Genetic counselors (GCs) play key roles in discussing pregnancy management options with patients, including abortion care and coordination. Since the 2022 overturn of Roe v. Wade, total or near-total abortion bans and frequent ban switching have occurred in many US states. A mixed methods approach (27 question survey assessing prenatal GCs' abortion referral/coordination practices before and after the overturn and semi-structured qualitative interviews exploring counseling adaptations, emotional well-being, and job satisfaction) was used to assess the effects of the overturn on prenatal GC practice. Survey responses from 35 prenatal GCs who have practiced for over 1 year were analyzed in four state categories that considered type and number of gestational age restriction changes after the overturn: Stable Restrictive (SR; N = 5), Newly Restrictive (NR; N = 5), Unstable (US; N = 8), and Stable Permissive (SP; N = 17). Paired t-tests compared "before" to "after" responses, and one-way ANOVA and Tukey tests compared differences between state categories. Results showed a statistically significant increase in reported distance to the nearest abortion clinic (p = 0.002) and reported wait times for abortion appointments (p < 0.001). Additionally, we found a statistically significant increase in prenatal GCs reporting that they often or always refer patients out of state for abortion care (p = 0.009). The reflexive thematic analysis framework was used for qualitative analysis. Through deductive and inductive analysis of follow-up interviews with 12 prenatal GCs from each state category (SR N = 2; NR N = 2; US N = 3; and SP N = 5), the researchers produced three cross-cutting themes: GCs altered practice due to legal uncertainty and changing policies, GCs built resource networks and self-educated, GCs experienced increased burden from their role in abortion coordination and care. These findings emphasize prenatal GCs' challenges in supporting their patients in all pregnancy management options and highlight the adaptations they have made to contend with abortion restrictions after the Roe v. Wade overturn.