The patient was dying after days of painful contractions as her body labored to push out a 20-week-old fetus that had already perished. And the cluster of doctors in the Kansas hospital room were helpless.

On the edge of the white-coated crowd, Alhambra Frarey felt sick to her stomach. Then 28 years old and training to be an obstetrician-gynecologist in 2009, Frarey knew the patient needed a surgical procedure most commonly used in abortion.

But none of the doctors present knew how to perform the operation needed to save the mother’s life because the hospital didn’t allow abortions and didn’t require staff physicians to train for the procedure.

Just as Frarey was giving up hope, the only surgeon on staff with experience in a procedure known in medicine as a dilation and evacuation rushed in from an out-of-town trip. Frarey decided on the spot that she needed to become an OB-GYN with the specialized skills to provide abortion.

“Because not everyone was willing to do it,” she said.

This is the calling described by doctors providing abortions in Pennsylvania:

Choosing a specialty out of fear that, if you don’t, patients will go without care. Comforting a mother of two who is racked by guilt over a decision her religion doesn’t support. Showing up to work in clinics thronged by protesters shouting insults. Taking a breath, counting to three, and letting go of the attacks on your profession, so you can open the exam room door and greet your patient with a smile.

Four Philadelphia-area doctors shared with The Inquirer why they do abortions following a recent U.S. Supreme Court ruling that upended the future of their medical specialty.

In Pennsylvania, the procedure remains legal through the 23rd week of pregnancy, although that could change depending on the outcome of this year’s governor’s race. So providers anxiously monitor national news for cases like the 10-year-old rape victim who was denied an abortion in her home state of Ohio, or the Louisiana woman whose local hospital told her to go to Florida for an abortion after she learned her baby was developing without a skull, a fatal birth defect.

Pennsylvania has long imposed strict regulations — including a 24-hour waiting period requiring two separate in-person visits — that make providing nonemergency abortion care outside a dedicated clinic extraordinarily difficult.

Doctors who provide abortions in Pennsylvania describe a commitment to a service that is often not medically complex — more than half of cases require only monitoring after a patient swallows pills. But the professionals in this specialty describe what they do as a calling.

» If you value this kind of journalism, please subscribe today.

Frarey had every intention of pursuing a job in abortion care immediately after completing her medical training in Kansas. The patient who nearly died from a 20-week miscarriage was among many whose health Frarey felt had been put at risk by abortion restrictions.

But a string of violent episodes in the United States, such as arson at clinics and fatal shootings of providers, made Frarey question whether she was ready to risk her own safety. So instead, she accepted a position at a Philadelphia OB-GYN practice, delivering babies and collecting pap smears.

The birth of her own child in 2013 changed Frarey’s perspective. She considered how different her life might be if she’d had to bear a child before she had her career and marriage established.

She began her application before returning to work from maternity leave.

Frarey remembers holding her newborn daughter and thinking, “What if she didn’t have the same right?’”

By the time Frarey was pregnant with her second child, she was training to become an abortion specialist and had a full caseload of patients.

Eyeing her bulging belly, some would ask if it was hard to be a pregnant abortion provider.

Her answer was always resolute: “No.”

Birthing and parenting are the hardest things she’s ever done, she explained to patients, and she was fortunate to have a stable job, supportive family, and the choice of when to become a parent.

“That should never be forced on anybody,” she said.

Lin-Fan Wang always wanted to become a family medicine doctor. She loved the idea of caring for entire families from birth to death.

In New York, where she trained, that was possible. But in Philadelphia, she found fitting abortion into a primary care practice was a regulatory nightmare. She would have had to follow dozens of state mandates to offer abortion services to her patients, including counseling patients on alternatives with a state-approved script and opening her clinic doors for additional building and health inspections twice a year.

In January, she left a private practice and joined Planned Parenthood as a full-time abortion provider at the Philadelphia affiliate’s West Chester clinic, where she had previously provided abortion care on a contract basis.

» READ MORE: Inside Planned Parenthood: In Philadelphia, most patients are not there to terminate a pregnancy.

She knew the risks. She locked her social media accounts and never takes the same way home two days in a row — she’s heard of doctors being tracked down online and followed in real life.

At the same time, Wang felt as if she was walking away from primary care patients who needed her, too.

“I know how important primary care is, too,” said Wang, who identifies as a queer person of color. There aren’t enough primary care doctors, particularly those who also are part of the LGBTQ community.

Still, the need for abortion care doctors seemed more urgent to Wang. The patients she’s treated at Planned Parenthood confirm that she’s in the right place.

She thinks often about one former patient: a 30-year-old mother of two who felt guilty about wanting an abortion, fearful that God would judge her. The physician and patient talked about religion, love, and family for a long time before the woman decided to end her pregnancy.

“If I put love out into the world, I will receive love back,” Wang recalled the woman telling her. “And my love now is being able to take care of the children I have.”

The recent Supreme Court ruling shifted Aishat Olatunde’s outlook on what it means to provide medical care to Black patients in America.

Olatunde, now 34, was drawn to obstetrics because of the deep relationships many OB-GYNs forge with their patients. A first-generation American whose family came to the U.S. from Nigeria, Olatunde knew how valuable it is for Black patients to find a doctor who looks like them and whom they trust to guide them through health-care decisions.

She always assumed pregnancy was something everyone should have the right to choose — or not. But in the final year of her training in 2020, the murder of George Floyd ignited a nationwide reckoning about racism that made Olatunde think more deeply about the particular significance of abortion rights to Americans historically denied their rights.

“It forced me in ways I probably wasn’t ready for to think about all those obstacles, the mental gymnastics you have to do to live in this country as a Black person and particularly a Black woman,” she said.

Now, as she begins her career in Philadelphia, the Supreme Court ruling feels personal — an attack on her patients’ and her own right to carve out their own lives, she said.

“It’s about the autonomy of a person, having the ability to decide what is right for them, in their life,” she said. “To live a life that is theirs in a way they want to, unapologetically and without fear or stigma.”

Since beginning work at a clinic specializing in reproductive health, Olatunde has seen the anguish of patients forced to wait 24 hours after a first appointment before they can terminate a pregnancy under Pennsylvania law. As other states with even more restrictive rules cut access, she is seeing patients struggle to book appointments.

The work is emotionally taxing, but she vows to press on.

“I, too,” she said, “want to live my life unapologetically.”

For Lisa Perriera, the recent Supreme Court abortion ruling forced a change she’d long considered: leaving clinical research at a top teaching hospital to care for patients seeking abortions at the Philadelphia Women’s Center.

When the court’s decision leaked earlier this year, Perriera worried about the future of abortion rights in Pennsylvania, patients’ anxiety, and how those from abortion-banning states would strain local providers.

In her academic position, she balanced a full scope of pregnancy and abortion care with research projects. Now, she dedicates her entire day to abortion care, as medical director of the Women’s Center’s five clinics in Pennsylvania, New Jersey, Connecticut, and Georgia.

Perriera decided to focus on abortion care because she was trained by an aging generation of doctors who remembered how patients fared before the 1973 Roe decision.

Perriera feared what would happen if her generation didn’t rise to meet the new challenge to reproductive rights.

“If abortion is legal but there’s nobody to provide them, we don’t have legal abortion,” Perriera said.

Perriera hears relief in patients’ voices when she calls before their initial visit to confirm they’re eligible for the procedure. These calls are especially important for a growing number of out-of-state patients, who may otherwise travel for hours only to find they can’t be treated at her clinic due to gestational age or medical history.

Those who get treatment leave the clinic expressing gratitude that amounts to “a deep, life-affirming thank-you.”