The sky is indeed falling, just not very fast.

Okay, so Alito got confirmed. And it's likely that in the next decade or two, we'll see either states' laws become more restrictive of abortion, or we'll see Roe overturned completely.

A little background first: Roe V. Wade didn't legalize abortion across the board, without restrictions, in every state. All it said was this: in the first trimester, a woman's right to an abortion cannot be subject to unreasonable restrictions by the state. "Unreasonable restriction" is a broad term: one that's been brought to the courts when states have attempted to pass parental or spousal consent or notification laws, laws restricting minors' access to abortion, waiting periods, education, and so on.

In the second and third trimesters, abortions are subject to a variety of restrictions that vary from state to state.

So let's take a worst-case-scenario view and say that the Constitutional right to privacy that is accepted as part of the not-specifically-named rights therein is decided not to cover the right of a woman to terminate a pregnancy.

Two things would then happen: a legal challenge would likely be mounted on the basis of equal protection under law--an argument that I find more compelling than the right to privacy in this particular case, as well as one that I'll leave for non-fluff-brained commenters and bloggers to handle.

The other thing that would happen would be this: access to abortion would return to a pre-Roe patchwork. It would likely be illegal where I live and in several surrounding states. Travel to New York and California would become commonplace for middle-class women, while other women would be either screwed to the wall or forced to obtain illegal abortions.

And, by the way, don't assume that women aren't already forced to obtain illegal abortions. Only 13% of counties in the US have an abortion provider; most of those providers are in urban states like Washington, California, and New York. I saw my first patient with complications from an illegal abortion during nursing school and my second only about a month ago. The situation for women in states where there are already notification laws and waiting periods is grim; there's no reason that it wouldn't get grimmer if, say, the three abortion providers within a day's drive of me went away.

But that's not really what I'm wanting to address here. The thing that bothers me about the thought of returning to pre-Roe days is this: each state will, in accordance with its rights under the Constitution, be able to define the beginning of life.

Think about that for a minute in context of pharmacists (who are, or who should be, nominally scientists) refusing to refill birth control pills or fill emergency contraceptive prescriptions on the basis that they might "abort" an embryo. Think about it in the context of doctors who refuse to fit women with IUDs for contraception on the same principle, even though repeated studies have shown that IUDs prevent ovulation and destroy sperm rather than embryos. All the science in the world won't convince these soi-disant scientists; do you think there'd be better luck with politicians?

Although Griswold V. Connecticut, which legalized birth control for married couples (and, as a result, opened the door to the contraceptive freedoms that you and I enjoy) will likely stand, access to contraceptives will probably become more difficult. Some forms might be legislated away, or surrounded by the sorts of requirements and caveats that make doctors loathe to prescribe them. After all, if legislators can require that abortion clinics meet the same standards as ambulatory surgery centers (which perform more complex and demanding surgeries), why not require that doctors meet special standards for, say, inserting an IUD? After all, women have been known to vagal out and seize during the procedure before.

That's scary enough for me to look wall-eyed at my pals in Canada and make sure their addresses in my book are current. What's worse, though, is what's likely to happen to us as healthcare providers.

It was not unusual, back in the day, for doctors to be wary of providing even lifesaving treatment to women who were bleeding after an induced illegal abortion, for fear that they might be prosecuted for assisting in an illegal termination.

It was not unusual for the police to show up in the septic wards or the ED to question women who were suspected of trying to self-abort, or suspected of having seen an illegal practitioner.

It wasn't unusual for women to place themselves at the mercy of untrained abortion providers and suffer the consequences of abortion and sterility.

Many years ago, when I was still working at the clinic, I had the opportunity to talk to a woman who'd had an illegal abortion, and who was sterile as a result. The folks in the emergency room were so nervous about being questioned or prosecuted that she bled nearly to death before one doctor finally intervened...at which point he had to go before the hospital ethics committee and the police to explain his actions.

Moiv has a heartbreaking post on this. The thing that scares me most about her post is one little mention of an abortion provider being called to help set up a "septic ward"--the place where women who'd had illegal abortions and had had complications were cared for. There's at least one hospital near me that's contemplating the same thing.

So, as healthcare providers, we'll get a triple role if Roe is overturned:

If we live in a state where abortion is across-the-board illegal, we'll be seen as informants for the police, witnesses for women who claim they'll kill themselves if they don't have an abortion, and caregivers for women who don't get the lucky straw in the illegal-abortion lottery.

If we live in a state where abortion is legal, we'll see an influx of women, probably mostly middle-class, coming across state lines and choking clinics and hospitals. Some of those women will have complications, even from a relatively safe procedure: it happens. And, if the state that woman with complications came from criminalizes crossing state lines, we may be called upon to release medical records or otherwise testify to her situation and our care.

Caregiver, witness for the prosecution, witness for the defense.

This is what'll happen, people. Not all those women will end up in septic wards, by the way. Pennyroyal, an herb that causes intestinal cramping and pain and can occasionally dislodge a pregnancy, comes in an oil-extract form that is highly toxic to the liver. When a person tries to self-abort with pennyroyal oil, she'll likely end up on a floor that deals with livers, kidneys, or neuro issues as a result of hepatic encephalopathy.

If worse comes to worst, it's gonna be an interesting ride.