist in Ohio, said hospitals’ responses after the Dobbs decision often varied, leaving clinicians unsure how to proceed. Some health systems have since developed informal agreements about what care they will provide under state bans, he said. A shared approach can help clinicians avoid decisions driven by uncertainty, which may lead them to comply with restrictions more broadly than necessary and worsen patient outcomes. Not every high-risk case is an emergency. Some involve a patient’s pre-existing condition, a serious illness that develops during pregnancy or a late diagnosis of a fetal anomaly in a wanted pregnancy. The society’s guidance says patients in those situations should be informed that termination is an option, even when they may need to travel to obtain it. Dr. Leilah Zahedi-Spung, a co-author of the statement, moved from Tennessee to Colorado in 2023 after Tennessee enacted a near-total abortion ban. She said a lack of legal clarity and institutional support made it difficult to care for patients there. The guidance, she said, is intended in part to reassure clinicians that they are not alone in navigating those pressures. The Society for Maternal-Fetal Medicine and the American College of Obstetricians and Gynecologists consider access to abortion and counseling about options part of obstetric care, while recognizing that some physicians have conscientious objections to providing abortions. The new recommendations also emphasize that health systems can organize care and referrals even when individual clinicians do not provide the procedure.