Impossible Choices: A Physicians Guidance on High-Risk Pregnancy in a World Without Roe

How the overturning of Roe has imperiled high-risk pregnancies-and how to ensure safe patient healthcare in the future. From a leading doctor on the front lines after the Dobbs decision. Doctors and patients confronting high-risk pregnancies have always faced profound and life-altering decisions. But after the 2022 Dobbs decision overturning Roe, many of these decisions seem impossible. As a firsthand witness to this convulsion, David Hackney, a leading physician in maternal fetal medicine, offers knowledgeable, thoughtful guidance to patients and practitioners contending with high-risk pregnancies in our new reality. Impossible Choices focuses on the practical implications of high-risk complications for people who are pregnant or considering pregnancy-including conditions such as pre-eclampsia, premature membrane rupture, or birth defects-especially in states now under abortion bans. And because maternal fetal medicine overlaps with other medical fields as pregnant patients struggle with, for instance, kidney disease, lupus, diabetes, and cancer, the book also addresses a wide array of medical questions and complications. How do we make decisions when thrown into extreme and uncertain circumstances? The author answers this question and more by painting a nuanced and clear-eyed picture of obstetrics after Dobbs, illustrating his reflections with stories from his own practice, as well as those of his wife, in pediatric oncology. Without being partisan or polemical, the book offers the informed compassion and way forward that this fraught moment in maternal medicine calls for.

About the Author :
David N. Hackney, MD, MS is Professor of Reproductive Biology at Case Western Reserve University and Division Chief of Maternal Fetal Medicine. He is currently District Legislative Chair of the American College of Obstetricians and Gynecologists and was the Section Chair for Ohio at the time of the Dobbs decision.

Review :
ENDORSEMENTS

“Impossible Choices is a sharp and compelling exploration of the human cost for both patients and doctors of politically-driven medical care. A deeply necessary read.”
—Danielle Ofri, MD, PhD; author of When We Do Harm

“In a post-Roe world, it’s more important than ever to hear directly from physicians about how their work, and their patients’ lives, are being affected. Impossible Choices is for anyone who wants to better understand how laws shape the most complex moments in reproductive health care.”
—Nicole Karlis, award-winning staff writer at Salon; author of Your Brain on Altruism

“In this invaluable book, David Hackney gives lay-readers a highly readable account of the many ways a pregnancy can go wrong and how the Dobbs decision has created unacceptable conditions for physicians and patients alike.”
—Carole Joffe, coauthor of After Dobbs

"A heartfelt and compelling read for anyone wanting to understand the diverse challenges and devastating consequences of restricting reproductive rights."
—Jay Baruch, MD; author of Tornado of Life

“Hackney expertly guides the reader through the challenging terrain of high-risk pregnancy, deftly navigating the medical, political, and emotional aspects of obstetrical care and abortion. A great read.”
—Mikkael A. Sekeres, MD, MS; author of When Blood Breaks Down and Drugs and the FDA

“As an experienced provider, Hackney explores how the Dobbs Supreme Court decision has changed care for patients. His is an important voice, anchored in science and actual clinical practice, offering a clear-eyed view of what it's like to do this crucial and emotional work today.”
—Chavi Eve Karkowsky, MD; author of High Risk

“Hackney provides a critical perspective on high-risk pregnancy in the post-Roe era, offering singular insight into the intersection of medicine, law, and bodily autonomy.”
—Merle Hoffman, author of Choices; Founder and President of Choices Women’s Medical Center, Inc.™