OB-GYN residents reflect on changing standards post-Roe, weigh community impact

One year after the reversal of Roe v. Wade, Sweet Hope Mapatano started her residency in the UNC Department of Obstetrics & Gynecology Residency Program. 

Mapatano said many changes resulting from the landmark case’s reversal were starting to happen around the time she was interviewing for residency programs. 

“One of the big things that was important to me, even though the laws in North Carolina are a little bit more restrictive than other states, was showing up for the women in North Carolina and not abandoning them, and not having to force them — because there's not a lot of people getting trained in North Carolina — to go to other states in order to receive their care,” Mapatano said. She said her opinions do not represent the residency program.

Residency Program Director for OB-GYN, Jes Morse, said the size of the program hasn't changed in roughly 15 years. However, Morse said she has no doubt that applicants take state abortion restrictions into consideration when making decisions about where to pursue residency. 

Mapatano said one of the strengths of UNC is that it has access to a lot of specialists. For example, Mapatano is considering maternal fetal medicine, which UNC receives unique cases of. Whereas, if she did a community program in Virginia, she wouldn't have seen some of those cases.

There are also opportunities for advocacy, she said. A lot of the residents, at least once or twice a year, she said, will go to Washington D.C. and try to talk to legislators about how they can advocate for patients in North Carolina, especially when it comes to reproductive rights.  

Morse said residency at a tertiary care center like UNC involves treating the sickest and the most complicated patients. 

“Those are the patients that we can legally still care for in North Carolina — it's a sick mom or an unhealthy baby,” Morse said. “I think what [residents] are losing now is more routine second trimester abortion care that is not legal in our state.” 

Mapatano said residents are still trained in performing dilation and evacuation procedures. This is when residents use forceps and a vacuum to evacuate all the contents in the uterus, including sometimes fetal parts and placenta after a certain gestational age. 

Before S.B. 20, North Carolina’s 2023 abortion law, D&Es could be used as procedures to end a pregnancy in the second trimester. 

However, Mapatano said there’s many reasons why people get D&Es. A lot of the D&Es she’s done this year are for fetal anomalies, which are life-limiting, and can be done after the second trimester. 

“What is a little bit frustrating about the law is, regardless of where and why you train in OB-GYN and what you feel about abortion laws, those kind of skills are required to help people that have miscarriages, people that have babies with life-limiting anomalies and want to not go through what can sometimes be a very traumatic process of having an induction,” Mapatano said. “So having the ability to offer the different options to patients, regardless of what you feel about abortions — the training is really important.” 

She said that, due to the restrictive laws, a lot of residents find opportunities to do D&Es in other places, such as Virginia. After completing her residency, Mapatano may also find opportunities in Virginia to gain more experience with D&Es where she said she would feel comfortable providing this care to the community.

“We're still trained, and whenever we have the opportunity to do them, we still do them,” Mapatano said. But, she said the cases are more rare than they used to be.

A recent graduate of the program, who wanted to stay anonymous for safety concerns, said that residents do virtual clinic visits all the time. However, with regard to terminations, everything has to be done in-person now. 

Mapatano said residents see a lot more patients from other states. When Mapatano was on her family planning rotation, she saw patients coming from Florida, South Carolina and other states, who were traveling in order to receive care, which she doesn’t think was as common as it is now. 

On Jan. 16, Gov. Josh Stein announced an executive order that directs cabinet agencies to safeguard medical privacy, ensures women receive accurate information about their pregnancies and protects doctors providing lawful reproductive health care.

Morse wrote in an email to The Daily Tar Heel that this executive order provides an additional level of reassurance for providers who may be nervous about caring for the multitudes of patients coming from even more restrictive states seeking out life-saving care. 

“Reflecting on my own opinions as a citizen of North Carolina, not in my role as Program Director, I think Gov. Stein's Executive Order sends an important message to the women of our state that we will take care of them in their most vulnerable moments and provides some reassurances to women's health providers that they can practice patient-centered care within the scope of our abortion restrictions,” Morse wrote.

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