Dr. Nicole Teal was working a night shift in September 2022, when a patient came into UNC Medical Center’s labor and delivery unit with a particularly dangerous set of symptoms.

Her blood pressure had suddenly spiked. Her platelets were decreasing. Liver enzymes in her blood were rising. She had the hallmarks of severe preeclampsia, one of the leading causes of death for pregnant women.

“I don’t want to threaten my life,” Teal recalled the patient telling her. “I’d like an abortion.”

After four years of medical school, four years of training to become an OB-GYN and now, nearly three years of specialized maternal-fetal medicine training, Teal knew her patient’s instincts were in line with medical recommendations.

At 21 weeks, the fetus was unlikely to survive outside the womb, and without intervention, the patient was at risk of “catastrophic” complications like seizures, strokes and renal failure.

But about a month earlier, the U.S. Supreme Court’s decision to overrule Roe v. Wade allowed a 20-week abortion ban to take effect in North Carolina. To end the pregnancy, Teal would have to be able to show it was an imminent risk to her patient’s life.

The patient did not yet meet that legal bar. So they waited.

“I watched her for several days until she got sick enough — until her organs were starting to fail,” she said. “Then we could provide her abortion.”

The following months brought a string of similar cases. Even though she split her time between research and clinical work, Teal estimated North Carolina law forced her to delay care about once every two months. She imagined it would become even more common once the state’s newest abortion law, which bans most abortions after 12 weeks, took effect in July.

When Teal’s maternal-fetal medicine fellowship ended in June, she was offered what would have been a dream job: a faculty position in UNC’s Department of Obstetrics & Gynecology.

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