{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T07:46:57Z","timestamp":1782805617962,"version":"3.54.5"},"reference-count":41,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100001146","name":"Greenwall Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001146","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Dobbs decision enabled widespread state abortion bans, creating legal ambiguity for clinicians managing reproductive emergencies in the ED. While impacts on obstetricians are documented, less is known about how these laws influence emergency medicine practice. We explored how ED clinicians navigate care for patients with vaginal bleeding under Indiana's restrictive abortion ban.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a team\u2010based ethnographic study at an urban academic ED and Level 1 Trauma Center in Indiana between August 2023 and October 2024. Data included six weeks of site\u2010based observations and semi\u2010structured interviews with 20 emergency clinicians. Interviews explored clinical decision\u2010making, documentation practices, and perceptions of legal risk following implementation of the abortion ban. Transcripts and field notes were analyzed using an iterative, consensus\u2010based qualitative coding process informed by ethnographic methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three interrelated themes shaped clinician decision\u2010making: knowing, documentation, and reporting. Clinicians described altered approaches to history\u2010taking, particularly around self\u2010managed abortion, balancing medical relevance against concerns for patient stigma and legal harm. Documentation practices were characterized by uncertainty and fear, with many clinicians intentionally limiting chart detail to protect patients while simultaneously worrying about medico\u2010legal vulnerability. Knowledge of state\u2010mandated reporting requirements varied widely, contributing to anxiety, misinterpretation of the law, and defensive clinical behaviors. Across themes, clinicians reported persistent tension between ethical obligations to patient safety and autonomy and perceived pressure to ensure legal self\u2010protection. Robust institutional support was identified as a critical mitigating factor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Indiana's abortion ban has introduced legal uncertainty into emergency care for patients with vaginal bleeding, reshaping clinician behavior around information gathering, documentation, and reporting. These shifts risk delayed or defensive care, erosion of patient trust, and widening inequities in time\u2010sensitive emergency settings. Clear institutional guidance, interdisciplinary collaboration, and legal support are essential to safeguard evidence\u2010based emergency care and uphold ethical practice in restrictive reproductive policy environments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.70328","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T11:54:31Z","timestamp":1780660471000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Abortion Bans on Emergency Care for Patients With Vaginal Bleeding: An Ethnographic Analysis"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8483-1124","authenticated-orcid":false,"given":"Andreia B.","family":"Alexander","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Indiana University School of Medicine  Indianapolis USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1849-4873","authenticated-orcid":false,"given":"Kathryn J.","family":"LaRoche","sequence":"additional","affiliation":[{"name":"Department of Public Health Purdue University  West\u00a0Lafayette USA"},{"name":"Department of Anthropology Purdue University  West Lafayette USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7647-9500","authenticated-orcid":false,"given":"Risa","family":"Cromer","sequence":"additional","affiliation":[{"name":"Department of Anthropology Purdue University  West Lafayette USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brownsyne Tucker","family":"Edmonds","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Indiana University School of Medicine  Indianapolis USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori","family":"Freedman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Reproductive Sciences University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"Abortion in the United States Dashboard Kaiser Family Foundation 2026accessed January 19 2026 https:\/\/www.kff.org\/womens\u2010health\u2010policy\/abortion\u2010in\u2010the\u2010u\u2010s\u2010dashboard\/."},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.3183"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.52109"},{"key":"e_1_2_13_5_1","first-page":"21","article-title":"A National Survey of Obgyns' Experiences After Dobbs","author":"Frederiksen B.","year":"2023","journal-title":"Kaiser Family Foundation"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2025.117856"},{"key":"e_1_2_13_7_1","article-title":"Kansas Hospital Sued for Refusing Emergency Abortion","author":"Pierson B.","year":"2024","journal-title":"Reuters"},{"key":"e_1_2_13_8_1","article-title":"Texas Hospital That Sent Woman Home With Nonviable Pregnancy Violated the Law, Federal Inquiry Finds","author":"Seitz A.","year":"2025","journal-title":"Associated Press"},{"key":"e_1_2_13_9_1","article-title":"Neveah Crain Died in October 2023 After Doctor Reportedly Called for Two Ultrasounds to \u2018Confirm Fetal Demise\u2019","author":"Dunbar M.","year":"2024","journal-title":"Guardian"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2023.05.011"},{"key":"e_1_2_13_11_1","unstructured":"C.Murphy K.Johnson F.Jacobs P.Shin andL.Nketiah In States with Abortion Bans Community Health Center Patients Face Challenges Getting Reproductive Health Care. 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