Texas Gov. The Supreme Court is expected to rule soon on whether abortion providers and the Biden administration may challenge the law notwithstanding its novel structure. An attendee holds her child during A Texas Rally for Abortion Rights at Discovery Green in Houston, Texas, on May 7. Eventually, she laid out their options: Keep carrying the pregnancy or leave Texas to get an abortion. Many physicians disagree, pointing out that the law can disrupt care for pregnant women who have underlying health problems that are not immediately life-threatening, such as pulmonary hypertension or certain types of cancer. The measure deputizes private citizens even those with no connection to the patient, doctor or health center to sue anyone who performs an abortion once cardiac activity can be detected in the embryo. "Any law that creates a hesitancy for physicians to uphold the standard of care for a patient has a cascade of harmful effects both for the patient but also for everyone else," said Esplin. Nitsch says she chose sterilization at age 36 rather than risk getting pregnant by another rapist. Everyone was so scared.. These dismissals only increase the sense of isolation, stigma and shame. In Texas, the second-largest state in the nation, legal abortion immediately ceased to be an option except to save the life of the pregnant patient. Once she made her way through the clinics stringent security, the nurses took her into a private room. "It's just really unimaginable to be in a position of having to think: How close to death am I before somebody is going to take action and help me?". Texas law reflects this important distinction. Disclosure: Southern Methodist University, Texas Medical Association and New York Times have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Updated: Oct. 24, 2022. And I told her 'No, ma'am. She and her husband began trying in late 2021. the U.S. that have trigger laws in place banning abortion in the . "And yet we're being pulled through this.". There are currently no abortion laws that outlaw treatment of ectopic pregnancy. ", State abortion laws are complicating other types of obstetric care. An ectopic pregnancy, which occurs when a fertilized egg . At least several OB-GYNs in the Austin area received a letter from a pharmacy in late 2021 saying it would no longer fill the drug methotrexate in the case of ectopic pregnancy, citing the recent Texas laws, said Dr. Charlie Brown, an Austin-based obstetrician-gynecologist who provided a copy to KHN. Crescenda Uhles, a genetic counselor in Dallas, said the Texas law puts people like her in a bind when advising patients. When they learned they were having a girl, Hall and her husband even picked out a name: Amelia. Seventeen weeks into the pregnancy, they learned they were expecting a girl. ", Later on, Elizabeth said she realized that her anger at Methodist was misplaced. If you do something to prevent that, you might be in fact performing an illegal abortion.. Some hesitate to counsel patients about the option of termination, or refer them to doctors in other states, for fear their advice could be interpreted as aiding an abortion. If a woman's life is in danger, she will be able to have an abortion. She was so tiny. Every OB-GYN has cared for someone who has died from a hemorrhage, she said. State House Bill 2709, filed Thursday, would penalize individuals for the use of medication to cause abortion in the state of Texas, whether the pills were acquired at a local pharmacy or . But Im still so angry I had to leave.. Their conundrum became painfully, distressingly clear: wait to get sicker, or wait until the fetal heartbeat ceased. After holding it together all morning, Hall burst into tears. At the same time, she was searching for abortion clinics. 9:42 AM on Jul 1, 2022 CDT. "That's torture to have to carry a pregnancy which has such a low chance of survival," says Dr. Peaceman. by Mara Mndez Either way, she saw nothing ahead but fear and grief prolonged, delayed, amplified. Family members hold photos of Olga Reyes, a 22-year-old law student who died of an untreated ectopic pregnancy in Nicaragua in 2007. After she got through the first trimester, Hall and her husband both heaved a sigh of relief and got to work telling their friends and family. Halls fetus was diagnosed with anencephaly, a neural tube defect in which the brain, skull and scalp do not develop properly in the womb. And I knew my baby was suffering, I knew I was suffering, I knew my husband was suffering.". Researchers with the Texas Policy Evaluation Project at the University of Texas at Austin documented several cases in which doctors waited to treat pregnancy complications until a patients health had deteriorated to the point that their life was in danger. We do what we can to honor each of those cases.. There have been no criminal charges against providers since the U.S. Supreme Courts decision in late June to overturn the constitutional right to abortion access that was protected by Roe v. Wade, but anti-abortion groups and state lawmakers have threatened to ramp up the pressure against abortion providers and their allies. Even if it had, the Wellers were determined to proceed. "I told her 'Look, Doctor, people around me are telling me to keep hope. The maternal fetal medicine specialist at the University of Texas Southwestern Medical Center in Dallas published a blog post last August to inform patients that treatment for cesarean-scar ectopic pregnancies is legal under Texas's abortion law. There was still a fetal heartbeat, but it could stop at any moment. Eventually, she found a clinic near Seattle that provides specialty care for patients who have decided to terminate due to lethal fetal abnormalities. "It's terrible," says Dr. Alan Peaceman, a professor of maternal-fetal medicine at Northwestern University's Feinberg School of Medicine. Other complications that occur when a woman is carrying twins or multiples can be resolved by a selective reduction, or abortion, of one of the fetuses so that the other has a better chance to live. The definition of abortion in Texas Health and Safety Code explicitly states an act that is done to "remove an ectopic pregnancy" is not defined as an abortion. She called her doctor and begged to get in. She had to go two days in a row and both times the staff gave her the support, sympathy and care shed been missing in Texas. Health & Safety Code 245.002(1)(A)-(C). As Elizabeth recalled hearing, it was one particular doctor who had argued her case: "They found a doctor from East Texas who spoke up and was so patient forward, so patient advocating, that he said 'This is ridiculous.'". And so they don't even know what the rules are.". But as has been true in Texas and in many of the 12 other states where abortion is banned . The Texas Health and Safety Code allows abortion in cases of an ectopic pregnancy or during a "medical emergency," when a "life-threatening physical condition aggravated by, caused by, or . oral contrace ptives." The term "abortion" in Texas law does not apply when these acts are done to "(A) save the life or preserve the health of an unborn child; (B) remove a dead, unborn child whose death was caused by spontaneous abortion; or (C) remove an ectopic pregnancy." Tex. Elizabeth touches the urn of her daughter. Starting last September, when the [ban on abortions after about six weeks of pregnancy] went into effect, we started getting calling from Texas and it hasnt stopped.. Sometimes, she said, a woman has a spontaneous miscarriage and is heavily bleeding, but the fetus has not passed and cardiac activity can still be detected. At the office, her ob-gyn turned down the ultrasound volume so they wouldn't have to hear. No one really knows what the legislature means by that, and they are afraid of overstepping. First she said, I cant, I want this baby so badly, Dr. Gunby recalled. I'm so sorry,'" Elizabeth says. Thats what recently caused Dr. Jessian Munoz, an OB-GYN in San Antonio, to wait a day to treat a patient who had started to miscarry and developed a womb infection, according to the Associated Press. Many doctors say they are unable to discuss the procedure as an option until the patients condition deteriorates and her life is at risk. Dr. John Thoppil, an obstetrician in Austin who is president of the Texas Association of Obstetricians and Gynecologists, said that shortly after the new law went into effect in September, a patient who relied on an intrauterine device for birth control became pregnant. I'm so sorry,'" Elizabeth says. I'm actually headed home right now because I have to await my dead baby's delivery.' Many physicians say they cannot intervene in complex pregnancies that may not pose an immediate threat to the patient but can rapidly spin out of control. "The penalties are quite draconian," he said, noting that someone could be convicted of a felony. The Texas Tribune Festival is almost here! Elizabeth was induced late Friday night, and the labor became painful enough that she had to get an epidural. In a sudden obstetrical emergency, a termination might be the least risky option, clinically. All you can do now is just hope and pray that things go well.". "'I'm just using this because this is not a viable pregnancy.'". Dr. Ghazaleh Moayedi, an obstetrician/gynecologist and abortion provider in Texas, said the new law leaves unclear whether a physician can act when a woman has a spontaneous miscarriage and is bleeding heavily, but the fetus has not passed. Post-Roe v. Wade, abortion bans may keep doctors from providing timely, necessary care. In a joint statement, Maureen G. Phipps, MD, MPH, FACOG, ACOG chief executive officer and Eugene Toy, MD, FACOG, chair of ACOG District XI (Texas), stated, "By allowing third . Immediately, they sensed hesitation from the doctor. An ectopic pregnancy is when a fertilized egg implants outside the uterus, typically in one of the woman's fallopian tubes. The risks to Elizabeth's health were simply too high. Even before the passage of the two bills, existing Texas law stated that the act is not an abortion if it involves the treatment of an ectopic pregnancy which most commonly occurs when the pregnancy grows in the fallopian tube or to "remove a dead, unborn child whose death was caused by spontaneous abortion," he said, pointing to the statute. If I offer the patient the standard of care, I could be sued for aiding and abetting, he said. And she just recklessly and negligently goes out and gets abortions all willy-nilly, left and right," she says. 678, Sec. It also sets out civil, criminal, and professional penalties for abortion providers who violate the law. And at least one Texas pharmacy has let area physicians know that they would no longer dispense methotrexate, the medication used to treat ectopic pregnancy, citing the law. After talking with James, they both agreed they should end the pregnancy. Then Elizabeth felt another sudden, forceful gush of fluid leave her body. However, Mayo said that his reading of the law allows for the use of methotrexate to treat an ectopic pregnancy. Julia Robinson for NPR Texas abortion laws make no exception for these cases, which are not as rare as people would like to imagine, said Dr. John Thoppil, an Austin OB-GYN and president of the Texas Association of Obstetricians and Gynecologists. Grumet: Fears over Texas' abortion laws interfere with urgent, life-saving care. Julie Ann Nitsch, a sexual assault survivor and community college trustee in Austin, Texas, is among many women in states with restrictive abortion laws who are taking drastic steps. The law does not make an exception for pregnant women who learn that the fetus has chromosomal abnormalities or anomalies that will cause the baby to die soon after birth. Texas Attorney General Ken Paxton quickly sued the Biden administration over the federal guidance. "And they decide to sue for malpractice," she said. Because once they reached Methodist, while they were still checking in at the emergency room, her doctor called. It doesnt take a huge leap to see that our rates of complications will go up because we have a selection bias on who is going to have to continue more complicated pregnancies.. Austin woman trying for baby says Texas abortion law nearly caused her death. "And that may mean in certain circumstances protecting the mother in this situation and the child passing away.". The earliest time that any genetic testing could be done would be at seven weeks, Dr. Palmer said, so the patient decided to terminate her pregnancy before the six-week mark, in Texas. A doctor sat down and told her: "There's very little amniotic fluid left. Since the Supreme Court ruling of June 24, 2022 that overturned Roe v. Wade, many states have banned abortion, or severely restricted abortion access. But two of those drugs, misoprostol and mifepristone, are the only drugs recommended in the American College of Obstetricians and Gynecologists guidelines for treating a patient after an early pregnancy loss. Lauren Hall stands for a portrait on Sept. 10, 2022, in the room that she and her husband had prepared as a nursery. Even with the slim chance of survival to 24 weeks, the newborn would face intense physical challenges and aggressive medical interventions. Carrying the pregnancy to term would be emotionally grueling and would also raise the mothers risk of blood clots and severe postpartum bleeding, the doctor warned. Enough to make her retch. Methotrexate or surgery are the only two options listed in the medical guidelines to prevent the fallopian tubes from rupturing and causing dangerous bleeding. It was like an evidence bag. The women who will be forced to carry these babies are the women with less resources, he said. If patients run into trouble filling prescriptions, Thoppil and Crawford say they should try to find another pharmacy or talk to their health care provider. Sec. An attendee holds her child during A Texas Rally for Abortion Rights at Discovery Green in Houston, Texas, on May 7. They don't want to get sucked into a legal morass. Thaxton, who supervises the obstetrics-gynecology residents who have seen these patients, said sometimes the prescribing clinic will intervene, but it takes the patient longer to get the medication. And it just occurred to me that the people Ive been told my whole life are going to hell for their actions were the most kind and angelic individuals through this whole thing.. But there is professional judgment involved in making these determinations, and some physicians in Texas now fear these opinions will be second-guessed in a courtroom. Coming back to Texas a few days later only amplified those feelings. These are the patients that are the most affected.. If I dont provide my patient the standard of care, which they are due, I could be sued.. The Biden administration last week told hospitals they must treat pregnant patients who need an abortion to stabilize a life-threatening condition. How Every State Pro-Life Law Handles Ectopic Pregnancy and Miscarriage Texas police separate anti-abortion protestors from abortion supporters during the nationwide Women's March in Austin, Texas . They also had an anatomy scan, which revealed no problems. You cant even mention what someones choices would be, because of fear that talking about options would be considered aiding and abetting someone getting an abortion, he said. In Texas, a 2021 law made it easier to sue anyone who helps a person get an abortion after about six weeks of pregnancy. "Ectopic pregnancies can kill people," said Brown, a district chair for the American College of Obstetricians and Gynecologists, representing Texas. "I remember hearing her, from my room, speaking loudly about how nothing is being done here.". "The challenge is that the treatment for an abortion and the treatment for a miscarriage are exactly the same," said Dr. Sarah Prager, a professor of obstetrics and gynecology at the University of Washington in Seattle and an expert in early pregnancy loss. Confusion around the laws has caused issues for patients outside of emergencies. On Saturday, May 14, about 2 a.m., she gave birth. Texas laws banning abortions make narrow exceptions only to save the life of a pregnant patient or prevent substantial impairment of major bodily function. And lawmakers in recent years have clarified state statutes to say treatments for miscarriages, known as spontaneous abortions in medicine, and ectopic pregnancies, in which a fertilized egg grows outside of the uterus and becomes unviable, do not count as abortions. Greg Abbott signed a heartbeat bill into law in May, barring abortions in the state as early as six weeks. Or in cases of rape or incest? A doctor she had never met entered the room. ", The Wellers do want to try again, but first they need to get to a "mentally healthier place," Elizabeth says. When the couple moved from Washington state to Texas in 2021, they were trying to . If an ectopic pregnancy has ruptured, the pregnant person needs care immediately because they could start bleeding and lose up to 2 liters up blood very quickly. Anyone who aids and abets the procedure can also be sued, and the law promises plaintiffs $10,000 and legal fees if they win the lawsuit. And theyve had to navigate complicated politics when sharing their news. I'm trying to understand. "It's going to take a while before the medical community comes to some kind of consensus on where you draw this line, and where you say enough is enough. "It's not just the fear that it could happen again, but also the added fear of what if it happens again and I can't get help? Anencephalic babies born alive will likely survive only for hours or days; they will be unconscious, blind, deaf and will not voluntarily respond to touch or sound, according to the Cleveland Clinic. For some, that's too difficult, given the emotions surrounding the pregnancy loss, she said. Sometimes theyre the primary caregiver. Texas Health and Safety Code, Chapter 171. And Ogburn, who noted that he was speaking personally and not for the medical school, worries that fears about the Texas laws have already delayed care. An ectopic pregnancy is 100% fatal if . I need you to give me the facts.'". If she wanted to stay in Texas, Halls only choice was to continue with a pregnancy that would not yield a healthy, living baby. But now "your medical provider says that it's illegal and they can't provide it. For doctors treating such patients, the Texas law creates quite a conundrum, Dr. Snyder said. Double your gift when you give by 6 p.m. Thursday. The American College of Obstetricians and Gynecologists has information on early pregnancy loss, finding an OB-GYN and having better conversations with your doctor. The new law does not apply to removing ectopic pregnancies that implant outside the uterus, which are not considered abortions under state law. But when membranes rupture earlier in pregnancy, particularly before 24 weeks, the chance of a fetus surviving plummets. But the point will be made by the Christian Taliban that women have only the value their reading of the Bible ascribed to them and no more. But as has been true in Texas and in many of the 12 other states where abortion is currently . As Hall learned the hard way, the law makes no exception for lethal fetal anomalies. But the statutes dont account for complicated miscarriages, and confusion has led some providers to delay or deny care for patients in Texas. One persons emergency may not be another persons emergency, said Dr. Robert Carpenter Jr., an obstetrician in Houston. ", Elizabeth thought of abortion rights in broad terms: "I have said throughout my life I believe that women should have the access to the right to an abortion. They also have abortion is permitted to protect the life of the mother or her from serious bodily harm that would result if an abortion is not performed. '", "It was devastating to hear that," Elizabeth says. All of Texas' abortion laws have exceptions to treat miscarriages and ectopic pregnancies, a potentially life-threatening condition in which a fertilized egg grows outside the uterus, as well as . I think most people would give tremendously leeway to that. Their daughter, as expected, was stillborn. For 24/7 mental health support in English or Spanish, call the Substance Abuse and Mental Health Services Administrations free help line at 800-662-4357. Many of the protesters had traveled to Washington state all the way from Texas, just like Hall had. I personally would never get one. "I told her 'I'm so sorry. It was May 10, 2022. The one exception is a medical emergency, but the law requires doctors to document the reasons for the exception with great specificity. hide caption. The emotional toll was what worried Hall most of all. She and her husband immediately jumped into planning mode, scheduling an appointment at one of the only OB-GYN practices in town. Cedar River offers specialty care for patients facing lethal fetal abnormalities like anencephaly. There they found themselves pinned down, clinically and emotionally, victims of a collision between standard obstetrical practice and the rigid new demands of Texas law. a letter from the Texas Medical Association. The color was darker and the odor was foul. Correction, Oct. 24, 2022 at 4:12 p.m.: It is life-threatening to the mother and is not viable and needs to be removed. And it's strong. I'm trying to mentally survive this.". July 20, 20225 PM Central. SB 8, which was signed into law by Texas Gov. AUSTIN (KXAN) Amanda and Josh Zurawski have been trying to have a baby for more than a year now. In retrospect, Elizabeth says their initial joy felt a little naive: "If it was so easy for us to get pregnant, then to us it was almost like a sign that this pregnancy was going to be easy for us.". But first, shes focused on her mental health and getting through the next few months. "I was born with a physical disability. Missouri legislators held a hearing on a bill that, if signed into law, would make it a felony to "perform or induce an abortion" to treat ectopic pregnancy. You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 988. You can reach them at 212-255-9252. A few weeks after Texas adopted the most restrictive abortion law in the nation, Dr. Andrea Palmer delivered terrible news to a Fort Worth patient who was midway through her pregnancy. She felt lost and confused. But he did not address the question of lethal fetal anomalies, which are fatal for the fetus during pregnancy or shortly after birth. Cheng, in San Antonio, said that even as she cautiously points her patients to their options out-of-state, shes well aware that many of them struggle to even make it to their appointments in-state. Greg Abbott last year, not only bans abortion after six weeks of pregnancy but also deputizes citizens to enforce it, allowing any person to bring a . They told her the signs of a more severe infection would include a fever of 100.4 degrees and chills. She was through with being dismissed, being told to wait. Frustrated with her experience on hormonal birth control, she and her husband decided it was time for her to get off of it. To deal with the increased demand, Cedar River has reopened a previously shuttered location, enhanced its telemedicine services and worked to find ways to help patients pay for travel and procedures. But the Wellers and 28 million other Texans had already been living under a de facto abortion ban for 8 months, since September 2021. Elizabeth could not receive the medical care she needed until several days later because of a Texas law that banned abortion after six weeks. To Elizabeth, it seemed obvious that things were deteriorating. ", "Because that doesn't really exist right now," he added. But the lack of clarity accompanying the threat of jail time and six-figure fines for medical professionals has led some hospitals and doctors in the state to deny or delay care for pregnancy complications, according to multiple reports. 7:49 PM on Jul 14, 2022 CDT. It just didnt occur to them that a ban would include cases like this.. Methotrexate, another abortion-inducing medication, is used to treat ectopic pregnancies as well as rheumatic illnesses, inflammatory bowel disease, psoriasis and cancer. Acts 1989, 71st Leg., ch. Thats why Crawford said its important for patients to quickly seek medical care if they notice their pregnancy isnt progressing normally or they are bleeding. . Texas is the state weve seen the biggest increase from, Sanchez said. There was an infection, and she did need treatment. Its also had to heighten security since Roe was overturned, Sanchez said, the clinics have seen more and more aggressive protesters, including people from out-of-state like those Hall faced. Hall shelled out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. A few days later, she went out to celebrate a friends birthday and was raped on her way home. They had to call their OB/GYN repeatedly to get the $500 delivery deposit refunded. Hall was 18 weeks along when she went in for hers on a Friday afternoon. Im a nurse. Those can be acute life-threatening emergencies, she said. Your donation keeps our trusted reporting free and accessible for all Texans and during a legislative session when lawmakers are set to tackle issues from school choice for K-12 students to school safety improvements to changes in property taxes, its critical that Texans know what lawmakers decisions mean for their futures. Doctors and experts also worry that patients with pregnancy complications may be too afraid of being accused of inducing an abortion to seek care. It was just the most tender moment, she said. Another area of Texas law that Seago cited provides an exception to the state's abortion restrictions if the mother's life is in danger or she's at "serious risk of substantial impairment of a major bodily function" unless an abortion is performed. At 18 weeks, the watery, protective cushion of amniotic fluid was gone. The bill . When she first saw that positive pregnancy test, she panicked even at 27, she said, her first reaction was that of a 15-year-old, worried about telling her parents. That's when she felt something "shift" in her uterus, down low, and then "this burst of water just falls out of my body. I was losing my mind, Hall said. Since Sept. 1, abortion has been illegal in Texas after six weeks gestation, with one exception: If a doctor determines that a patient will face a " medical emergency " if the pregnancy continues, they can perform an abortion later on without breaking the law. An oncologist urged the woman to start treatment immediately, but the chemotherapy regimen would have been toxic to the fetus. "It wasn't that the Methodist Hospital was refusing to perform a service to me simply because they didn't want to, it was because Texas law put them in a position to where they were intimidated to not perform this procedure.". Dr. John Thoppil, an obstetrician in Austin, doesnt perform abortions, providing prenatal care and delivering babies. Pregnancies can be complicated by any number of medical conditions. Seek help right away for signs of ectopic pregnancy your doctor can talk you through next steps. The near-total ban on abortion in Texas meant that the doctors couldn't do anything to remove the unviable fetus unless Amanda's life was at risk. Financial supporters play no role in the Tribune's journalism. Since September 1, 2021, Texas Senate Bill 8 (SB8) has prohibited abortions after the detection of embryonic cardiac activity, which occurs around 6 weeks after a person's last menstrual period . Amplify your impact and donate now. Sept. 20, 2022 But the womans condition can quickly deteriorate, which is why physicians often prefer to offer an abortion. Misoprostol is used to help prevent stomach ulcers, but it can induce abortions, particularly if taken along with mifepristone. In the meantime, Grossman said the delay and denial of care will likely become more common. All too often, Cavazos says, patients are told to get over it, move on, try again. "Not because I wanted my baby to die, but because I needed this hell to end. 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