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For ob/gyns in Ohio, the practice of medicine changed in a heartbeat on Friday evening.

David Hackney, MD, a high-risk obstetrician in the Cleveland area, was on service Friday when a federal court judge lifted a 2019 injunction on the state's 6-week "heartbeat" abortion ban.

"All of a sudden, the law has just changed beneath my feet," Hackney told 乌鸦传媒 in an interview this weekend.

Hackney issued alerting colleagues to check in with their legal teams: "If you have a dying pregnant patient tomorrow, you will need legal counsel."

He and his colleagues had known about the injunction, of course, and that it would be at risk of lifting once the U.S. Supreme Court decision on Dobbs v. Jackson Women's Health Organization came down.

But they weren't expecting it to move as quickly as it did, he noted.

As soon as the federal decision was in, Ohio Attorney General Dave Yost requested the ban be lifted and go into effect immediately, and a federal court judge granted that request, Hackney said. It went into effect Friday evening, without a buffer or waiting period.

Hackney said he was familiar with the law, but not at the level of detail that someone who specializes in treating high-risk pregnant patients would need to be in order to practice within its bounds.

"What are the spelled-out exceptions for [saving the mother's] life?" he said. "Do you need a two-physician sign-off?"

"What if literally tonight, I have a patient coming in and she's hemorrhaging at 20 weeks," he continued. "I'm suddenly operating under a new set of laws, which I have not had time to prepare for. You don't want to have to be seeking legal counsel in the middle of something bad. You always want to care for the patient."

Underlying all of this is that in Ohio, now, "the stakes are jail." Abortion providers face felony charges and up to a year in prison.

Normally, there would be a period of time where lawyers know a law will go into effect and can determine what practices would be compliant with that law. Doctors and lawyers would work together to interpret the law, which is a complicated process under normal deadlines, Hackney said. Add to that the vagueries of this particular bill.

"The law isn't written to the level of specification that we would normally have in medicine," he said. "The demarcations are very artificial ones that we wouldn't use in medicine. They're things that sound good to legislators but don't translate well in the real world."

Not having that buffer period put ob/gyns -- especially those who treat high-risk pregnancies -- on edge.

"There were people on call in labor and delivery units all throughout the state of Ohio who were suddenly operating under an entirely different set of laws," he said. "It's by no means implausible that patients with life-threatening conditions would be coming in on a Saturday or Sunday."

The current 6-week ban in Ohio makes it illegal to perform an abortion once a fetus has a heartbeat, but the Republican-controlled Ohio General Assembly is expected to pass a full ban on abortion later this year, .

Hackney and his high-risk obstetrics colleagues know they'll only be facing more difficult situations in the weeks ahead. While the law makes exceptions for maternal health and death, there's no exception for rape, incest, or any terminal fetal complication, like anencephaly.

"At some point, I or one of my colleagues will diagnose a lethal birth defect, and then we're going to have to tell the patient she has to [take the pregnancy to term] or she'll have to leave the state," he said. "That's going to be rough."

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