The Iowa Supreme Court recently approved guidelines for abortion providers in response to the state’s ban on abortions after six weeks of pregnancy.

The strict abortion law is temporarily suspended while Governor Kim Reynolds appeals the lower court’s decision to halt its main components. However, the medical board has been told to proceed with creating rules so that doctors will have guidance when the court makes its ruling.

The language of the board states the expectations for physicians to adhere to the law, but the details on enforcement are restricted. The rules do not specify how the board would identify noncompliance or what disciplinary measures would be taken. There are also no clear guidelines on the level of endangerment to a pregnant woman’s health that would warrant protection from disciplinary action for physicians.

The proposed legislation would make it illegal to have an abortion after a fetal heartbeat is detectable, typically around six weeks into pregnancy and before most women are aware of their condition. This would be a significant shift for women in Iowa, as the current law permits abortion up to 20 weeks into pregnancy.

Physicians are directed to make a genuine attempt to identify a fetal heartbeat by conducting a transabdominal pelvic ultrasound in accordance with accepted medical practices.

Similar to other attempts by Republican leaders to limit access to abortion, this bill is based on the concept of detecting a “fetal heartbeat,” which does not align with medical terminology. While modern technology can detect slight cardiac movement as early as six weeks into a pregnancy, medical professionals note that at this stage, the embryo is not considered a fetus and does not have a developed heart.

During the meeting, a representative from the attorney general’s office clarified that the rules approved on Thursday have been updated to incorporate medical terminology used by doctors. This clarification supplements the existing definition of “unborn child” in the law to include all stages of development, including embryo and fetus.

The regulations also specify the details that doctors must record in order for a patient to receive treatment under the specific exceptions outlined in the legislation.

The patient’s medical records should include updated documentation to allow physicians to reference the information rather than relying on memory. This can prevent a dispute between witnesses if someone is called before the board, according to a representative from the attorney general’s office.

The legislation permits abortion in cases of rape, if reported to the authorities or a healthcare professional within 45 days of detecting cardiac activity during pregnancy; incest, if reported within 145 days; and fetal abnormalities.

When faced with a fetal abnormality, the board requires doctors to record their process in diagnosing the condition and justify why it is considered “incompatible with life.”

The legislation allows for a special circumstance known as a “medical emergency.” This includes instances where pregnancy complications put the pregnant woman’s life in danger, as well as situations where continuing the pregnancy would pose a serious threat of causing permanent and significant harm to a major bodily function of the pregnant woman.

However, the board did not offer further instructions on the specific level of urgency in which doctors are allowed to intervene, a matter causing frustration among physicians nationwide. This is particularly relevant following the Texas Supreme Court’s rejection of a pregnant woman’s request for abortion due to life-threatening complications.

Most Republican-led states have drastically limited abortion access since the U.S. Supreme Court overturned Roe v. Wade and handed authority on abortion law to the states. Fourteen states now have bans with limited exceptions and two states, Georgia and South Carolina, ban abortion after cardiac activity is detected.

Four states, Iowa included, currently have suspended bans awaiting court decisions.

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Geoff Mulvihill, a reporter for the Associated Press, contributed to this report from Cherry Hill, New Jersey.