SIOUX FALLS, S.D. (KELO) — Governor Kristi Noem continues to push for legislation restricting telemedicine abortion in South Dakota on the basis it’s dangerous for women. But physicians are pushing back, saying the proposed rules and legislation on medication abortion pose a greater danger to the women of South Dakota.

In a news conference this week, Governor Noem took questions about a recent lawsuit brought forward by Planned Parenthood and the American Civil Liberties Union (ACLU) about a rule requiring patients seeking a chemical abortion to make three visits to a physician. A District Court judge granted Planned Parenthood a temporary restraining order, delaying the rule from going into effect on January 27.

Governor Noem would like to see a ban on telemedicine abortion in South Dakota.

“The reason that we’re pushing it is because it is so dangerous for women to undergo this procedure,” Governor Noem said of the rule.

One reporter asked whether it was already illegal, and Noem added there is not yet a specific statue in South Dakota law outlawing telemedicine abortion.

Noem’s concerns center around the idea patients as young as 13-years-old could be having these drugs mailed to their home and take these medications without doctor supervision. But Planned Parenthood told KELOLAND News on Friday, as the only abortion provider in the state, they are required by law to meet with a patient in their Sioux Falls clinic prior to either a chemical or surgical abortion. There is a 72-hour waiting period in place in South Dakota for all abortions according to the Chief Medical Officer and Medical Director of the Sioux Falls Planned Parenthood, Dr. Sarah Traxler.

“It’s 4 times more dangerous for a woman to undergo this procedure and four times more likely they’ll end up in the emergency room,” Gov. Noem said of at-home medication abortion on Thursday.

Noem is pulling this statistic from a study titled “A Longitudinal Cohort Study of Emergency Room Utilization Following Mifepristone Chemical and Surgical Abortions, 1999–2015” that was funded by the Charlotte Lozier Institute.

The study says that compared to surgical abortions, chemical abortions among their sample population between 1999 and 2015, were four times more likely to visit the emergency room in the 30 days after an abortion procedure. The study also notes that chemical abortions began increasing in 2012, and almost doubled in 2015.

“The reasons for the increasing rate of ER visits following mifepristone abortions are not readily apparent but may be influenced by mifepristone abortion providers who are unable or unskilled to handle complications after chemical abortions,” states the study in its findings.

The study analyzes the usage and hospitalization of patients who use mifepristone, not misoprostol. The governor is worried that people may be able to receive mifepristone through the Internet and take it at home. But Dr. Traxler says that in South Dakota, patients are already required to take mifepristone under the supervision of a physician. The rule put forth by the Legislature’s Rules Committee would add an additional visit to take misoprostol under the supervision of the same physician.

How the chemical abortion procedure works

Dr. Traxler explained to KELOLAND News both mifepristone and misoprostol must be taken to complete the chemical abortion procedure. According to Traxler, a patient seeking a medication abortion would make a visit to the Sioux Falls clinic where they would receive counseling and education on abortions. After a 72-hour period, they would return to the clinic and take mifepristone under the supervision of the physician who counseled them.

The mifepristone blocks progesterone, which is a hormone necessary to maintain a pregnancy according to Traxler. She explains that by binding with progesterone receptors, the mifepristone increases uterine muscle contractions and primes the cervix for opening.

In the current abortion process in South Dakota, once mifepristone is taken at the clinic, the patient is then given misoprostol to take at home, 24 to 48 hours later. The misoprostol causes uterine contractions and enhances the efficacy of the abortion medication and completes the procedure.

Traxler says the timeline is important when taking mifepristone and misoprostol.

“Folks who take mifepristone, and then don’t take the misoprostol, are at increased risk of hemorrhage than people who complete the regimen,” Dr. Traxler said.

The rule brought forth by the State of South Dakota would require patients to make a third visit to take the misoprostol pill in person, rather than at home. Dr. Traxler said she is worried about patients being able to make it back to the clinic for a third visit in the appropriate time frame to take the misoprostol.

“Most of our patients are parents already, and most of our patients are traveling long distances to get to the abortion clinic,” Traxler said. Traxler adds that she does not believe the rule provides a medical reason for this third visit.

In a letter sent to the Legislature’s Rules Committee, the South Dakota Medical Association echoed the concerns of Traxler. Physicians said this rule did not “reflect evidence-based care” and that requiring the in-person dispensation of misoprostol creates a burden on the patient.

Right now, Planned Parenthood has three physicians that travel to South Dakota from Minnesota twice a week to perform abortion procedures. If the rule went into effect, Traxler says it would be difficult to operate due to staffing issues in the Sioux Falls clinic.

“It’s pretty unfeasible for us to, at this point, operationalize medication abortion in South Dakota if the rule were to go into effect,” Traxler said.

The rule would not impact surgical abortions, though, Traxler notes.

A U.S. District Court judge agreed with the ACLU and Traxler in their ruling this week and granted Planned Parenthood a temporary restraining order. Judge Karen Schreier ruled that Planned Parenthood and its patients would “…face irreparable harm if the temporary restraining order is not granted.” Schreier said the balance of harms is in Planned Parenthood’s favor.

An evidentiary hearing is scheduled for February 1st in Sioux Falls.