Pregnancies can be complicated by any number of medical conditions. 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.. Most recently, the Oklahoma Senate passed six abortion-limiting bills , including one that would ban abortions after 30 days from a woman's last . 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. 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. Almost immediately, though, Texas conflicting and confusing laws on abortion started to cause problems for pregnancy care. 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 bill . She was due just a few days before Christmas. October 22, 2021. Things did go fairly smooth at first. The one exception is a medical emergency, but the law requires doctors to document the reasons for the exception with great specificity. But Texas's medical exception is narrower, and less defined . And now the Texas abortion law has created an additional bind, Cavazos explains. 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 . hide caption. Crescenda Uhles, a genetic counselor in Dallas, said the Texas law puts people like her in a bind when advising patients. Selective reductions are forbidden under the new state law. In 2012, a woman died in Ireland after her waters broke at 17 weeks and doctors refused to give her an abortion. 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.. But pregnancy care isnt as clear cut as the law makes it out to be, doctors say, and fear of criminal prosecution has led medical professionals to delay or deny care they otherwise would have provided. 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. Elizabeth says. 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. How are you doing, and are you excited for the delivery?'". 1, eff. Many of the patients that we see in my practice already have to drive so far away to get basic prenatal care, Cheng said. Or in cases of rape or incest? That's when she felt something "shift" in her uterus, down low, and then "this burst of water just falls out of my body. These terms are left vague or undefined. Elizabeth and James Weller at their home in Houston two months after losing their baby girl due to a premature rupture of membranes. The ob-gyn, who said she could not speak to the media, laid out two options, according to Elizabeth. ", "Because that doesn't really exist right now," he added. The pregnancy made it impossible to remove the device, Dr. Thoppil said. Elizabeth and James keep remembrances of their baby in a picture frame at home. Some hesitate to counsel patients about the option of termination, or refer them to doctors in other states, for fear their advice could be interpreted as aiding an abortion. The women who will be forced to carry these babies are the women with less resources, he said. 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. One reason is that amniotic fluid plays a key role in fetal lung development. 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. Which sounds extreme, but Roe had just been overturned. "I told her 'Look, Doctor, people around me are telling me to keep hope. In the meantime, Grossman said the delay and denial of care will likely become more common. 245.002. Many of the protesters had traveled to Washington state all the way from Texas, just like Hall had. But Prager believes that the laws in Texas and perhaps elsewhere soon . 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. I couldn't give you life. Medical v. legal . 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 . "Ectopic pregnancies can kill people," said Brown, a district chair for the American College of Obstetricians and Gynecologists, representing Texas. 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.". 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. "And they decide to sue for malpractice," she said. It is an editorially independent operating program of KFF (Kaiser Family Foundation). 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. KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Back at home, the Wellers got more serious about their travel plans and started booking tickets. About 10% to 20% of confirmed . 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. 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. Supporters of the law say their goal is to save the life of every embryo, regardless of the circumstances of conception. But Prager believes that the laws in Texas and perhaps elsewhere soon could boost physicians' vulnerability to medical malpractice lawsuits. Texas new measure was intended to impose stringent limits on abortion. 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. 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. Very young rape victims tend to seek prenatal care late, and they are more likely to have small babies that score poorly on tests of heart rate and muscle tone given immediately after birth. I have seen cases where the woman has gone from completely normal to septic shock in less than an hour, Dr. Carpenter said. Recently passed laws make abortion illegal after about six weeks into a pregnancy. Her mental health spiraled to the point that she considered checking herself into the hospital. Sept. 1, 1989. The Supreme Court is expected to rule soon on whether abortion providers and the Biden administration may challenge the law notwithstanding its novel structure. Either way, she saw nothing ahead but fear and grief prolonged, delayed, amplified. They also had an anatomy scan, which revealed no problems. 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 . 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. . But there is no definition for that term in the statute. Hall shelled out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. 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. Elizabeth chose to go home rather than wait to get sick at the hospital. Financial supporters play no role in the Tribune's journalism. "He and I kept telling each other 'What is the whole point of the Hippocratic oath to do no harm?'" Julia Robinson for NPR The way the system is going to work is that the patients are going to always pay the price, Grossman said. She knew the doctors at the practice were both proud members of the American Association of Pro-Life Obstetricians and Gynecologists, but she waved it off. She was diagnosed with an aggressive lymphoma, a cancer of the immune system. Yet under the new law, Dr. Thoppil felt he could not counsel her on terminating the pregnancy. The facts were grim. For Elizabeth, that tragic conversation was just "the beginning of the hell that was going to ensue" for the rest of the week. With abortion laws in Texas about to change, The Dallas Morning News is answering your questions about what to expect without the protections established in Roe vs . The Texas Tribune Festival is almost here! Halls fetus was diagnosed with anencephaly, a neural tube defect in which the brain, skull and scalp do not develop properly in the womb. A fight began, which Elizabeth first became aware of as her doctor paced the hall outside her room, talking on her phone. The law, which still remains in effect, does contain one exception for a "medical emergency." Down in the kitchen, images from recent scans and ultrasounds were stuck to the fridge. It was just too hard, as she navigated a complicated mix of relief and grief. An ectopic pregnancy occurs when the fertilized egg is implanted outside the uterus, most commonly in a fallopian tube. We usually have our moms register for delivery at this point. 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. 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. The ethics panel had reached a decision, the doctor told them. Elizabeth was in graduate school for political science, and James taught middle-school math. 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 theyd told their families, picked out a name, built a crib and bought pink sheets. 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. She felt lost and confused. 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. Although distraught and heartbroken at this news, Elizabeth forced herself to think it through. Under the current text, any doctor who removes an ectopic pregnancy that is not actively causing the patient to bleed to death faces dire consequences. Because at this point, I'm in survival mode. 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. You open it. It is just possible that chemical abortions more than half of all U.S. abortions soon could be outlawed nationwide. "It's terrible," says Dr. Alan Peaceman, a professor of maternal-fetal medicine at Northwestern University's Feinberg School of Medicine. The pink-sheeted crib is still set up in the nursery, filled with all the baby supplies theyd bought or been gifted that they now have no use for. She knew she did not have the flexibility to be able to travel out of state for an abortion later on. For a fetus at 18 weeks, the chance of survival in that state is almost nonexistent, according to Peaceman: "This is probably about as close to zero as you'll ever get in medicine.". Many offer no exemptions for rape, incest or fetal anomolies. One of the most painful parts was trying to reach her medical team. 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. Right away, she ran into obstacles because of the Texas law. The Texas abortion "trigger law" will be effective on August 25th, 2022. 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. Methotrexate, another abortion-inducing medication, is used to treat ectopic pregnancies as well as rheumatic illnesses, inflammatory bowel disease, psoriasis and cancer. "You have to ask yourself, would I put any living thing through the pain, and the horrors, of having to try to fight for their life the minute that they're born?". 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. After holding it together all morning, Hall burst into tears. Wade and the return of laws governing abortion legality to the states. Misoprostol is used to help prevent stomach ulcers, but it can induce abortions, particularly if taken along with mifepristone. You're not going to tell me that what I'm experiencing isn't real, again.". Elizabeth could not receive the medical care she needed until several days later because of a Texas law that banned abortion after six weeks. . Every OB-GYN has cared for someone who has died from a hemorrhage, 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 . "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. No one really knows what the legislature means by that, and they are afraid of overstepping. So when Roe v . Such testing is done late in pregnancy, beyond the six-week limit, noted Crescenda Uhles, a genetic counselor in Dallas. Treatments for miscarriages and ectopic pregnancies are still legal under the states abortion ban, according to state law and legal experts. But she was barely out the door, still in the parking lot, when her phone rang. I'm actually headed home right now because I have to await my dead baby's delivery.' A previous version of this story incorrectly reported the name and location of a clinic. Texas' new abortion laws . And surprisingly, both of their families sent money to help pay for the trip, despite their anti-abortion sentiments. Since the new laws took effect, Liedtke said, the pharmacist a handful of times declined to provide the medication, citing the new law despite Liedtke writing the prescription to treat a miscarriage. 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. 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 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 . The bill makes no exceptions for pregnancies that resulted from rape or incest. 245.001. 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. 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. 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. "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.". 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. When Roe v. Wade fell in June, Elizabeth's pain and anger surged up again. She had to go two days in a row and both times the staff gave her the support, sympathy and care shed been missing in Texas. "And she starts to cry and she tells me: 'They're not going to touch you.' This is already incredibly difficult news that someone receives, Thoppil said. 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. Thats what recently caused Dr. Jessian Munoz, an OB-GYN in San Antonio, to wait a day to treat a patient who had started to miscarry and developed a womb infection, according to the Associated Press. And it's strong. If Elizabeth exhibited enough of them, then it would be possible to document the encroaching infection, and therefore terminate the pregnancy under the law's "medical emergency" clause, he said. An attendee holds her child during A Texas Rally for Abortion Rights at Discovery Green in Houston, Texas, on May 7. Find a complete list of them here. Her doctor said she had been calling other hospitals, but none of them would help. This chapter may be cited as the Texas Abortion Facility Reporting and Licensing Act. Marlena Stell always wanted a big family. hide caption. And quickly. Abortion bans in Mississippi, North Dakota and Wyoming go into effect after the attorney . Sign up for The Brief, our daily newsletter that keeps readers up to speed on the most essential Texas news. 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. "'I'm just using this because this is not a viable pregnancy.'". An oncologist urged the woman to start treatment immediately, but the chemotherapy regimen would have been toxic to the fetus. Or hell honestly it shouldn't even get to the point where you're having to save a woman's life. She ate a healthy breakfast, went for a walk outside and came back home. "Ectopic pregnancy" means the implantation of a fertilized egg or embryo outside of the uterus. In the medical profession, doctors will continue to grapple with the new legal restrictions, and the resultant dilemmas in obstetrical care, says Dr. Peaceman. The holidays are going to be especially hard. 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. She was through with being dismissed, being told to wait. Texas' current heartbeat ban enables private citizens to sue anyone who helps someone get an abortion after about six weeks. We havent seen a large issue, but there are certainly anecdotes, Thoppil said. But those numbers have skyrocketed since Roe v. Wade was overturned. The next day, a Thursday, she started throwing up. Dr. John Thoppil, an obstetrician in Austin, doesnt perform abortions, providing prenatal care and delivering babies. But in early May, not long after the uneventful anatomy scan, the Wellers suddenly arrived at that crossroads. We both have good jobs, weve got a house and we were at a place where if it happens, it happens, she said. If I offer the patient the standard of care, I could be sued for aiding and abetting, he said. She said Houston Methodist had convened an ethics panel of doctors, but her doctor didn't seem very optimistic. "I said 'Well, is there a heartbeat still?' 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. Ilana Panich-Linsman for The New York Times. Texas is the state weve seen the biggest increase from, Sanchez said. The American College of Cardiology and the American Heart Association, for example, advise women with certain congenital heart conditions to avoid pregnancy altogether, as they are at higher risk of illness or death shortly after giving birth. The crisis the Wellers endured is emblematic of the vast and perhaps unintended medical impacts of the criminalization of abortion in Republican-led states. Like other physicians, Dr. Palmer said she was uncertain whether counseling that patient about all of her options, including terminating the pregnancy outside Texas, would have been considered aiding and abetting., The law is murky, but heres the bottom line, she said. ", 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. At 18 weeks, the watery, protective cushion of amniotic fluid was gone. 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. 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). 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. Anyone can bring that civil action, posing a quandary for physicians and other providers. She places the blame for the ensuing medical trauma on the Republican legislators who passed the state's anti-abortion law, on Texas Gov. For example, in rare cases an infection can make the amniotic sac rupture before the fetus is viable. After all, she didnt need an abortion she needed convenient pregnancy care. Financial supporters play no role in the Tribune's journalism. They're not allowed to do that in Texas. After talking with James, they both agreed they should end the pregnancy. They stood up in the middle of the ER and embraced. "At first I was really enraged at the hospital and administration," she says. Treatment of ectopic pregnancy is not prohibited by Texas' abortion laws. We do what we can to honor each of those cases.. "The penalties are quite draconian," he said, noting that someone could be convicted of a felony. Julia Robinson for NPR A fertilized egg can't survive an ectopic pregnancy and can result in life-threatening bleeding, according to the Mayo Clinic. Texas Gov. If I dont provide my patient the standard of care, which they are due, I could be sued.. The other miscarriage treatment is a procedure described as surgical uterine evacuation to remove the pregnancy tissue the same approach as for an abortion. In Texas' anti-abortion . Greg Abbott signed a heartbeat bill into law in May, barring abortions in the state as early as six weeks. Austin woman trying for baby says Texas abortion law nearly caused her death. But now in Texas, the new laws are creating uncertainties that may deter some doctors and other providers from offering optimal miscarriage treatment. It was because of the state law which forbids termination of a pregnancy as long as there is fetal cardiac activity. Starting last September, when the [ban on abortions after about six weeks of pregnancy] went into effect, we started getting calling from Texas and it hasnt stopped.. 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.. Double your gift when you give by 6 p.m. Thursday. And a tubal ectopic pregnancy, let's say, is clearly excluded. 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 . 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