"I told her 'Look, Doctor, people around me are telling me to keep hope. She never had to use that bag. 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. But Texas's medical exception is narrower, and less defined . An attendee holds her child during A Texas Rally for Abortion Rights at Discovery Green in Houston, Texas, on May 7. hide caption. SHORT TITLE. AUSTIN (KXAN) Amanda and Josh Zurawski have been trying to have a baby for more than a year now. An ectopic pregnancy occurs when the fertilized egg is implanted outside the uterus, most commonly in a fallopian tube. She and her husband began trying in late 2021. The result has been disarray and confusion for doctors and hospitals in multiple states, and risky delays and complications for patients facing obstetrical conditions such as ectopic pregnancies, incomplete miscarriages, placental problems, and premature rupture of membanes. Lauren Hall, 27, fought the urge to scream back and tell them just how badly she wished life was a choice she could have made. Sign up for The Brief, our daily newsletter that keeps readers up to speed on the most essential Texas news. Yet under the new law, Dr. Thoppil felt he could not counsel her on terminating the pregnancy. With regard to pregnancy-related complications for women of any age, Dr. Skop said, the new law allows doctors to act when necessary and to justify their treatments in court if they are sued. 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. Elizabeth was 18 weeks pregnant. And I told her 'No, ma'am. KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Many of the patients that we see in my practice already have to drive so far away to get basic prenatal care, Cheng said. It was just a matter of time before the baby died, or maybe Id have to go through the trauma of carrying to term knowing I wasnt bringing a baby home, said 27-year-old Lauren Hall. How theyd told their families, picked out a name, built a crib and bought pink sheets. When Roe v. Wade fell in June, Elizabeth's pain and anger surged up again. Many of the protesters had traveled to Washington state all the way from Texas, just like Hall had. Growing up outside Dallas, Hall often heard that abortion was murder and, perhaps worse, interfering with Gods plan. She was admitted to the hospital, and later that night, when her own obstetrician called, she begged her for information. Treatments for certain pregnancy complications are distinct from abortions under Texas laws, experts say, but confusion has already limited some patients access to life-saving procedures and medicines. Eventually, she found a clinic near Seattle that provides specialty care for patients who have decided to terminate due to lethal fetal abnormalities. 1, eff. And for a few tense . Recently passed laws make abortion illegal after about six weeks into a pregnancy. Outcomes from expectant management vary greatly depending on when the waters break. And how can I be so sure I'm not going to get too sick to the point where that's it now you can't have kids. Julia Robinson for NPR Under Texas' Senate Bill 8, abortions are banned after six weeks of pregnancy, and the only exception is if a doctor determines a patient will face a "medical emergency" if the procedure isn't . If youre having severe pain, if youre getting a fever, you need to keep your medical team in the loop, Crawford said. There is no treatment to stop a miscarriage once it has started, and miscarriages can become life-threatening to the pregnant patient if complications are untreated. Even in cases of rape or incest, we dont advocate for taking the life of an unborn child for the crime of the father, he said. But the most confusing development involves the exemptions that exist for the woman's life or health, or because of a "medical emergency." 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. An ectopic pregnancy is 100% fatal if . Aborting the embryo is often the best treatment for an ectopic . But now "your medical provider says that it's illegal and they can't provide it. Those can be acute life-threatening emergencies, she said. But the National Advocates for Pregnant Women provide free legal assistance to women who have been charged with a crime because of a pregnancy loss like a miscarriage. A doctor hugs a patient at an abortion clinic in Santa Teresa, New Mexico, on 13 January 2023. The Ohio state legislature, which introduced a bill in 2019 requiring doctors to "reimplant an ectopic pregnancy" into the uterus, or face charges of "abortion murder," despite the fact . A doctor sat down and told her: "There's very little amniotic fluid left. The Biden administration last week told hospitals they must treat pregnant patients who need an abortion to stabilize a life-threatening condition. I have seen cases where the woman has gone from completely normal to septic shock in less than an hour, Dr. Carpenter said. care provider and intended to remove an ectopic pregnancy that . And now the Texas abortion law has created an additional bind, Cavazos explains. If she is developed enough to be menstruating and become pregnant, and reached sexual maturity, she can safely give birth to a baby, Dr. Skop said. Texas never repealed its original law prohibiting abortion except when the life of the mother was in danger after Roe. Dr. Palmer, the obstetrician in Fort Worth, said that one of her patients was trying to get pregnant after the new law went into effect, and she had consensual sex with her partner. They now had some of the symptoms they needed to show the infection was getting worse. Dr. Lauren Thaxton, an OB-GYN and assistant professor at the Dell Medical School at the University of Texas-Austin, has already heard about local patients who have been miscarrying, and couldn't get a pharmacy to fill their misoprostol prescription. She was diagnosed with an aggressive lymphoma, a cancer of the immune system. not include an abortion that uses suction to dismember the body of an unborn child by sucking pieces of the unborn child into a . 9:42 AM on Jul 1, 2022 CDT. Elizabeth's experience amounts to a kind of medical trauma, which is layered on top of the grief of pregnancy loss, says Elaine Cavazos, a psychotherapist specializing in the perinatal period, and the chief clinical officer of Reproductive Psychiatry and Counseling in Austin. An IUD can make menstruation irregular, and she did not realize she had conceived until after the six-week mark. "I was just laying in bed, you know, wondering: Am I pregnant or am I not pregnant? "To them my life was not in danger enough.". 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.'". 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. Photograph: Esteban Flix/AP "This poor woman had no idea what she was telling me. And it had to smell foul, really bad. Julia Robinson for NPR Mark Felix/AFP via Getty Images Because once they reached Methodist, while they were still checking in at the emergency room, her doctor called. And she says 'Yes. Losing a pregnancy is a particular kind of loss, one that tends to make other people even health professionals uncomfortable. Due to her history of hemorrhaging, Seewald added that passing the pregnancy at home didn't seem like a good option. A miscarriage is generally defined as the loss of a fetus before the 20th week of pregnancy typically because of complications outside of a patient's control. After talking with James, they both agreed they should end the pregnancy. Since the Texas laws include a stipulation that there must be intent to induce an abortion, Mayo said that he'd advise physicians and other clinicians to closely document the rationale for medical care, whether it's to treat a miscarriage or an ectopic pregnancy. She had cramps, and was passing clots of blood. Abortion is permitted in Texas after six weeks only when a woman is facing a life-threatening or disabling medical emergency linked to her pregnancy. "You know they paint this woman into being this individual that doesn't care about her life, doesn't care about the life of the children she creates or whatever. It was just the most tender moment, she said. Once inside the car, they both burst into tears, for their baby and the terrible choices they were now left to navigate. "It's this woman who was saying 'Hi Miss Weller, you're at the 19 week mark. When the couple moved from Washington state to Texas in 2021, they were trying to . July 20, 20225 PM Central. According to a letter from the Texas Medical Association, a physician in Central Texas was instructed not to treat an ectopic pregnancy until it ruptured, which can cause serious medical complications. 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. Patients experiencing miscarriage have also struggled to get prescriptions filled for misoprostol, which is used both to treat miscarriages and induce abortions. I think most people would give tremendously leeway to that. One persons emergency may not be another persons emergency, said Dr. Robert Carpenter Jr., an obstetrician in Houston. An ectopic pregnancy, which occurs when a fertilized egg . Elizabeth and James look at clothes that were meant for their baby, whom they lost in the second trimester of pregnancy. It is the Cedar River Clinics in Renton, Washington, not the Cedar River Clinic in Seattle. 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. She felt lost and confused. "You have to ask yourself, would I put any living thing through the pain, and the horrors, of having to try to fight for their life the minute that they're born?". ABACA. Many offer no exemptions for rape, incest or fetal anomolies. This article originally appeared on Austin American-Statesman: Here's what current Texas abortion laws say, plus birth control info Under Texas law, doctors can be sued by almost anyone for performing an abortion. The pink-sheeted crib is still set up in the nursery, filled with all the baby supplies theyd bought or been gifted that they now have no use for. Julia Robinson for NPR 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 . It was because of the state law which forbids termination of a pregnancy as long as there is fetal cardiac activity. Her water had broken midway through the pregnancy, but her doctors, fearing prosecution if they violated the abortion ban, did not begin treating her until the fetuss heart stopped on its own. 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 . tex. Hall, raised in a conservative Christian family outside Dallas, felt like she had whiplash from the sudden and tragic events that had brought her to an abortion clinic halfway across the country. Hall was outraged about the world that her daughter was going to be born into, but she didnt worry too much about how this would affect her pregnancy. One Texas law passed last year lists several medications as abortion-inducing drugs and largely bars their use for abortion after the seventh week of pregnancy. Or in cases of rape or incest? As the Supreme Court appears poised to return abortion regulation to the states, recent experience in Texas illustrates that medical care for miscarriages and dangerous ectopic pregnancies would also be threatened if restrictions become more widespread. 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. The color was darker and the odor was foul. I need you to give me the facts.'". The crisis the Wellers endured is emblematic of the vast and perhaps unintended medical impacts of the criminalization of abortion in Republican-led states. Seventeen weeks into the pregnancy, they learned they were expecting a girl. 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. 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 . John Seago, legislative director for Texas Right to Life, described this type of hesitation as "an awful misunderstanding of the law." UPDATE: The Supreme Court voted 5-4 to deny an emergency appeal from abortion providers and reproductive rights groups to block the " Texas Heartbeat Act ," or Senate Bill 8 (SB 8). "He and I kept telling each other 'What is the whole point of the Hippocratic oath to do no harm?'" James and Elizabeth cried out their thanks to the doctor. She knew she did not have the flexibility to be able to travel out of state for an abortion later on. Elizabeth chose to go home rather than wait to get sick at the hospital. But it is also affecting women who have no desire for termination but are experiencing medically risky pregnancies. She and her husband booked outrageously expensive last-minute flights, got a hotel and, four days after they got the news that upended their world, flew out of Dallas/Fort Worth International Airport. Earlier this month, Gov. I'm so sorry,'" Elizabeth says. The risks to Elizabeth's health were simply too high. Or, like Hall, they can shell out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. In Texas, a 2021 law made it easier to sue anyone who helps a person get an abortion after about six weeks of pregnancy. "And if you leave it up to individuals, you're going to get uncertainty and people unwilling to make decisions. It was someone else at Methodist Hospital, perhaps a clerk, calling to go over some paperwork. Hall went on to become a nurse and, together with her husband, created a life in the same town where they both grew up. This represents more confusion around state policy. "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? For a fetus at 18 weeks, the chance of survival in that state is almost nonexistent, according to Peaceman: "This is probably about as close to zero as you'll ever get in medicine.". To the extent anybody is delaying or denying care for ectopic pregnancy, they are simply misunderstanding the law, Grossman said. This current law excludes treatment for miscarriage or ectopic pregnancy. So I'm here to call you to register for your delivery on October 5th, so I can collect all your insurance information. "I told her 'I'm so sorry. Its been a difficult few weeks since the procedure. Treatment of ectopic pregnancy is not prohibited by Texas' abortion laws. Many doctors say they are unable to discuss the procedure as an option until the patients condition deteriorates and her life is at risk. She considered Colorado and New Mexico, the nearest states without a total ban, but both states are being inundated with patients from Texas and elsewhere. This is already incredibly difficult news that someone receives, Thoppil said. Elizabeth Weller never dreamed that her own hopes for a child would become ensnared in the web of Texas abortion law. Many Texans facing this same set of circumstances wont have the means to leave the state, Thoppil said, contributing to the states high rates of maternal morbidity and mortality, particularly among communities of color. James rushed home from work and drove Elizabeth to the nearby Woodlands Hospital, part of the Houston Methodist hospital system. ", "Let's say I do have to go through this situation again. . For patients who are not pregnant, it can also open up the cervix and make surgeries safer, Crawford said. Wade and the return of laws governing abortion legality to the states. This chapter contains a variety of laws related to abortion. "Most women would find it extremely difficult and emotionally very challenging. Texas abortion laws penalize the person who performs an abortion and, under a state law from 1925, anyone who furnishes the means for an abortion. Elizabeth and James keep remembrances of their baby in a picture frame at home. Dr. Ingrid Skop, an obstetrician in San Antonio who belongs to the American Association of Pro-Life Obstetricians and Gynecologists, said that even a girl as young as 9 or 10, impregnated by a father or a brother, could carry a baby to term without health risks. Consider the patient whose miscarriage care is delayed and develops a serious infection and other complications, Prager said. I knew something was wrong.. Crescenda Uhles, a genetic counselor in Dallas, said the Texas law puts people like her in a bind when advising patients. Whether terminating an ectopic pregnancy is legal will depend on individual state laws. 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. One of the most painful parts was trying to reach her medical team. The staff remained vague about what came next, Elizabeth recalls. Thankfully, I think theres still plenty of pharmacies that understand the proper utilization of some of the medications we use for nonelective [pregnancy] terminations.. 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. 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. She recalls looking at her baby's little hands and crying. "I wouldn't say this is true for our practice," he said. She places the blame for the ensuing medical trauma on the Republican legislators who passed the state's anti-abortion law, on Texas Gov. In this chapter: (1) "Abortion" means the act of using or prescribing an instrument, a drug, a medicine, or any other substance, device, or means . But that comes with the same significant risks that accompany a viable pregnancy, said Dr. CeCe Cheng, a high-risk OB-GYN in San Antonio. The women who will be forced to carry these babies are the women with less resources, he said. "Later they laid down this beautiful baby girl in my arms. At 6 weeks, many people . Im a nurse. (1) the immediate abortion of her pregnancy without the delay necessary to determine the probable post-fertilization age of the unborn child; (2) the abortion of her pregnancy even though the post-fertilization age of the unborn child is 20 or more weeks; or (3) the use of a method of abortion other than a method described by Section 171.045(b). She and her husband immediately jumped into planning mode, scheduling an appointment at one of the only OB-GYN practices in town. The patient ended up driving 15 hours to New Mexico for life-saving treatment after no one in Texas would help her. On Saturday, May 14, about 2 a.m., she gave birth. But I need you to tell me the truth, because I don't think all the positive things that they're telling me are real. They had bought a house in Kingwood, a lakeside development in Houston. Very young rape victims tend to seek prenatal care late, and they are more likely to have small babies that score poorly on tests of heart rate and muscle tone given immediately after birth. I have a code of ethics to uphold, and that is making sure I discuss with my patients all of their options, regardless of what is available in their area, Ms. Uhles said. But even from a young age, she had a lot of questions about what she saw as a deeply unforgiving idea. ", And at this particular point in her life, pregnant for the first time at age 26, it was still somewhat abstract: "I had not been put in a position to where I had to weigh the real nuances that went into this situation. 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. In 2012, a woman died in Ireland after her waters broke at 17 weeks and doctors refused to give her an abortion. Family members hold photos of Olga Reyes, a 22-year-old law student who died of an untreated ectopic pregnancy in Nicaragua in 2007. It went into effect on Sept. 1. 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. Texas new measure was intended to impose stringent limits on abortion. The American College of Cardiology and the American Heart Association, for example, advise women with certain congenital heart conditions to avoid pregnancy altogether, as they are at higher risk of illness or death shortly after giving birth. With abortion laws in Texas about to change, The Dallas Morning News is answering your questions about what to expect without the protections established in Roe vs . For example, last year's Texas Heartbeat Law incorporated Texas' Health & Safety Code 245.002, which states (emphasis added): 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. In one case, a central Texas hospital reportedly told a physician not to treat an ectopic pregnancy until it ruptured, the letter said. "But I have certainly heard discussion among physicians that they're very hesitant to do any kind of intervention until they're absolutely certain that this is not possibly a viable pregnancy even though the amount of bleeding would warrant intervening because it's a threat to the mother's life.". They have jobs and multiple children to take care of and they dont have the finances to take four or five days to go to a different state. The Supreme Court is expected to rule soon on whether abortion providers and the Biden administration may challenge the law notwithstanding its novel structure. "And yet we were. A wait for fetal death, or her own encroaching illness. Once she made her way through the clinics stringent security, the nurses took her into a private room. But in other situations, he said, providers may need to intervene to stop bleeding and make sure no pregnancy tissue remains, as a guard against infection. She knew the doctors at the practice were both proud members of the American Association of Pro-Life Obstetricians and Gynecologists, but she waved it off. In September, the justices turned down an emergency request to block the law. How are you doing, and are you excited for the delivery?'". The other miscarriage treatment is a procedure described as surgical uterine evacuation to remove the pregnancy tissue the same approach as for an abortion. A more common scenario also raises difficult questions, said Dr. Ghazaleh Moayedi, an obstetrician and gynecologist in Texas who provides abortions. In this case, the woman had the means to travel, and she obtained an abortion in another state, an option unavailable to many low-income and working class women. It's an emotional and legal dilemma that potentially faces not just obstetricians and midwives, but also family physicians, emergency physicians, pharmacists, and anyone else who might become involved with pregnancy care. Because at this point, I'm in survival mode. hide caption. ", Her waters had broken, launching her into what she calls a "dystopian nightmare" of "physical, emotional and mental anguish." The patient lost liters of blood and had to be put on a breathing machine because of the 24-hour delay in care. You open it. Right away, she ran into obstacles because of the Texas law. Laws modelled on Texas's S.B. Most recently, the Oklahoma Senate passed six abortion-limiting bills , including one that would ban abortions after 30 days from a woman's last . And I told her 'I'm so sorry. She was due just a few days before Christmas. In fact, no abortion law in any state in America prevents lifesaving treatment for women with ectopic pregnancies and other life-threatening conditions . From Thursday through Saturday, Sept. 22-24, in downtown Austin, TribFest attendees will enjoy three days full of mind-expanding events, conversations and panels featuring more than 350 big names including Chris Bosh, Pete Buttigieg, Liz Cheney, Annette Gordon-Reed and many others. She ate a healthy breakfast, went for a walk outside and came back home. "The care providers are treading on eggshells. An oncologist urged the woman to start treatment immediately, but the chemotherapy regimen would have been toxic to the fetus. Confusion around the laws has caused issues for patients outside of emergencies. Texas Gov. Post-Roe v. Wade, abortion bans may keep doctors from providing timely, necessary care. She recalls looking at her baby's little hands and crying. The fetus had a rare neural tube defect. 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. 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