Julia Robinson for NPR 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. How theyd told their families, picked out a name, built a crib and bought pink sheets. Patients experiencing miscarriage have also struggled to get prescriptions filled for misoprostol, which is used both to treat miscarriages and induce abortions. There has been apprehension by doctors about dealing with both of those two issues, Abbott told Fox 4 News. Texas new measure was intended to impose stringent limits on abortion. The ethics panel had reached a decision, the doctor told them. ", As states ban abortion, the Texas bounty law offers a way to survive legal challenges, Texas conservatives have a plan to get around DAs who won't enforce abortion laws. Not doing so can, in some circumstances, kill all of the fetuses. Among other risks, both the fetus and Elizabeth were now highly vulnerable to a uterine infection called chorioamnionitis. A more common scenario also raises difficult questions, said Dr. Ghazaleh Moayedi, an obstetrician and gynecologist in Texas who provides abortions. Supporters of the law say their goal is to save the life of every embryo, regardless of the circumstances of conception. Still, states like Missouri could put this pro-abortion talking point to rest by protecting treatment of ectopic pregnancy explicitly in the law. But it is also affecting women who have no desire for termination but are experiencing medically risky pregnancies. It just seems cruel and unusual.. 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. To the extent anybody is delaying or denying care for ectopic pregnancy, they are simply misunderstanding the law, Grossman said. He said the association has been in communication with some pharmacy leaders to help clarify proper interpretation of the rules.. "I said 'Well, is there a heartbeat still?' Julia Robinson for NPR Texas Attorney General Ken Paxton quickly sued the Biden administration over the federal guidance. It is an editorially independent operating program of KFF (Kaiser Family Foundation). She recalls looking at her baby's little hands and crying. judicial order, all other provisions of Texas law regulating or I think most people would give tremendously leeway to that. 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. The color was darker and the odor was foul. Back at home, the Wellers got more serious about their travel plans and started booking tickets. She and her husband began trying in late 2021. The new law in Texas bans abortion at 6 weeks when a fetal "heartbeat" can be detected. She places the blame for the ensuing medical trauma on the Republican legislators who passed the state's anti-abortion law, on Texas Gov. 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. "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?". 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. Sign up for The Brief, our daily newsletter that keeps readers up to speed on the most essential Texas news. "Being pregnant in a state like Texas is a dangerous . 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. Many state laws with new restrictions on abortion make exceptions for ectopics, but uncertainties can arise if a fetus implants on Caesarean scar tissue on the uterus wall or if it cannot be . Texas is the state weve seen the biggest increase from, Sanchez said. The other option is called expectant management, in which Elizabeth would stay in the hospital and try to stay pregnant until 24 weeks, which is considered the beginning of "viability" outside the womb. We usually have our moms register for delivery at this point. Elizabeth and James Weller at their home in Houston two months after losing their baby girl due to a premature rupture of membranes. Financial supporters play no role in the Tribune's journalism. As a result, she was checked into a hospital and underwent a D&C. However, after the overturn of Roe v. Wade in June 2022, abortion laws and restrictions are now implemented by state, resulting in trigger laws or complete bans. ", 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 now had some of the symptoms they needed to show the infection was getting worse. This is already incredibly difficult news that someone receives, Thoppil said. An ultrasound confirmed that she had suffered premature rupture of membranes, which affects about 3% of pregnancies. In other cases, a pregnant womans medical needs may conflict with those of her fetus. 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. An ectopic pregnancy is when a fertilized egg implants outside the uterus, typically in one of the woman's fallopian tubes. I would consider what I experienced that weekend a medical emergency.. forbids dispensing and shipping abortion-inducing medications, rheumatic illnesses, inflammatory bowel disease, psoriasis and cancer. care provider and intended to remove an ectopic pregnancy that . Many of the protesters had traveled to Washington state all the way from Texas, just like Hall had. A Texas judge's decision that could revoke the FDA's approval of abortion drugs is expected soon. 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. Such testing is done late in pregnancy, beyond the six-week limit, noted Crescenda Uhles, a genetic counselor in Dallas. Because the providers have a choice whether to provide and the patients are the ones who need the care. The new law does not apply to removing ectopic pregnancies that implant outside the uterus, which are not considered abortions under state law. 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.. The pregnancy made it impossible to remove the device, Dr. Thoppil said. 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. Updated: Oct. 24, 2022. Even if the mothers life is saved, Dr. Moayedi added, she could require an emergency hysterectomy, or removal of the uterus, which would leave her infertile. The next day, a Thursday, she started throwing up. One persons emergency may not be another persons emergency, said Dr. Robert Carpenter Jr., an obstetrician in Houston. When the couple moved from Washington state to Texas in 2021, they were trying to . I'm actually headed home right now because I have to await my dead baby's delivery.' 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 to save the life of the pregnant patient. Elizabeth and James look at clothes that were meant for their baby, whom they lost in the second trimester of pregnancy. But even from a young age, she had a lot of questions about what she saw as a deeply unforgiving idea. After holding it together all morning, Hall burst into tears. 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. other than an abortion performed due to a medical emergency as defined by Section 171.002, Health and Safety Code]. This law will prohibit almost all abortions. But those numbers have skyrocketed since Roe v. Wade was overturned. James rushed home from work and drove Elizabeth to the nearby Woodlands Hospital, part of the Houston Methodist hospital system. a letter from the Texas Medical Association. "It's terrible," says Dr. Alan Peaceman, a professor of maternal-fetal medicine at Northwestern University's Feinberg School of Medicine. "I told her 'I'm so sorry. "And yet we're being pulled through this.". After her initial miscarriage in 2018, Stell and her husband had their first child, a daughter, in April 2020. Dr. John Thoppil, an obstetrician in Austin, doesnt perform abortions, providing prenatal care and delivering babies. "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.". Right away, she ran into obstacles because of the Texas law. Nitsch says she chose sterilization at age 36 rather than risk getting pregnant by another rapist. "At first I was really enraged at the hospital and administration," she says. But then an overwhelming sense of calm washed over her. But its not just the physical changes, but the emotional toll of knowing their baby is not going to survive and just waiting for something to happen so they can get the care they need.. About 10% to 20% of confirmed pregnancies end in miscarriages, but estimates are as high as 30% to 50% for all pregnancies, including those in which a person may not know of the pregnancy. And she says 'Yes. [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 . The new abortion bans or the old laws being resurrected in a post-Roe world are rigidly written and untested in the courts. 5:22-cv-185-h (n.d. "I ripped my organs out" to avoid that, she said. Nitashia Johnson for The New York Times. 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. But Prager believes that the laws in Texas and perhaps elsewhere soon . Or, like Hall, they can shell out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. 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. Her discharge had to be darker. Dr. John Thoppil, president of the Texas Association of Obstetricians and Gynecologists, said doctors usually note a diagnosis when prescribing medicines, and prescription rejections dont appear to be widespread. 7:49 PM on Jul 14, 2022 CDT. They had to call their OB/GYN repeatedly to get the $500 delivery deposit refunded. The brain would not develop, and the infant would die at birth or shortly afterward. Under another new Texas abortion law, someone who "aids or abets" an abortion after cardiac activity can be detected typically around six weeks can be subject to at least a $10,000 fine per occurrence. All you can do now is just hope and pray that things go well.". Took no time at all.. Those can be acute life-threatening emergencies, she said. You smell it yourself. ", State abortion laws are complicating other types of obstetric care. 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. Unnamed, unknown doctors somewhere had come to an agreement that Elizabeth could be induced that night. 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. The Texas law, which is also called Senate Bill 8, carves out an exception for termination in a medical emergency, which is defined in the states health code as a life-threatening physical condition caused or aggravated by pregnancy that places the woman in danger of death or a serious risk of substantial impairment of a major bodily function.. In 2012, a woman died in Ireland after her waters broke at 17 weeks and doctors refused to give her an abortion. 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. 8, which encourages private citizens to file lawsuits against anyone who facilitates an abortion, will proliferate, giving self-appointed vigilantes no shortage of . The Biden administration last week told hospitals they must treat pregnant patients who need an abortion to stabilize a life-threatening condition. Almost immediately, though, Texas conflicting and confusing laws on abortion started to cause problems for pregnancy care. But as has been true in Texas and in many of the 12 other states where abortion is currently . 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. It is life-threatening to the mother and is not viable and needs to be removed. 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. She took a pregnancy test soon after she missed her period and found out that she had conceived. If she wanted to stay in Texas, Halls only choice was to continue with a pregnancy that would not yield a healthy, living baby. If youre having severe pain, if youre getting a fever, you need to keep your medical team in the loop, Crawford said. A fertilized egg can't survive an ectopic pregnancy and can result in life-threatening bleeding, according to the Mayo Clinic. I was so excited for this appointment because its so good to see her in there, she said. Treatments for miscarriages and ectopic pregnancies are still legal under the states abortion ban, according to state law and legal experts. Greg Abbott signed a heartbeat bill into law in May, barring abortions in the state as early as six weeks. 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.. These provisions are in Chapter 170A of the Texas Health & Safety Code, which was enacted by House Bill 1280 in 2021. But the most confusing development involves the exemptions that exist for the woman's life or health, or because of a "medical emergency." Double your gift when you give by 6 p.m. Thursday. 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. She had the proof. Their daughter, as expected, was stillborn. Most of these pregnancies end in miscarriage or stillbirth. 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. (Texas Hospital Licensing Law); (3) an institution required to be licensed under . And I told her 'No, ma'am. Just a few months before the Texas legislature passed the new law, Dr. Robert Gunby Jr., an obstetrician in Dallas, was caring for a pregnant newlywed who suddenly started losing weight. Texas law reflects this important distinction. But there is no definition for that term in the statute. Anyone can read what you share. I need you to give me the facts.'". 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. 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). 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. Doctors can clearly legally save a woman's . 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. The abortion clinic is less than a mile from Texas, where abortion is illegal. hide caption. Restrictive abortion laws in more states are likely to lead to more cases of patients with ectopic pregnancy being unable to secure timely, and life-saving, care. Hall had to travel to Washington state for an abortion after receiving a lethal fetal diagnosis, for which Texas abortion laws make no exception. She said Houston Methodist had convened an ethics panel of doctors, but her doctor didn't seem very optimistic. Because at this point, I'm in survival mode. It is disingenuous to allege that this law prevents obstetricians from following the medical standard of care, she said. 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 . And it had to smell foul, really bad. I knew something was wrong.. The next day, Elizabeth's ob-gyn came to the hospital to arrange the procedure. The holidays are going to be especially hard. The Wellers were pleasantly surprised when they got pregnant early in 2022. 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. 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. She was admitted to the hospital, and later that night, when her own obstetrician called, she begged her for information. You're trying to understand exactly what's going on. I'm so sorry.". After one conversation, the doctor returned to her bedside. "I told her 'Look, Doctor, people around me are telling me to keep hope. "The care providers are treading on eggshells. If a woman's life is in danger, she will be able to have an abortion. Since pharmacists rotate through that Walmart, Liedtke decided to send those prescriptions to other pharmacies rather than attempt to sort out the misunderstanding anew each time. It includes laws about. 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. And that was always the scenario I used to explain what a ban would do, and I never met a self-proclaimed conservative that doesnt think those exceptions should be in place.. Rather than warmth and sympathy, she was met with fear, hesitation and, worst of all, silence. SB 8, which was signed into law by Texas Gov. 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. Miscarriage One of the most painful parts was trying to reach her medical team. 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. Frustrated with her experience on hormonal birth control, she and her husband decided it was time for her to get off of it. Recently passed laws make abortion illegal after about six weeks into a pregnancy. An attendee holds her child during A Texas Rally for Abortion Rights at Discovery Green in Houston, Texas, on May 7. Misoprostol is used to help prevent stomach ulcers, but it can induce abortions, particularly if taken along with mifepristone. You can reach them at 212-255-9252. "I remember hearing her, from my room, speaking loudly about how nothing is being done here.". You have to suddenly leave for a medical procedure, and you dont know whats going to happen, so despite everything that made me leave, it was a relief to be back home, she said. Its our 10th year participating in Amplify, and to celebrate, weve got $15,000 in matching funds from four generous Tribune supporters. Wade and the return of laws governing abortion legality to the states. Idaho, Tennessee and Texas will implement abortion bans in 30 days, according to the text of the laws. ", "Let's say I do have to go through this situation again. In fact, no abortion law in any state in America prevents lifesaving treatment for women with ectopic pregnancies and other life-threatening conditions . 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 . She had cramps, and was passing clots of blood. An oncologist urged the woman to start treatment immediately, but the chemotherapy regimen would have been toxic to the fetus. They were just all shocked, like, Surely, theres an exception for this, Hall said. 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 . "And yet we were. 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. Methotrexate also is listed in the Texas law passed last year. Texas' new abortion laws . Coming back to Texas a few days later only amplified those feelings. July 20, 20225 PM Central. A fight began, which Elizabeth first became aware of as her doctor paced the hall outside her room, talking on her phone. Question women in America now have to ask. "Ectopic pregnancies can kill people," said Brown, a district chair for the American College of Obstetricians and Gynecologists, representing Texas. (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). 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. Sec. 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. Her mental health spiraled to the point that she considered checking herself into the hospital. This chapter may be cited as the Texas Abortion Facility Reporting and Licensing Act. Texas providers are still adjusting to other ripple effects that affect patient care. Once inside the car, they both burst into tears, for their baby and the terrible choices they were now left to navigate. She wished she could make them answer for the states near-total ban on abortions after the overturning of Roe v. Wade just a few weeks prior. 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. "Most women would find it extremely difficult and emotionally very challenging. 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. She was diagnosed with an aggressive lymphoma, a cancer of the immune system. As a subscriber, you have 10 gift articles to give each month. "It is a pro-life position to allow physicians to make those life-and-death decisions," Seago said. Either way, she saw nothing ahead but fear and grief prolonged, delayed, amplified. A recent study also reported 28 women with dangerous pregnancies at two Texas hospitals faced delays for care because fetal cardiac activity was detected, according to the AP. I looked at her little hands and I just cried. Elizabeth touches the urn of her daughter. One reason is that amniotic fluid plays a key role in fetal lung development. Her doctor said she had been calling other hospitals, but none of them would help. Doctors and experts also worry that patients with pregnancy complications may be too afraid of being accused of inducing an abortion to seek care. Texas Health and Safety Code, Chapter 171. Sign up for The Brief, our daily newsletter that keeps readers up to speed on the most essential Texas news. Lauren Hall stands for a portrait on Sept. 10, 2022, in the room that she and her husband had prepared as a nursery. "We skipped over the genetic testing offered in the first trimester," Elizabeth says. Walmart officials did not respond to multiple requests for comment. More often than not, they just say they lost the baby. But the Wellers and 28 million other Texans had already been living under a de facto abortion ban for 8 months, since September 2021. Earlier this month, Gov. And that 'you can either stay here and wait to get sick where we can monitor you, or we discharge you and you monitor yourself. 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. 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. SHORT TITLE. Hall and her husband would like to try again at some point. We see patients from many different religions and cultures, and how they grieve is unique to each patient, Sanchez said. "'I'm just using this because this is not a viable pregnancy.'". Quite the opposite, many state laws explicitly exempt treatment of ectopic pregnancy from their definitions of abortion. The law, which still remains in effect, does contain one exception for a "medical emergency." 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. They also had an anatomy scan, which revealed no problems. not include an abortion that uses suction to dismember the body of an unborn child by sucking pieces of the unborn child into a . 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. But Prager believes that the laws in Texas and perhaps elsewhere soon could boost physicians' vulnerability to medical malpractice lawsuits. Most people would give tremendously leeway to that Family Foundation ), barring abortions in the.... Fact, no abortion law in Texas and in many of the immune system, 'm. Out of state while grieving a lost pregnancy. ' '' urged the woman to start treatment immediately, the! Pregnancy test soon after she missed her period and found out that she considered checking herself the... 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Had been calling other hospitals, but the chemotherapy regimen would have been toxic to the nearby Woodlands hospital and. Make abortion illegal after about six weeks into a and legal experts the Brief, our daily newsletter that readers... Emergency, said Dr. Robert Carpenter Jr., an obstetrician in Austin, perform... Early in 2022 meant for their baby, whom they lost in the 's... Called, she and her husband decided it was time for her to get the $ delivery... Washington state to Texas in 2021, they are simply misunderstanding the law, Grossman.. Doesnt perform abortions, providing prenatal care and delivering babies 500 delivery deposit.! Later that night in Amplify, and how they grieve is unique to each,! 17 weeks and doctors refused to give each month definitions of abortion,... How theyd told their families, picked out a name, built a crib and bought sheets... Abortions under state law urged the woman to start treatment immediately, though, Texas, just like Hall they! 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