Even when Roe v. Wade was the law of the land, Heather Pugmire, a Latter-day Saint OB-GYN, didn’t perform elective abortions.

“I chose not to,” the Idahoan told The Salt Lake Tribune in a recent “Mormon Land” podcast. “I didn’t want to. I don’t want to.”

So she was taken aback when, in 2022, hospital lawyers informed her that her practice would have to change in the wake of the Dobbs decision ending a constitutional right to an abortion.

In the podcast, the doctor discussed those changes, their steep costs and her wrestle with whether to vote for Idaho’s Proposition 1 expanding abortion access — a measure opposed by The Church of Jesus Christ of Latter-day Saints. The following excerpts have been edited for length and clarity.

What is the medical definition of an abortion?

The medical definition is actually quite broad. It really is just the ending of a pregnancy, whether that’s spontaneous or induced.

In all the medical literature and in my charting, when I talk about your history of your pregnancies, I’ll list your births, your preterm births and your abortions. That includes a miscarriage, a loss before 20 weeks, an induced abortion and an elective abortion, which I use to refer to someone choosing to end a pregnancy for nonmedical reasons. All of those fit into that category.

Now, we wouldn’t use the term “abortion” that way when talking with patients because of all of the social definitions that come with it. I would say miscarriage, for instance, even though when I’m talking to other colleagues, I would say spontaneous abortion.

How did your practice change in the wake of the Supreme Court’s decision overturning Roe v. Wade?

When Roe v. Wade was overturned with the Dobbs decision, the lawyers told us there’s a trigger law on the books that was voted in two years ago. And we said, OK — we don’t do abortions.

But they explained that by abortion, they mean every time a baby dies for whatever reason. When it first passed, the law didn’t exclude miscarriage or ectopic. They did change that. But we’re trying to understand, what do you mean by abortion?

Practice-wise, it’s made it impossible to recruit other OB-GYNs to the area. And so my ability to keep practicing at my current pace has been really hard. I’ve been on the verge of having to quit because I don’t have the support I need. I can’t be on 24/7. I’ve tried. It doesn’t work.

A lot of people will say just offer job candidates more money, but we can’t even get to where we can offer them more money. The law has made it feel like Idaho doesn’t trust doctors, that we’re trying to get away with something. And that’s been very clear to other physicians across the nation.

And truly, if laws don’t change, I’m not going to be able to keep doing this. So then I leave and that shuts down OB services in my area. That puts strain on the surrounding areas. And they’re not getting doctors either.

Are would-be job applicants afraid of being arrested? What are the precise concerns?

The precise concern is that every difficult decision I make is going to be scrutinized by a lawyer and then potentially go in front of a jury.

So I am questioning, if I do what is right in this situation, is that going to put me behind bars? Is that going to take away my license? Is that going to get my name plastered on a billboard and my kids bullied because other kids think their mom is a baby killer?

A second thing it does is hinder my ability to compassionately care for my patients.

I had a patient whose water broke at 14 weeks. Babies can’t survive earlier than 22 weeks — and that’s pushing it. The umbilical cord was coming out. She was not going to be able to keep the pregnancy until 22 weeks. It was certain.

But the baby was still alive. In those cases, usually what we do is give women medicine to help them deliver. That helps avoid infection and hemorrhaging. And I will sit and hold their hand and help them grieve. But, in this case, I had to spend almost two hours calling my lawyer, calling my CEO, calling three other doctors to be able to put statements in the medical record that I’m not the only one who thinks this is the right way to go.

Say the pregnancy will make the patients sick, but it’s not necessarily going to kill them right now — and I know that there are laws that say it doesn’t have to be right now, it doesn’t have to be immediate. However, that’s a very wide zone. For women whose babies have lethal anomalies, I have to transfer them out of state where the laws are less strict. There’s no other option for me.

So instead of them being able to grieve that loss in a place where they have their community, their faith, their family, their insurance to pay for things, they have to go somewhere else, even though the outcome is still the same.

There’s one other way that my practice has changed, which has been a little more subtle. I’ve found that I used to get women who were pregnant, and it was not a planned pregnancy and they were scared to death of it and saying, “I don’t know what I’m going to do. I don’t think I can do this. What do you think? What should I do?”

And I used to be able to counsel them on their options. And I used to be able to discuss with them how life will be different no matter what they choose. Abortion, adoption, keeping the baby — those are your choices. All three of those change your life completely. And there are risks and benefits to all of them. I know that I was able to help women decide against abortion in at least half those cases.

I’m not getting those patients anymore. They’re afraid to come talk to me because they know the laws are strict, and they know that I’m hindered on what I can even say.

Based on your experience, do you believe the status quo or Prop 1 align more with church policies and teachings?

That’s a little bit hard to say.

The status quo for sure is not in line with church teachings other than it opposes elective abortion — and that’s because it opposes everything that lawmakers are calling abortion. Prop 1, though, does not square with church teachings because it allows for elective abortion.

However, I know that I can follow the church’s policy and the teachings — and I am comfortable with those teachings — and that I can be a competent and compassionate physician under Prop 1 easier than the status quo.

Now, truly, if they would change the law, that could be easy, too. I don’t think they would even have to change it very far. If they added protections for the health of the mother and cases in which severe defects mean the baby won’t survive, I don’t think we’d have an issue.

But something needs to change. I’ve personally worked with legislators and have been speaking out for more than three years now about this. And talking with legislators, I find them unable or unwilling to make those changes. And the big reason is because it is political suicide.

We need enough legislators to understand that this really is hindering their constituents. This really is limiting their options for good, compassionate, moral and competent healthcare.

Do you know how you plan to vote?

I was a 100% yes for it until the church made its statement. Now I’m quite torn. I absolutely believe in prophets. I do believe they receive revelation. I do believe that they speak out on important things.

I don’t know if they understand the nuances, especially with them issuing a similar statement in Nevada. But really, for me, Prop 1 is a wake-up call to the Legislature that says we need to do something. This isn’t sustainable.

What’s the feeling when you talk to members of the church there?

A lot of people are in my shoes, actually. And that is one thing that I have noticed since the church has spoken out against this — I have gotten more people talking to me about it than before, people asking what’s going on.

A lot of them were voting no before because it seemed clear: It’s either for abortion or against, right? Now that the church has spoken out, they’re asking a few more questions, and they’re looking into it more, which I think is good.

Is there anything else that you wish the general public understood about this?

The big thing for me is that the status quo does need to change. We need to not penalize doctors for helping people make hard decisions. But we absolutely can have a culture of not doing elective abortions in our state. That was there when I came. I came in 2012. It was very clear. That’s part of why I came. I didn’t want to be asked to do them. And we didn’t. No one in southeast Idaho did.

But you have to be very careful. The current stance among lawmakers is very anti-doctor and one that “we don’t trust you.” Everything’s based around fear when it comes to this issue. If we could flip that, we could get to where we’re supporting people instead.

Our goals are the same. We want healthy moms and babies. And if we can work together to do that and agree on that, then I think it makes it much easier to get rid of that fear.

Note to readers • To hear the podcast, go to sltrib.com/podcasts/mormonland. To receive ad-free “Mormon Land” episodes, along with our complete newsletter and access to all Tribune religion content, support us at Patreon.com/mormonland.