"The care providers are treading on eggshells. The Texas Tribune Festival is almost here! Rather than warmth and sympathy, she was met with fear, hesitation and, worst of all, silence. The one exception is a medical emergency, but the law requires doctors to document the reasons for the exception with great specificity. For doctors treating such patients, the Texas law creates quite a conundrum, Dr. Snyder said. Tom Mayo, a professor of law at Southern Methodist University's Dedman School of Law in Dallas, understands why some in Texas' pharmacy community might be nervous. Enough to make her retch. Texas Gov. And I knew my baby was suffering, I knew I was suffering, I knew my husband was suffering.". Or in cases of rape or incest? The slew of anti-abortion legislation comes on the heels of a Texas law, passed in June, which banned abortions after about six weeks into a pregnancybefore most people realize they are pregnant. Hall shelled out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. The facts were grim. ", 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. "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. Their conundrum became painfully, distressingly clear: wait to get sicker, or wait until the fetal heartbeat ceased. She places the blame for the ensuing medical trauma on the Republican legislators who passed the state's anti-abortion law, on Texas Gov. "Most women would find it extremely difficult and emotionally very challenging. The Texas abortion "trigger law" will be effective on August 25th, 2022. 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 . 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. "'I'm just using this because this is not a viable pregnancy.'". 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.". Doctors can clearly legally save a woman's . In a sudden obstetrical emergency, a termination might be the least risky option, clinically. Then Elizabeth felt another sudden, forceful gush of fluid leave her body. "It is a pro-life position to allow physicians to make those life-and-death decisions," Seago 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. ", 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. In 2012, a woman died in Ireland after her waters broke at 17 weeks and doctors refused to give her an abortion. "Abortions are sometimes needed out of an act of an emergency, out of an act of saving a woman's life. Because once they reached Methodist, while they were still checking in at the emergency room, her doctor called. Back at home, the Wellers got more serious about their travel plans and started booking tickets. Elizabeth was in graduate school for political science, and James taught middle-school math. John Seago, legislative director for Texas Right to Life, described this type of hesitation as "an awful misunderstanding of the law." 7:49 PM on Jul 14, 2022 CDT. It is disingenuous to allege that this law prevents obstetricians from following the medical standard of care, she said. These dismissals only increase the sense of isolation, stigma and shame. A few days later, she went out to celebrate a friends birthday and was raped on her way home. I was losing my mind, Hall said. Right away, she ran into obstacles because of the Texas law. And surprisingly, both of their families sent money to help pay for the trip, despite their anti-abortion sentiments. 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. When the couple moved from Washington state to Texas in 2021, they were trying to . In Texas, a 2021 law made it easier to sue anyone who helps a person get an abortion after about six weeks of pregnancy. . "It's hard to form a relationship to say, 'Hey look, I'm not using this for an elective abortion,'" she said. This is already incredibly difficult news that someone receives, Thoppil said. After all, she didnt need an abortion she needed convenient pregnancy care. The next day, Elizabeth's ob-gyn came to the hospital to arrange the procedure. No one really knows what the legislature means by that, and they are afraid of overstepping. These cases are only going to grow until the law is either repealed or clarified. Her doctor said she had been calling other hospitals, but none of them would help. "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. There has been apprehension by doctors about dealing with both of those two issues, Abbott told Fox 4 News. Elizabeth Weller never dreamed that her own hopes for a child would become ensnared in the web of Texas abortion law. Elizabeth touches the urn of her daughter. 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. 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. I'm so sorry,'" Elizabeth says. Texas' "trigger" law, which outlaws abortion "wholly or partly", is set to be in effect 30 days following the . 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. They now had some of the symptoms they needed to show the infection was getting worse. hide caption. She felt lost and confused. I'm trying to mentally survive this.". Houston Methodist Hospital declined to comment on the specifics of Elizabeth's care, except to say they follow all state laws and that there's a medical ethics committee that sometimes reviews complex cases. Julia Robinson for NPR "They can absolutely do that.". "The penalties are quite draconian," he said, noting that someone could be convicted of a felony. The hospital where she works pays me to have these conversations with patients, but theres not necessarily any guarantee they would have my back should someone decide to list my name on a lawsuit, she said. Treatments for miscarriages and ectopic pregnancies are still legal under Texas abortion ban. 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. And that's a big part of this problem, when we as physicians are trying to relieve patients' suffering. Elizabeth and James look at clothes that were meant for their baby, whom they lost in the second trimester of pregnancy. What youre really worried about is that period of time when whats going to be a miscarriage, if you let it take a natural course, might cause severe suffering, and/or death to the mother, to the pregnant person, she said. "At first I was really enraged at the hospital and administration," she says. You open it. In the medical profession, doctors will continue to grapple with the new legal restrictions, and the resultant dilemmas in obstetrical care, says Dr. Peaceman. 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. ABACA. Once she made her way through the clinics stringent security, the nurses took her into a private room. 9:42 AM on Jul 1, 2022 CDT. I'm trying to understand. They had savings to fund this last-minute trip, and because her company is based in Illinois, her insurance covered the procedure. The holidays are going to be especially hard. They also had an anatomy scan, which revealed no problems. Today, abortion is also illegal in Texas under an old 1925 law that the state's Attorney General Ken Paxton declared to be in effect after Roe was overturned. Texas has a trigger law on the books that will outlaw abortion almost universally beginning 30 days after the Supreme Court . 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. For some, that's too difficult, given the emotions surrounding the pregnancy loss, she said. An ultrasound confirmed that she had suffered premature rupture of membranes, which affects about 3% of pregnancies. 245.002. 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 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. For patients who are not pregnant, it can also open up the cervix and make surgeries safer, Crawford said. Whether terminating an ectopic pregnancy is legal will depend on individual state laws. Texas Attorney General Ken Paxton quickly sued the Biden administration over the federal guidance. This current law excludes treatment for miscarriage or ectopic pregnancy. There was still a fetal heartbeat, but it could stop at any moment. It is the Cedar River Clinics in Renton, Washington, not the Cedar River Clinic in Seattle. Coming back to Texas a few days later only amplified those feelings. She recalls looking at her baby's little hands and crying. With it in place, his patient faces a pregnancy rife with potential medical problems. How are you doing, and are you excited for the delivery?'". Elizabeth and James Weller at their home in Houston two months after losing their baby girl due to a premature rupture of membranes. Such a rupture can be life-threatening. Elizabeth and James Weller at their home in Houston two months after losing their baby girl due to a premature rupture of membranes. Dr. Jennifer Liedtke, a family physician in Sweetwater, Texas, who delivers about 175 babies annually, no longer sends misoprostol prescriptions to the local Walmart. 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 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. The ob-gyn, who said she could not speak to the media, laid out two options, according to Elizabeth. The Oklahoma Senate last week passed six abortion-limiting bills, including one that mirrors the law passed in Texas and another that would ban abortions after 30 days from a woman's last period . When they learned they were having a girl, Hall and her husband even picked out a name: Amelia. 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 . 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. The abortion clinic is less than a mile from Texas, where abortion is illegal. "Later they laid down this beautiful baby girl in my arms. 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. All you can do now is just hope and pray that things go well.". "partial-birth" abortions, medical abortions, the stage of a pregnancy at which an abortion can be performed, and informed consent related to abortions. 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 . Initially, the patient may not be in danger, and under the law physicians may be prohibited from taking action, even though the baby will not survive. [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 . Many doctors say they are unable to discuss the procedure as an option until the patients condition deteriorates and her life is at risk. But Prager believes that the laws in Texas and perhaps elsewhere soon could boost physicians' vulnerability to medical malpractice lawsuits. "I was just laying in bed, you know, wondering: Am I pregnant or am I not pregnant? I think most people would give tremendously leeway to that. 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. To Dr. Peaceman at Northwestern, it sounded like the hospital's clinicians were using the most common clinical signs of chorioamnionitis as a guideline. Or the judge could at least nullify FDA decisions in 2016 and 2021 that allowed at-home and mail-order chemical abortions. I couldnt do that.. I'm so sorry,'" Elizabeth says. And she goes 'I'm so sorry, I'm so sorry, I didn't know.'". "Being pregnant in a state like Texas is a dangerous . by Mara Mndez This can occur as early as two weeks after a missed period, when most women do not yet know they are pregnant. The staff remained vague about what came next, Elizabeth recalls. Delays in care particularly for first-trimester conditions such as bleeding, hemorrhaging, septic miscarriages and ectopic pregnancies can become lethal, said Dr. Natalie Crawford, an OB/GYN and cofounder of a fertility clinic. 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. 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 . pursuant to the preliminary injunction in texas v. becerra, no. These situations can create significant moral distress for patients and providers, said Bryn Esplin, a bioethicist and assistant professor of medical education at the University of North Texas Health Science Center in Fort Worth. 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.. '", "It was devastating to hear that," Elizabeth says. 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. Acts 1989, 71st Leg., ch. It just seems cruel and unusual.. She recalls looking at her baby's little hands and crying. The emotional toll was what worried Hall most of all. Hall had to travel to Washington state for an abortion after receiving a lethal fetal diagnosis, for which Texas abortion laws make no exception. Many offer no exemptions for rape, incest or fetal anomolies. 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. The other miscarriage treatment is a procedure described as surgical uterine evacuation to remove the pregnancy tissue the same approach as for an abortion. These terms are left vague or undefined. That's not a good thing. 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. But now "your medical provider says that it's illegal and they can't provide it. "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. Methotrexate also is listed in the Texas law passed last year. Question women in America now have to ask. Eventually, she laid out their options: Keep carrying the pregnancy or leave Texas to get an abortion. Nitsch says she chose sterilization at age 36 rather than risk getting pregnant by another rapist. But the Wellers and 28 million other Texans had already been living under a de facto abortion ban for 8 months, since September 2021. 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. 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. But Texas's medical exception is narrower, and less defined . Miscarriages occur in roughly 1 out of 10 pregnancies. "And she starts to cry and she tells me: 'They're not going to touch you.' Which sounds extreme, but Roe had just been overturned. But he did not address the question of lethal fetal anomalies, which are fatal for the fetus during pregnancy or shortly after birth. A doctor she had never met entered the room. You're not going to tell me that what I'm experiencing isn't real, again.". You dont get a lot of time to respond, and if you dont respond quickly enough, your patient expires.. 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. She would either have to get sick enough for . These provisions are in Chapter 170A of the Texas Health & Safety Code, which was enacted by House Bill 1280 in 2021. 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 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? hide caption. The new law in Texas bans abortion at 6 weeks when a fetal "heartbeat" can be detected. AUSTIN The Texas Medical Association wants regulators to step in after hospitals reportedly refused to treat patients with serious pregnancy complications for fear . Its one of the most egregious invasions of the physician-patient relationship that weve ever seen, said Dr. Rick Snyder, a cardiologist in Dallas who is chair of the board of trustees of the Texas Medical Association. 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. 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. CONROE, Texas (KTRK) -- A Conroe woman who suffered a miscarriage says the state's restrictive abortion laws forced her into a dangerous health situation. 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. Were going to take care of you, and youre going to be OK, Hall remembers. Sign up for The Brief, our daily newsletter that keeps readers up to speed on the most essential Texas news. It was like an evidence bag. Or you wait till your baby's heartbeat stops.'". The new law does not apply to removing ectopic pregnancies that implant outside the uterus, which are not considered abortions under state law. 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. 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. Health & Safety Code 245.002(1)(A)-(C). Either way, she saw nothing ahead but fear and grief prolonged, delayed, amplified. ", The Wellers do want to try again, but first they need to get to a "mentally healthier place," Elizabeth says. 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. The case spurred a movement that led to the overturning of Ireland's abortion ban in 2018. ", "Because that doesn't really exist right now," he added. Texas law reflects this important distinction. 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. Even with the slim chance of survival to 24 weeks, the newborn would face intense physical challenges and aggressive medical interventions. Pregnancies can be complicated by any number of medical conditions. Dr. Ingrid Skop, a San Antonio obstetrician and member of the American Association of Pro-Life Obstetricians and Gynecologists, during a House Oversight Committee hearing in September. 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. Miscarriage Most of these pregnancies end in miscarriage or stillbirth. Elizabeth says. The law makes no exceptions for nonviable pregnancies in which the fetus has no chance of survival. Thankfully, I think theres still plenty of pharmacies that understand the proper utilization of some of the medications we use for nonelective [pregnancy] terminations.. It is life-threatening to the mother and is not viable and needs to be removed. An ectopic pregnancy, which occurs when a fertilized egg . But the language is ambiguous, and travel can be expensive and onerous for pregnant women, especially if they are unwell. You smell it yourself. A doctor hugs a patient at an abortion clinic in Santa Teresa, New Mexico, on 13 January 2023. Many of the patients that we see in my practice already have to drive so far away to get basic prenatal care, Cheng said. Treatments for miscarriages and ectopic pregnancies are still legal under the states abortion ban, according to state law and legal experts. "And yet we're being pulled through this.". So we look at them like a ticking time bomb and wait for the complications to develop.. Pregnant people are now required to just wait, endangering their own lives with no hope of ever bringing home a baby. Such testing is done late in pregnancy, beyond the six-week limit, noted Crescenda Uhles, a genetic counselor in Dallas. I would always say, What if it was necessary to save the life of the mother? Eventually, she found a clinic near Seattle that provides specialty care for patients who have decided to terminate due to lethal fetal abnormalities. Misoprostol is used to help prevent stomach ulcers, but it can induce abortions, particularly if taken along with mifepristone. The color was darker and the odor was foul. Crescenda Uhles, a genetic counselor in Dallas, said the Texas law puts people like her in a bind when advising patients. It was someone else at Methodist Hospital, perhaps a clerk, calling to go over some paperwork. 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. They had to call their OB/GYN repeatedly to get the $500 delivery deposit refunded. 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. Halls maternal-fetal medicine specialist laid out the best-case scenario: If she managed to carry to term and deliver a live baby, with miracles of medicine, science and technology, they might be able to keep her alive for a few weeks, tied to machines and without hope of recovery. Fetuses who do survive a premature delivery can die soon after birth, or, if they survive, may experience major problems with their lungs, or suffer strokes, blindness, cerebral palsy or other disabilities and illnesses. The women who will be forced to carry these babies are the women with less resources, he said. 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 . Texas Health and Safety Code, Chapter 171. Every OB-GYN has cared for someone who has died from a hemorrhage, she said. Walmart officials did not respond to multiple requests for comment. At 18 weeks, the watery, protective cushion of amniotic fluid was gone. One persons emergency may not be another persons emergency, said Dr. Robert Carpenter Jr., an obstetrician in Houston. But the womans condition can quickly deteriorate, which is why physicians often prefer to offer an abortion. Recently passed laws make abortion illegal after about six weeks into a pregnancy. "The pharmacy has said, 'We don't know whether or not you might be using this medication for the purposes of abortion,'" she said. It includes laws about. "Abortion and pregnancy outcomes are under a microscopein a way we . 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. SB 8, which was signed into law by Texas Gov. I couldnt do that., by Eleanor Klibanoff I was so excited for this appointment because its so good to see her in there, she said. And she says 'Yes. The pregnancy made it impossible to remove the device, Dr. Thoppil said. Took no time at all.. KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. "I told her 'I'm so sorry. (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). The next day, a Thursday, she started throwing up. But even from a young age, she had a lot of questions about what she saw as a deeply unforgiving idea. A fight began, which Elizabeth first became aware of as her doctor paced the hall outside her room, talking on her phone. It went into effect on Sept. 1. That's when a new state law banned all abortions after fetal cardiac activity is detected usually at about six weeks of pregnancy. 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 associations say these women should be given the option of termination if they become pregnant. So I'm here to call you to register for your delivery on October 5th, so I can collect all your insurance information. The new abortion bans or the old laws being resurrected in a post-Roe world are rigidly written and untested in the courts. not include an abortion that uses suction to dismember the body of an unborn child by sucking pieces of the unborn child into a . "Ectopic pregnancies can kill people," said Brown, a district chair for the American College of Obstetricians and Gynecologists, representing Texas. 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. But the most confusing development involves the exemptions that exist for the woman's life or health, or because of a "medical emergency." 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