Photograph: Esteban Flix/AP 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. Due to her history of hemorrhaging, Seewald added that passing the pregnancy at home didn't seem like a good option. Midnight came and went in a blur. Growing up outside Dallas, Hall often heard that abortion was murder and, perhaps worse, interfering with Gods plan. Nitashia Johnson for The New York Times. There has been apprehension by doctors about dealing with both of those two issues, Abbott told Fox 4 News. No one really knows what the legislature means by that, and they are afraid of overstepping. Texas Attorney General Ken Paxton quickly sued the Biden administration over the federal guidance. If I offer the patient the standard of care, I could be sued for aiding and abetting, he said. Elizabeth could not receive the medical care she needed until several days later because of a Texas law that banned abortion after six weeks. 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. 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. Time is of the essence. I have seen cases where the woman has gone from completely normal to septic shock in less than an hour, Dr. Carpenter said. Almost immediately, though, Texas conflicting and confusing laws on abortion started to cause problems for pregnancy care. Texas' new abortion laws . 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. Things did go fairly smooth at first. 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. 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. He said the association has been in communication with some pharmacy leaders to help clarify proper interpretation of the rules.. An oncologist urged the woman to start treatment immediately, but the chemotherapy regimen would have been toxic to the fetus. . But Prager believes that the laws in Texas and perhaps elsewhere soon . The fetus had a rare neural tube defect. A few days later, she went out to celebrate a friends birthday and was raped on her way home. So we look at them like a ticking time bomb and wait for the complications to develop, Dr. Palmer said of her patients. I'm trying to understand. Hall managed not to scream any of this at the protesters, instead just silently flipping them off. In other cases, a pregnant womans medical needs may conflict with those of her fetus. Elizabeth touches the urn of her daughter. 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. [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 . Recently passed laws make abortion illegal after about six weeks into a pregnancy. It was someone else at Methodist Hospital, perhaps a clerk, calling to go over some paperwork. 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. Her mental health spiraled to the point that she considered checking herself into the hospital. 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. There are currently no abortion laws that outlaw treatment of ectopic pregnancy. And she goes 'I'm so sorry, I'm so sorry, I didn't know.'". Dr. Jennifer Liedtke, a family physician in Sweetwater, Texas, who delivers about 175 babies annually, no longer sends misoprostol prescriptions to the local Walmart. A wait for fetal death, or her own encroaching illness. 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. And I told her 'No, ma'am. "And that may mean in certain circumstances protecting the mother in this situation and the child passing away.". Double your gift when you give by 6 p.m. Thursday. They had bought a house in Kingwood, a lakeside development in Houston. In some cases, the infection can become severe or life-threatening, leading to sepsis, hysterectomy or even death. A previous version of this story incorrectly reported the name and location of a clinic. In Texas it's literally written in the law that an act is not an abortion to remove an ectopic pregnancy. 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.. I would consider what I experienced that weekend a medical emergency.. 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.". ", Later on, Elizabeth said she realized that her anger at Methodist was misplaced. AUSTIN (KXAN) Amanda and Josh Zurawski have been trying to have a baby for more than a year now. Elizabeth chose to go home rather than wait to get sick at the hospital. "That's torture to have to carry a pregnancy which has such a low chance of survival," says Dr. Peaceman. 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 it was the only choice they had to save this young woman. She eventually agreed, and the treatment was begun as soon as an abortion was performed. 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. 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. They had to call their OB/GYN repeatedly to get the $500 delivery deposit refunded. The ob-gyn, who said she could not speak to the media, laid out two options, according to Elizabeth. It just seems cruel and unusual.. We physically watched her get sicker and sicker and sicker, he told the AP. I was losing my mind, Hall said. 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. 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. She was bereft, unable to even process the news. Julia Robinson for NPR For example, in rare cases an infection can make the amniotic sac rupture before the fetus is viable. 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. An ultrasound confirmed that she had suffered premature rupture of membranes, which affects about 3% of pregnancies. "They can absolutely do that.". Everyone was so scared.. ", State abortion laws are complicating other types of obstetric care. Even with the slim chance of survival to 24 weeks, the newborn would face intense physical challenges and aggressive medical interventions. She was due just a few days before Christmas. The other miscarriage treatment is a procedure described as surgical uterine evacuation to remove the pregnancy tissue the same approach as for an abortion. One study showed they were four times as likely to develop an infection and 2.4 times as likely to experience a postpartum hemorrhage, compared with women who terminated the pregnancy. After all, she didnt need an abortion she needed convenient pregnancy care. "Later they laid down this beautiful baby girl in my arms. Most of these pregnancies end in miscarriage or stillbirth. "And yet we're being pulled through this.". Family members hold photos of Olga Reyes, a 22-year-old law student who died of an untreated ectopic pregnancy in Nicaragua in 2007. Whether an ectopic pregnancy is legal will depend on individual state laws. 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 . Last week, the Texas Medical Association warned that several hospitals in the state have turned away or waited to treat patients with pregnancy complications including a physician in Central Texas who was allegedly instructed by a hospital to not treat an ectopic pregnancy until a rupture occurred. Hall had to travel to Washington state for an abortion after receiving a lethal fetal diagnosis, for which Texas abortion laws make no exception. At least several OB-GYNs in the Austin area received a letter from a pharmacy in late 2021 saying it would no longer fill the drug methotrexate in the case of ectopic pregnancy, citing the recent Texas laws, said Dr. Charlie Brown, an Austin-based obstetrician-gynecologist who provided a copy to KHN. It was just the most tender moment, she said. The associations say these women should be given the option of termination if they become pregnant. Eventually, she found a clinic near Seattle that provides specialty care for patients who have decided to terminate due to lethal fetal abnormalities. The brain would not develop, and the infant would die at birth or shortly afterward. 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. To Elizabeth, termination also felt like the most merciful option for her fetus. But in early May, not long after the uneventful anatomy scan, the Wellers suddenly arrived at that crossroads. She was through with being dismissed, being told to wait. It just didnt occur to them that a ban would include cases like this.. 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 . The law makes no exceptions for nonviable pregnancies in which the fetus has no chance of survival. After one conversation, the doctor returned to her bedside. All you can do now is just hope and pray that things go well.". Still, states like Missouri could put this pro-abortion talking point to rest by protecting treatment of ectopic pregnancy explicitly in the law. 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.. When they learned they were having a girl, Hall and her husband even picked out a name: Amelia. Quite the opposite, many state laws explicitly exempt treatment of ectopic pregnancy from their definitions of abortion. That's not a good thing. Greg Abbott said there were some things that we need to work on to ensure patients can get treatment for miscarriages and ectopic pregnancies. 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 . At the same time, she was searching for abortion clinics. Sept. 1, 1989. Join us for Texas biggest politics and policy event when you buy your tickets today. Her discharge was yellow and smelled weird. Some people experience loss of pregnancy at home and don't require additional care, other than emotional support, said Dr. Tony Ogburn, who chairs the OB-GYN department at the University of Texas-Rio Grande Valley School of Medicine. "Ectopic pregnancy" means the implantation of a fertilized egg or embryo outside of the uterus. She and her husband began trying in late 2021. Sometimes theyre the primary caregiver. But even from a young age, she had a lot of questions about what she saw as a deeply unforgiving idea. 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. a letter from the Texas Medical Association. Unnamed, unknown doctors somewhere had come to an agreement that Elizabeth could be induced that night. "The penalties are quite draconian," he said, noting that someone could be convicted of a felony. It is an editorially independent operating program of KFF (Kaiser Family Foundation). Another pending ban, a so-called "trigger law" passed by Texas in 2021, is expected to go into effect within weeks. In Poland, protests over that countrys abortion laws erupted this year after a 30-year-old pregnant woman died of septic shock. In September, the justices turned down an emergency request to block the law. The risks to Elizabeth's health were simply too high. 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. Among other risks, both the fetus and Elizabeth were now highly vulnerable to a uterine infection called chorioamnionitis. 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 . 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 . This can occur as early as two weeks after a missed period, when most women do not yet know they are pregnant. This law will prohibit almost all abortions. The crisis the Wellers endured is emblematic of the vast and perhaps unintended medical impacts of the criminalization of abortion in Republican-led states. The next day, a Thursday, she started throwing up. But the womans condition can quickly deteriorate, which is why physicians often prefer to offer an abortion. The ethics panel had reached a decision, the doctor told them. ", 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. I need you to give me the facts.'". Anyone can read what you share. These dismissals only increase the sense of isolation, stigma and shame. At 6 weeks, many people . The women who will be forced to carry these babies are the women with less resources, he said. In one case, a central Texas hospital reportedly told a physician not to treat an ectopic pregnancy until it ruptured, the letter said. 245.001. 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. "Because I didn't want anybody to tell me they did not believe me," she says. 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. 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. Im a nurse. She wanted to tell these strangers about the day she ran into her husbands home office, pants still around her ankles, waving that positive pregnancy test. 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. It also sets out civil, criminal, and professional penalties for abortion providers who violate the law. The definition of abortion in Texas Health and Safety Code explicitly states an act that is done to "remove an ectopic pregnancy" is not defined as an abortion. Amplify your impact and donate now. I'm so sorry.". "He and I kept telling each other 'What is the whole point of the Hippocratic oath to do no harm?'" Treatments for miscarriages and ectopic pregnancies are still legal under the states abortion ban, according to state law and legal experts. When she first saw that positive pregnancy test, she panicked even at 27, she said, her first reaction was that of a 15-year-old, worried about telling her parents. For some, that's too difficult, given the emotions surrounding the pregnancy loss, she said. Texas Health and Safety Code, Chapter 171. But the incentives are all very strong for those providers to err on the side of not providing care.. Federal law typically trumps state laws, but it will now be up to courts to decide whether that will be the case in this instance. 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 . Because at this point, I'm in survival mode. Find a complete list of them here. 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. Because the providers have a choice whether to provide and the patients are the ones who need the care. These cases are only going to grow until the law is either repealed or clarified. Coming back to Texas a few days later only amplified those feelings. Doctors in Texas say they cannot head off life-threatening medical crises in pregnant women if abortions cannot be offered or even discussed. 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. As a subscriber, you have 10 gift articles to give each month. 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. I think most people would give tremendously leeway to that. Post-Roe v. Wade, abortion bans may keep doctors from providing timely, necessary care. "Any law that creates a hesitancy for physicians to uphold the standard of care for a patient has a cascade of harmful effects both for the patient but also for everyone else," said Esplin. She just put her arms around me and took my hand and she was like, I know you dont want to be here, but youre in good hands. And theyve had to navigate complicated politics when sharing their news. Many offer no exemptions for rape, incest or fetal anomolies. 8, which encourages private citizens to file lawsuits against anyone who facilitates an abortion, will proliferate, giving self-appointed vigilantes no shortage of . And I knew my baby was suffering, I knew I was suffering, I knew my husband was suffering.". Right away, she ran into obstacles because of the Texas law. Texas is the state weve seen the biggest increase from, Sanchez said. "'I'm just using this because this is not a viable pregnancy.'". Dr. Ghazaleh Moayedi, an obstetrician/gynecologist and abortion provider in Texas, said the new law leaves unclear whether a physician can act when a woman has a spontaneous miscarriage and is bleeding heavily, but the fetus has not passed. On Saturday, May 14, about 2 a.m., she gave birth. ", "Let's say I do have to go through this situation again. The Texas Tribune Festival is almost here! Texas Gov. The Biden administration last week told hospitals they must treat pregnant patients who need an abortion to stabilize a life-threatening condition. Double your gift when you give by 6 p.m. Thursday. 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. And it's this stupid, like, distinction that you're just making in this grief. "Most women would find it extremely difficult and emotionally very challenging. 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 . Hall has struggled with depression, and as the weekend wore on, her mental health deteriorated. 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. She and her husband immediately jumped into planning mode, scheduling an appointment at one of the only OB-GYN practices in town. Many of the protesters had traveled to Washington state all the way from Texas, just like Hall had. "It's this woman who was saying 'Hi Miss Weller, you're at the 19 week mark. Her husband took over, asking the doctor what, if anything, they could do. An ectopic pregnancy occurs when the fertilized egg is implanted outside the uterus, most commonly in a fallopian tube. And for a few tense . The next day, Elizabeth's ob-gyn came to the hospital to arrange the procedure. And surprisingly, both of their families sent money to help pay for the trip, despite their anti-abortion sentiments. Laws modelled on Texas's S.B. She never had to use that bag. She took a pregnancy test soon after she missed her period and found out that she had conceived. And she says 'Yes. 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. And she said, If you do that, dont tell anybody why youre traveling, dont tell your jobs, dont tell anyone at the airport, Hall remembers. These terms are left vague or undefined. hide caption. But Prager believes that the laws in Texas and perhaps elsewhere soon could boost physicians' vulnerability to medical malpractice lawsuits. 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. Or, like Hall, they can shell out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. Sign up for The Brief, our daily newsletter that keeps readers up to speed on the most essential Texas news. 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. The new law does not apply to removing ectopic pregnancies that implant outside the uterus, which are not considered abortions under state law. "And they decide to sue for malpractice," she said. 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. Treatments for miscarriages and ectopic pregnancies are still legal under Texas abortion ban. Even in Texas, whose "heartbeat bill" was one . Treatments for miscarriages and ectopic pregnancies are still legal under Texas' abortion ban.<br/> By: By Mara Mndez, The Texas Tribune Posted at 10:06 PM, Jul 20, 2022 The pregnancy made it impossible to remove the device, Dr. Thoppil said. That's when a new state law banned all abortions after fetal cardiac activity is detected usually at about six weeks of pregnancy. Methotrexate, another abortion-inducing medication, is used to treat ectopic pregnancies as well as rheumatic illnesses, inflammatory bowel disease, psoriasis and cancer. She called her doctor and begged to get in. ", 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. After her initial miscarriage in 2018, Stell and her husband had their first child, a daughter, in April 2020. 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. 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 . Such testing is done late in pregnancy, beyond the six-week limit, noted Crescenda Uhles, a genetic counselor in Dallas. More often than not, they just say they lost the baby. After holding it together all morning, Hall burst into tears. 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. It was just too hard, as she navigated a complicated mix of relief and grief. It was like an evidence bag. 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. "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. The facts were grim. tex. I was so excited for this appointment because its so good to see her in there, she said. AUSTIN The Texas Medical Association wants regulators to step in after hospitals reportedly refused to treat patients with serious pregnancy complications for fear . KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Updated: Oct. 24, 2022. 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. 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. A Texas judge's decision that could revoke the FDA's approval of abortion drugs is expected soon. 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. "Ectopic pregnancies can kill people," said Brown, a district chair for the American College of Obstetricians and Gynecologists, representing Texas. "Abortion and pregnancy outcomes are under a microscopein a way we . She had the proof. John Seago, legislative director for Texas Right to Life, described this type of hesitation as "an awful misunderstanding of the law." But things can be murkier when it comes to treating miscarriages, she said. It is a horrible gamble that we are making Texas women go through.". Elizabeth Weller never dreamed that her own hopes for a child would become ensnared in the web of Texas abortion law. 5:22-cv-185-h (n.d. Elizabeth touches the urn of her daughter. She knew she did not have the flexibility to be able to travel out of state for an abortion later on. 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. 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