"I can't help them like I used to": Evolving prenatal genetic counseling practices in a post-Roe U.S.

This exploratory empirical study documents how prenatal genetic counseling practice was evolving one year after the 2022 Supreme Court decision overturning the constitutional right to abortion in Dobbs v. Jackson Women's Health Organization. This study captures a moment when prenatal genetic counselors, clinicians who provide education and counseling about genetic and other fetal health issues before and during pregnancy, were navigating new state abortion restrictions. Qualitative interviews were conducted with 27 genetic counselors in 15 states representing a range of abortion regulations. Thematic analysis identified five key findings: 1) Genetic counselors in restrictive states adapted their practices in response to the evolving legal landscape and institutional context by continuing to discuss abortion but shifting their counseling approach and limiting medical record documentation; 2) Variable institutional guidance and interpretation of laws resulted in inconsistent support as counselors navigated restrictions; 3) Genetic counselors responded to patient questions and concerns emerging from the legal context; 4) Legal and medical ambiguity about lethal fetal anomalies led to varied medical and institutional approaches to patient care; 5) Abortion restrictions complicated provider relationships and expectations. Our data show that legal restrictions, uncertainty and a climate of fear resulted in logistical challenges, challenges to professional practice standards, and moral distress. Our findings contribute to a greater understanding of how healthcare for pregnancies with fetal anomalies is evolving post-Dobbs, and how reproductive healthcare providers beyond physicians are affected by state laws restricting abortion.