In some cases, the infection can become severe or life-threatening, leading to sepsis, hysterectomy or even death. (Texas Hospital Licensing Law); (3) an institution required to be licensed under . Seventeen weeks into the pregnancy, they learned they were expecting a girl. A more common scenario also raises difficult questions, said Dr. Ghazaleh Moayedi, an obstetrician and gynecologist in Texas who provides abortions. You're not going to tell me that what I'm experiencing isn't real, again.". "I wouldn't say this is true for our practice," he said. John Seago, legislative director for Texas Right to Life, described this type of hesitation as "an awful misunderstanding of the law." Elizabeth touches the urn of her daughter. Or what if the pregnancy wasnt viable? she said. Ectopic pregnancy develops in an estimated 2% of reported pregnancies. This chapter contains a variety of laws related to abortion. Even with the slim chance of survival to 24 weeks, the newborn would face intense physical challenges and aggressive medical interventions. ", Later on, Elizabeth said she realized that her anger at Methodist was misplaced. The Wellers were pleasantly surprised when they got pregnant early in 2022. 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.. However, if the ectopic pregnancy is located in the cervix or on the scar tissue from a cesarean section, the treatment could be the same as an abortion, according to Addante. If you do something to prevent that, you might be in fact performing an illegal abortion.. Texas laws banning abortions make narrow exceptions only to save the life of a pregnant patient or prevent substantial impairment of major bodily function. And lawmakers in recent years have clarified state statutes to say treatments for miscarriages, known as spontaneous abortions in medicine, and ectopic pregnancies, in which a fertilized egg grows outside of the uterus and becomes unviable, do not count as abortions. 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. The abortion clinic is less than a mile from Texas, where abortion is illegal. It was May 10, 2022. Elizabeth says. You're trying to understand exactly what's going on. And surprisingly, both of their families sent money to help pay for the trip, despite their anti-abortion sentiments. 5:22-cv-185-h (n.d. Because the state has made it very clear that if you talk about this, you're vulnerable to being sued," she added. After Hall made it through the protesters and the clinics security screening, the clinic itself was an oasis, she said. 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. With it in place, his patient faces a pregnancy rife with potential medical problems. "That's torture to have to carry a pregnancy which has such a low chance of survival," says Dr. Peaceman. In addition, he said, other Texas laws and the Roe v. Wade decision provide an exception to permit abortion if a pregnant person's life is in danger. Texas' new abortion laws . "And yet we're being pulled through this.". There have been no criminal charges against providers since the U.S. Supreme Courts decision in late June to overturn the constitutional right to abortion access that was protected by Roe v. Wade, but anti-abortion groups and state lawmakers have threatened to ramp up the pressure against abortion providers and their allies. 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. Elizabeth and James look at clothes that were meant for their baby, whom they lost in the second trimester of pregnancy. They're not allowed to do that in Texas. Every OB-GYN has cared for someone who has died from a hemorrhage, she said. hide caption. "I was just laying in bed, you know, wondering: Am I pregnant or am I not pregnant? If patients run into trouble filling prescriptions, Thoppil and Crawford say they should try to find another pharmacy or talk to their health care provider. If she had any physical ailments, I would never abort her for that issue. One of the most painful parts was trying to reach her medical team. We physically watched her get sicker and sicker and sicker, he told the AP. "I was born with a physical disability. ", "Let's say I do have to go through this situation again. And for a few tense . Methotrexate or surgery are the only two options listed in the medical guidelines to prevent the fallopian tubes from rupturing and causing dangerous bleeding. 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. However, Mayo said that his reading of the law allows for the use of methotrexate to treat an ectopic pregnancy. I couldnt do that.. Or you wait till your baby's heartbeat stops.'". 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. But even from a young age, she had a lot of questions about what she saw as a deeply unforgiving idea. Texas law reflects this important distinction. A fertilized egg can't survive an ectopic pregnancy and can result in life-threatening bleeding, according to the Mayo Clinic. In Texas, a 2021 law made it easier to sue anyone who helps a person get an abortion after about six weeks of pregnancy. "We skipped over the genetic testing offered in the first trimester," Elizabeth says. 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. Hall declined those services. 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 quickly. They had savings to fund this last-minute trip, and because her company is based in Illinois, her insurance covered the procedure. 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. Miscarriages occur in roughly 1 out of 10 pregnancies. 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 . Methotrexate also is listed in the Texas law passed last year. Julia Robinson for NPR She said Houston Methodist had convened an ethics panel of doctors, but her doctor didn't seem very optimistic. Its our 10th year participating in Amplify, and to celebrate, weve got $15,000 in matching funds from four generous Tribune supporters. To Elizabeth, it seemed obvious that things were deteriorating. Crescenda Uhles, a genetic counselor in Dallas, said the Texas law puts people like her in a bind when advising patients. "We shouldn't have been celebrating," Elizabeth says. Down in the kitchen, images from recent scans and ultrasounds were stuck to the fridge. Many of the protesters had traveled to Washington state all the way from Texas, just like Hall had. 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. Most recently, the Oklahoma Senate passed six abortion-limiting bills , including one that would ban abortions after 30 days from a woman's last . This law will prohibit almost all abortions. 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. CONROE, Texas (KTRK) -- A Conroe woman who suffered a miscarriage says the state's restrictive abortion laws forced her into a dangerous health situation. 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. We usually have our moms register for delivery at this point. 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. You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 988. For the women, expectant management after premature rupture of membranes comes with its own health risks. This article originally appeared on Austin American-Statesman: Here's what current Texas abortion laws say, plus birth control info I am still going to tell my patients the information they need., Texas Abortion Law Complicates Care for Risky Pregnancies, https://www.nytimes.com/2021/11/26/health/texas-abortion-law-risky-pregnancy.html, We cant do anything unless the mom is sick, said Dr. Andrea Palmer, an obstetrician in Fort Worth. Quite the opposite, many state laws explicitly exempt treatment of ectopic pregnancy from their definitions of abortion. But in early May, not long after the uneventful anatomy scan, the Wellers suddenly arrived at that crossroads. For example, in rare cases an infection can make the amniotic sac rupture before the fetus is viable. And it's strong. 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.". 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. These are the patients that are the most affected.. But Im still so angry I had to leave.. 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 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. The patient ended up driving 15 hours to New Mexico for life-saving treatment after no one in Texas would help her. Amplify your impact and donate now. James and Elizabeth cried out their thanks to the doctor. Acts 1989, 71st Leg., ch. But those numbers have skyrocketed since Roe v. Wade was overturned. It is an editorially independent operating program of KFF (Kaiser Family Foundation). Elizabeth was induced late Friday night, and the labor became painful enough that she had to get an epidural. These dismissals only increase the sense of isolation, stigma and shame. For patients who are not pregnant, it can also open up the cervix and make surgeries safer, Crawford said. She never had to use that bag. . This is already incredibly difficult news that someone receives, Thoppil said. Coming back to Texas a few days later only amplified those feelings. A wait for fetal death, or her own encroaching illness. Other times patients don't report the problem and miscarry on their own, she said, but without medication they risk additional bleeding. Because once they reached Methodist, while they were still checking in at the emergency room, her doctor called. 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. Anyone can read what you share. 8, which encourages private citizens to file lawsuits against anyone who facilitates an abortion, will proliferate, giving self-appointed vigilantes no shortage of . But now "your medical provider says that it's illegal and they can't provide it. Their daughter, as expected, was stillborn. But the patient was past six weeks gestation, and under the new law, an abortion was not an option in Texas because the woman was not immediately facing a life-threatening medical crisis or risk of permanent disability. Because at this point, I'm in survival mode. "The pharmacy has said, 'We don't know whether or not you might be using this medication for the purposes of abortion,'" she said. For Elizabeth, that tragic conversation was just "the beginning of the hell that was going to ensue" for the rest of the week. A clinical battle begins behind the scenes. care provider and intended to remove an ectopic pregnancy that . The holidays are going to be especially hard. Sometimes theyre the primary caregiver. At the same time, she was searching for abortion clinics. Confusion around the laws has caused issues for patients outside of emergencies. 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. The protesters outside a Seattle-area abortion clinic waved pictures of bloody fetuses, shouting that she was a baby killer and begging her to choose life. How theyd told their families, picked out a name, built a crib and bought pink sheets. 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. She and her husband began trying in late 2021. It went into effect on Sept. 1. 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. 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. Growing up outside Dallas, Hall often heard that abortion was murder and, perhaps worse, interfering with Gods plan. Amplify your impact and donate now. 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. 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. 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. 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. "And that may mean in certain circumstances protecting the mother in this situation and the child passing away.". Marlena Stell always wanted a big family. 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. State House Bill 2709, filed Thursday, would penalize individuals for the use of medication to cause abortion in the state of Texas, whether the pills were acquired at a local pharmacy or . Hall was outraged about the world that her daughter was going to be born into, but she didnt worry too much about how this would affect her pregnancy. An ectopic pregnancy is when a fertilized egg implants outside the uterus, typically in one of the woman's fallopian tubes. Financial supporters play no role in the Tribune's journalism. On Saturday, May 14, about 2 a.m., she gave birth. After one conversation, the doctor returned to her bedside. The emotional toll was what worried Hall most of all. hide caption. I want to see legislation come out that will both do more as well as clarify the ways that we are protecting the life of the mother.. She places the blame for the ensuing medical trauma on the Republican legislators who passed the state's anti-abortion law, on Texas Gov. Elizabeth knows it was just a terrible coincidence, an awful bureaucratic oversight, and yet it drove home to her how powerless she was, how alone, in that vast medical system of rules, legal regulations and revenue. I'm trying to understand. If I offer the patient the standard of care, I could be sued for aiding and abetting, he said. "And she starts to cry and she tells me: 'They're not going to touch you.' 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. Texas never repealed its original law prohibiting abortion except when the life of the mother was in danger after Roe. 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. In a sudden obstetrical emergency, a termination might be the least risky option, clinically. 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. Hall managed not to scream any of this at the protesters, instead just silently flipping them off. She took a pregnancy test soon after she missed her period and found out that she had conceived. For doctors treating such patients, the Texas law creates quite a conundrum, Dr. Snyder said. Even in Texas, whose "heartbeat bill" was one . Most of these pregnancies end in miscarriage or stillbirth. Updated: Oct. 24, 2022. If the lawsuit is successful, plaintiffs can receive up to $10,000. Once she made her way through the clinics stringent security, the nurses took her into a private room. 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. But he did not address the question of lethal fetal anomalies, which are fatal for the fetus during pregnancy or shortly after birth. In cases in which a medical provider may be hesitant to conduct a needed treatment, itll be critical for patients to stay informed, seek help or get more than one medical opinion, said Joanna Grossman, a professor at Southern Methodist Universitys Dedman School of Law. With regard to pregnancy-related complications for women of any age, Dr. Skop said, the new law allows doctors to act when necessary and to justify their treatments in court if they are sued. 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. It was just too hard, as she navigated a complicated mix of relief and grief. Halls fetus was diagnosed with anencephaly, a neural tube defect in which the brain, skull and scalp do not develop properly in the womb. 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. "At first I was really enraged at the hospital and administration," she says. Recently passed laws make abortion illegal after about six weeks into a pregnancy. 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. Texas providers are still adjusting to other ripple effects that affect patient care. And I screamed because that's when I knew something wrong was happening. It just didnt occur to them that a ban would include cases like this.. We havent seen a large issue, but there are certainly anecdotes, Thoppil said. Elizabeth Weller never dreamed that her own hopes for a child would become ensnared in the web of Texas abortion law. a letter from the Texas Medical Association. These cases are only going to grow until the law is either repealed or clarified. Texas' current heartbeat ban enables private citizens to sue anyone who helps someone get an abortion after about six weeks. These terms are left vague or undefined. "I remember hearing her, from my room, speaking loudly about how nothing is being done here.". But there was a vibe immediately. She was admitted to the hospital, and later that night, when her own obstetrician called, she begged her for information. 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. But as has been true in Texas and in many of the 12 other states where abortion is banned . I couldn't give you life. Cheng did not treat Hall, but has counseled patients facing similar situations. In the nursery upstairs, they had already stashed some baby clothes and new cans of paint. 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. not include an abortion that uses suction to dismember the body of an unborn child by sucking pieces of the unborn child into a . The maternal fetal medicine specialist at the University of Texas Southwestern Medical Center in Dallas published a blog post last August to inform patients that treatment for cesarean scar ectopic pregnancies are legal under Texas's abortion law. the U.S. that have trigger laws in place banning abortion in the . 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. Supporters of the law say their goal is to save the life of every embryo, regardless of the circumstances of conception. And they're telling me to think of the positives. The new law does not apply to removing ectopic pregnancies that implant outside the uterus, which are not considered abortions under state law. No one really knows what the legislature means by that, and they are afraid of overstepping. The new abortion bans or the old laws being resurrected in a post-Roe world are rigidly written and untested in the courts. Aborting the embryo is often the best treatment for an ectopic . The next day, Elizabeth's ob-gyn came to the hospital to arrange the procedure. Greg Abbott said there were some things that we need to work on to ensure patients can get treatment for miscarriages and ectopic pregnancies. He said the association has been in communication with some pharmacy leaders to help clarify proper interpretation of the rules.. 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