The doctor, David Mehr, spoke to a dozen voters gathered at the Missourians for Constitutional Freedom headquarters in Columbia on Saturday morning. The coalition behind a proposed amendment would enshrine the right to abortion in the Missouri Constitution.

Meanwhile, doctors welcomed volunteers in St. Louis County and even more gathered in Kansas City as part of the coalition’s final campaign before the Nov. 5 election.

“I have cared about women my whole life,” Mehr told the group of volunteers in Colombia. “It’s important that we keep this decision between a woman and her doctor.”

Mehr works at University of Missouri Health Care but spoke as an individual and not on behalf of the hospital.

An hour later, he was navigating a thicket in a northwest Columbia neighborhood, looking for the right door to knock on. By the end of the day, he and his advertising partner had knocked on 44 doors.

Like other states with abortion bans, Missouri’s state law provides exceptions “for medical emergencies.” Medical professionals who perform abortions deemed unnecessary may be found guilty of a Class B felony and have their license revoked or suspended.

“There is no definition of what could be a medical emergency,” said Betsy Wickstrom, a high-risk obstetrician who works in Kansas City. “So if my patient is bleeding and her cervix is ​​open, there is still cardiac activity, how much do I have to do to make her bleed?”

Wickstrom preferred not to reveal her hospital affiliation. Their reticence was shared by doctors who gathered in St. Louis on Saturday and reflects a broader trend of doctors hiding their jobs when discussing abortion, as found in a 2023 study.

Last month, a group of 800 Missouri medical professionals, including 500 doctors, signed a letter in support of the abortion rights amendment, which appears on the ballot as Amendment 3.

No doctor in any state has been prosecuted for performing an abortion during a medical emergency, according to an article published last month by the Association of American Medical Colleges. But doctors across the country have warned that a lack of clarity about what constitutes a medical emergency is affecting their ability to provide emergency abortions.

In August, a group of OB/GYN residents in Missouri anonymously published an article in the Journal of Graduate Medical Education describing their shock and fear about entering the profession in a state with a strict abortion ban.

“Because the law is so punitive, it has frightened physicians and resulted in life-saving treatments being unnecessarily delayed or blatantly denied,” the authors wrote.

Since abortion became illegal in Missouri in 2022, the state has seen a decline in applications for OB-GYN residency training, according to a May report from the Association of American Medical Colleges.

In a high-profile 2022 case, two hospitals, including one in Missouri, turned away Missouri resident Mylissa Farmer when she sought help after her water ruptured as early as 18 weeks pregnant. Last year, the Centers for Medicare and Medicaid found that the two hospitals — Freeman Hospital West in Joplin and the University of Kansas Health System in Kansas City, Kansas — violated federal law when they denied care to farmers.

Numerous other examples of women being denied emergency medical care have appeared in the news media since the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization ended the constitutional right to abortion.

Health care abortion opponents argue that media reports promote an exaggerated narrative that abortion bans threaten women’s access to emergency care.

“All state laws allow the separation of maternal fetuses (by any means necessary) to save the mother’s life,” says Christina Francis, an ob-gyn and executive director of the American Association of Pro-Life OB-GYNs. wrote in his testimony for a Senate Finance Committee hearing in September.

Decisions in medicine are rarely black and white. If a woman’s water ruptures so early that fetal viability is unlikely, abortion is the standard treatment, Wickstrom said. When a woman is closer to 20 weeks, factors such as bleeding, signs of infection, and the amount of amniotic fluid in the uterus are taken into account.

Some women want to wait, and a doctor guides the patient through this decision.

“Of course we do that because it’s about the election. The point is, it’s her body’s choice to determine what’s right for her, and we stand by her, support her and guide her in what’s right for her,” Wickstrom said.

If a woman does not want to continue the non-viable pregnancy, the fetus has a heartbeat and her condition is not considered an emergency, she must leave the state for an abortion, Wickstrom said. In Kansas City and St. Louis, women can more easily get to clinics that offer abortion care in Kansas and Illinois than in central Missouri.

Wickstrom brings her metal water bottle to work at a hospital in Kansas City. When she talks to patients, she holds it out so they can see the stickers on it: Directly above a cutout of Taylor Swift is a sticker that says “ABORTION RESOURCES,” followed by a list of phone numbers and website URLs.

Wickstrom said she finds it difficult to speak openly with women with high-risk pregnancies about their options.

“You have to dance around it a lot more,” she said, “because the water is muddy.”

This story originally appeared in the Columbia Missourian. It can be republished in print or online.