Photograph: Esteban Flix/AP Under Texas law, doctors can be sued by almost anyone for performing an abortion. Sometimes patients don't realize that they have lost the pregnancy until they come in for a checkup and no cardiac activity can be detected, said Dr. Emily Briggs, a family physician who delivers babies in New Braunfels, Texas. "The penalties are quite draconian," he said, noting that someone could be convicted of a felony. Things did go fairly smooth at first. For example, in rare cases an infection can make the amniotic sac rupture before the fetus is viable. At that point, the patient can opt to wait until the bleeding starts and the pregnancy tissue is naturally released, Briggs said. She had the proof. "I can tell that she's been beat down, because she has been trying to fight for me all day, advocating on my behalf," Elizabeth says. Nitashia Johnson for The New York Times. They have private waiting rooms for these patients and offer grief support, genetic counseling and even bereavement services, including ways to memorialize the lost pregnancy. ", 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. Seek help right away for signs of ectopic pregnancy your doctor can talk you through next steps. I'm trying to mentally survive this.". They now had some of the symptoms they needed to show the infection was getting worse. All the changes your body faces in pregnancy are going to be very similar, no matter if your fetus is viable or whether the baby wont survive on the outside, said Cheng, who is also a fellow at Physicians for Reproductive Health. the U.S. that have trigger laws in place banning abortion in the . As a clinic that offers second-trimester abortions, Cedar River Clinics in the Renton, Washington has always seen a good number of patients from states with more restrictive laws, said clinic communications director Mercedes Sanchez. It just didnt occur to them that a ban would include cases like this.. Yet under the new law, Dr. Thoppil felt he could not counsel her on terminating the pregnancy. 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. How do they follow the latest guidelines when numerous other people from other medical professionals to friends and family members can question their intent: Are they helping care for a miscarriage or facilitating an abortion? KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Elizabeth has been sharing her story, and has found that whatever the political affiliation of the listener, they all agree her experience was horrible. 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 are legal under Texas's abortion law. How are you doing, and are you excited for the delivery?'". The next day, a Thursday, she started throwing up. But first, shes focused on her mental health and getting through the next few months. 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. James and Elizabeth cried out their thanks to the doctor. We never advocate taking a life of an unborn child unless it is necessary to protect the life of a woman, said Joe Pojman, executive director of the Texas Alliance for Life. In a sudden obstetrical emergency, a termination might be the least risky option, clinically. There has been apprehension by doctors about dealing with both of those two issues, Abbott told Fox 4 News. She had cramps, and was passing clots of blood. But Prager believes that the laws in Texas and perhaps elsewhere soon . Hall was in her second trimester when the U.S. Supreme Court overturned Roe v. Wade, ending the constitutional protection for abortion and allowing states to set their own laws governing abortion access. But then an overwhelming sense of calm washed over her. Im a nurse. New, untested abortion bans have made doctors unsure about treating some pregnancy complications, which has led to life-threatening delays and trapped families in a limbo of grief and helplessness . 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. They don't want to get sucked into a legal morass. Eventually, she found a clinic near Seattle that provides specialty care for patients who have decided to terminate due to lethal fetal abnormalities. 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. Sign up for The Brief, our daily newsletter that keeps readers up to speed on the most essential Texas news. "I said 'Well, is there a heartbeat still?' One reason is that amniotic fluid plays a key role in fetal lung development. Dr. Jennifer Liedtke, a family physician in Sweetwater, Texas, who delivers about 175 babies annually, no longer sends misoprostol prescriptions to the local Walmart. I couldn't give you life. She was admitted to the hospital, and later that night, when her own obstetrician called, she begged her for information. [1/2] Pro-choice and anti-abortion both demonstrate outside the United States Supreme Court as the court hears arguments over a challenge to a Texas law that bans abortion after six weeks in . He said the association has been in communication with some pharmacy leaders to help clarify proper interpretation of the rules.. She felt lost and confused. No one really knows what the legislature means by that, and they are afraid of overstepping. The Supreme Court is expected to rule soon on whether abortion providers and the Biden administration may challenge the law notwithstanding its novel structure. Their conundrum became painfully, distressingly clear: wait to get sicker, or wait until the fetal heartbeat ceased. But in cases of unviable pregnancies in which fetal cardiac activity can still be detected, treatment to remove the expected miscarriage could be considered illegal under Texas laws, Grossman said. Elizabeth's pregnancy crisis began and ended weeks before June 24, when the U.S. Supreme Court struck down the federal right to abortion in its Dobbs v. Jackson ruling. It was May 10, 2022. Instead, the patient may choose medication or a surgical evacuation procedure, which Briggs said may prove necessary anyway to avoid a patient becoming septic if some of the tissue remains in the uterus. It is life-threatening to the mother and is not viable and needs to be removed. A doctor hugs a patient at an abortion clinic in Santa Teresa, New Mexico, on 13 January 2023. Even in Texas, whose "heartbeat bill" was one . The law makes no exceptions for nonviable pregnancies in which the fetus has no chance of survival. Not only will the fetus not survive long-term, but "eventually, it ruptures the tube and the tube doesn't have the ability to contract like the uterus does to shut off the flow of blood, and so it keeps bleeding and bleeding," says Dr. Ingrid Skop, an OB-GYN in Texas . 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. But when she called, they told her that nausea and vomiting weren't among the symptoms they were looking for. "They can absolutely do that.". 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. But Prager believes that the laws in Texas and perhaps elsewhere soon could boost physicians' vulnerability to medical malpractice lawsuits. Although distraught and heartbroken at this news, Elizabeth forced herself to think it through. hide caption. 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. Due to her history of hemorrhaging, Seewald added that passing the pregnancy at home didn't seem like a good option. Or hell honestly it shouldn't even get to the point where you're having to save a woman's life. CONROE, Texas (KTRK) -- A Conroe woman who suffered a miscarriage says the state's restrictive abortion laws forced her into a dangerous health situation. Given the states severe penalties, Grossman said medical professionals and their legal teams might err on the side of caution in regard to the law, even if it puts patients at risk. It also sets out civil, criminal, and professional penalties for abortion providers who violate the law. We both have good jobs, weve got a house and we were at a place where if it happens, it happens, she said. Crawford, the OB/GYN and fertility clinic co-founder, said shes seen instances of pharmacies not wanting to fill prescriptions for certain medications that are related to abortions but being used for other treatments. "It's this woman who was saying 'Hi Miss Weller, you're at the 19 week mark. The abortion clinic is less than a mile from Texas, where abortion is illegal. Texas providers are still adjusting to other ripple effects that affect patient care. ", "Because that doesn't really exist right now," he added. She took a swipe of the new discharge, and placed the toilet paper in a Ziploc bag to carry with her. She took a pregnancy test soon after she missed her period and found out that she had conceived. 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. A miscarriage is generally defined as the loss of a fetus before the 20th week of pregnancy typically because of complications outside of a patients control. Disclosure: Texas Medical Association and University of Texas at Austin 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. And quickly. But even from a young age, she had a lot of questions about what she saw as a deeply unforgiving idea. "I was born with a physical disability. 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. You dont get a lot of time to respond, and if you dont respond quickly enough, your patient expires.. Hall had to travel to Washington state for an abortion after receiving a lethal fetal diagnosis, for which Texas abortion laws make no exception. This article originally appeared on Austin American-Statesman: Here's what current Texas abortion laws say, plus birth control info Family members hold photos of Olga Reyes, a 22-year-old law student who died of an untreated ectopic pregnancy in Nicaragua in 2007. 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 . 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. The Biden administration last week told hospitals they must treat pregnant patients who need an abortion to stabilize a life-threatening condition. They told her the signs of a more severe infection would include a fever of 100.4 degrees and chills. I am still going to tell my patients the information they need., Texas Abortion Law Complicates Care for Risky Pregnancies, https://www.nytimes.com/2021/11/26/health/texas-abortion-law-risky-pregnancy.html, We cant do anything unless the mom is sick, said Dr. Andrea Palmer, an obstetrician in Fort Worth. 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. Nitsch says she chose sterilization at age 36 rather than risk getting pregnant by another rapist. But the language is ambiguous, and travel can be expensive and onerous for pregnant women, especially if they are unwell. 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. 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. For doctors treating such patients, the Texas law creates quite a conundrum, Dr. Snyder said. Elizabeth Weller never dreamed that her own hopes for a child would become ensnared in the web of Texas abortion law. And now the Texas abortion law has created an additional bind, Cavazos explains. Its our 10th year participating in Amplify, and to celebrate, weve got $15,000 in matching funds from four generous Tribune supporters. It is a horrible gamble that we are making Texas women go through.". A wait for fetal death, or her own encroaching illness. Her discharge had to be darker. . I was so excited for this appointment because its so good to see her in there, she said. Ectopic pregnancy develops in an estimated 2% of reported pregnancies. 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. The laws supporters say that it provides sufficient leeway for physicians to act if a mothers life or bodily functions are compromised, and they insist those cases are rare. It is disingenuous to allege that this law prevents obstetricians from following the medical standard of care, she said. And theyve had to navigate complicated politics when sharing their news. As Hall learned the hard way, the law makes no exception for lethal fetal anomalies. While another law enacted last year forbids dispensing and shipping abortion-inducing medications like misoprostol, mifepristone and methotrexate past seven weeks of a pregnancy, it makes exceptions for when the drugs are used for other medical reasons.. Eventually, she laid out their options: Keep carrying the pregnancy or leave Texas to get an abortion. Seventeen weeks into the pregnancy, they learned they were expecting a girl. Amplify your impact and donate now. DEFINITIONS. If someone is hemorrhaging while miscarrying, how long do I have to wait?. 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 Poland, protests over that countrys abortion laws erupted this year after a 30-year-old pregnant woman died of septic shock. 245.001. And it had to smell foul, really bad. The ob-gyn, who said she could not speak to the media, laid out two options, according to Elizabeth. Most recently, the Oklahoma Senate passed six abortion-limiting bills , including one that would ban abortions after 30 days from a woman's last . Elizabeth could not receive the medical care she needed until several days later because of a Texas law that banned abortion after six weeks. At 6 weeks, many people . Those can be acute life-threatening emergencies, she said. And they're telling me to think of the positives. Sign up for The Brief, our daily newsletter that keeps readers up to speed on the most essential Texas news. As Friday dragged on, Elizabeth started wondering if maybe the heartbeat had stopped. How theyd told their families, picked out a name, built a crib and bought pink sheets. And she says 'Yes. She places the blame for the ensuing medical trauma on the Republican legislators who passed the state's anti-abortion law, on Texas Gov. Consider the patient whose miscarriage care is delayed and develops a serious infection and other complications, Prager said. 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. "It is a pro-life position to allow physicians to make those life-and-death decisions," Seago said. Texas Attorney General Ken Paxton quickly sued the Biden administration over the federal guidance. Because once they reached Methodist, while they were still checking in at the emergency room, her doctor called. Hall was in her second trimester when the U.S. Supreme Court overturned Roe v. Wade. Confusion around the laws has caused issues for patients outside of emergencies. ", State abortion laws are complicating other types of obstetric care. A Texas judge's decision that could revoke the FDA's approval of abortion drugs is expected soon. But she was too scared to tell health care providers what was going on for fear that they would know she was considering an abortion. 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.'". 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. Another pending ban, a so-called "trigger law" passed by Texas in 2021, is expected to go into effect within weeks. Elizabeth touches the urn of her daughter. Texas never repealed its original law prohibiting abortion except when the life of the mother was in danger after Roe. care provider and intended to remove an ectopic pregnancy that . They were just all shocked, like, Surely, theres an exception for this, Hall said. It is the Cedar River Clinics in Renton, Washington, not the Cedar River Clinic in Seattle. You can reach them at 212-255-9252. Such testing is done late in pregnancy, beyond the six-week limit, noted Crescenda Uhles, a genetic counselor in Dallas. Took no time at all.. She wanted them to experience the agony she felt when she learned that her fetus was developing without a skull or a brain, a condition her doctors told her was incompatible with life.. I couldn't give you life. 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. The brain would not develop, and the infant would die at birth or shortly afterward. I'm so sorry,'" Elizabeth says. She recalls looking at her baby's little hands and crying. After one conversation, the doctor returned to her bedside. Elizabeth and James keep remembrances of their baby in a picture frame at home. 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.. We do what we can to honor each of those cases.. You open it. But studies show that pregnant teenagers are more prone than older women to developing a dangerous condition called pre-eclampsia, and they are more likely to have preterm deliveries, small babies and stillbirths. Elizabeth and James Weller at their home in Houston two months after losing their baby girl due to a premature rupture of membranes. Myth 5: Treatment for ectopic pregnancy is considered an abortion, and thus many women will likely die from lack of treatment in states where abortion is illegal. Texas Health and Safety Code, Chapter 245. Because the providers have a choice whether to provide and the patients are the ones who need the care. But she did not know who the biological father was. Elizabeth and James look at clothes that were meant for their baby, whom they lost in the second trimester of pregnancy. Since the Supreme Court ruling of June 24, 2022 that overturned Roe v. Wade, many states have banned abortion, or severely restricted abortion access. "At first I was really enraged at the hospital and administration," she says. 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. Her mental health spiraled to the point that she considered checking herself into the hospital. Losing a pregnancy is a particular kind of loss, one that tends to make other people even health professionals uncomfortable. At the office, her ob-gyn turned down the ultrasound volume so they wouldn't have to hear. And a tubal ectopic pregnancy, let's say, is clearly excluded. But he did not address the question of lethal fetal anomalies, which are fatal for the fetus during pregnancy or shortly after birth. Frustrated with her experience on hormonal birth control, she and her husband decided it was time for her to get off of it. 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. hide caption. 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. 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. "This poor woman had no idea what she was telling me. 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, she said. They're not allowed to do that in Texas. 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. Miscarriages occur in roughly 1 out of 10 pregnancies. But Im still so angry I had to leave.. Such a rupture can be life-threatening. "I was just laying in bed, you know, wondering: Am I pregnant or am I not pregnant? This can occur as early as two weeks after a missed period, when most women do not yet know they are pregnant. In Texas it's literally written in the law that an act is not an abortion to remove an ectopic 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. Hall and her husband would like to try again at some point. She would either have to get sick enough for . A recently scanned monitor shows a patients ultrasound at the Family Birth Center at Beaumont Hospital in Royal Oak, Michigan, in February 2022. They also had an anatomy scan, which revealed no problems. Pregnancies can be complicated by any number of medical conditions. The bill makes no exceptions for pregnancies that resulted from rape or incest. Medical v. legal . 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. "Most women would find it extremely difficult and emotionally very challenging. 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 . 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. I need you to give me the facts.'". 8, which encourages private citizens to file lawsuits against anyone who facilitates an abortion, will proliferate, giving self-appointed vigilantes no shortage of . One of the most painful parts was trying to reach her medical team. 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 . I couldnt do that., by Eleanor Klibanoff As a subscriber, you have 10 gift articles to give each month. More than ever, I think people, patients really need to be extremely well-informed and really aggressive about advocating for their own health because the system right now is basically designed to fail, she said. But in early May, not long after the uneventful anatomy scan, the Wellers suddenly arrived at that crossroads. When Roe v. Wade fell in June, Elizabeth's pain and anger surged up again. Hall shelled out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. But Texas's medical exception is narrower, and less defined . I'm so sorry.". 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). 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. 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. I'm so sorry,'" Elizabeth says. 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. The next day, Elizabeth's ob-gyn came to the hospital to arrange the procedure. For example, last year's Texas Heartbeat Law incorporated Texas' Health & Safety Code 245.002, which states (emphasis added): Double your gift when you give by 6 p.m. Thursday. 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