Elizabeth and James Weller at their home in Houston two months after losing their baby girl due to a premature rupture of membranes. In 2012, a woman died in Ireland after her waters broke at 17 weeks and doctors refused to give her an abortion. 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. She was bereft, unable to even process the news. Losing a pregnancy is a particular kind of loss, one that tends to make other people even health professionals uncomfortable. "I told her 'I'm so sorry. Enough to make her retch. 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. But now in Texas, the new laws are creating uncertainties that may deter some doctors and other providers from offering optimal miscarriage treatment. Notably, under Texas' law, at least one patient was told to wait until her ectopic pregnancy ruptured her fallopian tubewhich would have put her at immediate risk of death from hemorrhage . Or in cases of rape or incest? I'm so sorry,'" Elizabeth says. On Saturday, May 14, about 2 a.m., she gave birth. 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. And I told her 'I'm so sorry. Methotrexate, another abortion-inducing medication, is used to treat ectopic pregnancies as well as rheumatic illnesses, inflammatory bowel disease, psoriasis and cancer. And for a few tense . ", Later on, Elizabeth said she realized that her anger at Methodist was misplaced. 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. Elizabeth touches the urn of her daughter. Wade and the return of laws governing abortion legality to the states. When you join us at The Texas Tribune Festival Sept. 22-24 in downtown Austin, youll hear from changemakers who are driving innovation, lawmakers who are taking charge with new policies, industry leaders who are pushing Texas forward and so many others. 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. 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. Hall was in her second trimester when the U.S. Supreme Court overturned Roe v. Wade. If youre having severe pain, if youre getting a fever, you need to keep your medical team in the loop, Crawford said. Elizabeth has been sharing her story, and has found that whatever the political affiliation of the listener, they all agree her experience was horrible. "It's this woman who was saying 'Hi Miss Weller, you're at the 19 week mark. Took no time at all.. 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. "This poor woman had no idea what she was telling me. It was May 10, 2022. After Hall made it through the protesters and the clinics security screening, the clinic itself was an oasis, she said. "Abortion and pregnancy outcomes are under a microscopein a way we . Or, like Hall, they can shell out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. The women who will be forced to carry these babies are the women with less resources, he said. The other miscarriage treatment is a procedure described as surgical uterine evacuation to remove the pregnancy tissue the same approach as for an abortion. For example, last year's Texas Heartbeat Law incorporated Texas' Health & Safety Code 245.002, which states (emphasis added): The Wellers were pleasantly surprised when they got pregnant early in 2022. "It might even be scary for you to reach out and seek support even mental health support. Midnight came and went in a blur. It was just too hard, as she navigated a complicated mix of relief and grief. It is the Cedar River Clinics in Renton, Washington, not the Cedar River Clinic in Seattle. 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. 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. Right there in the office, James pulled out his cell phone, and started looking for flights to states with less restrictive abortion laws. The patient lost liters of blood and had to be put on a breathing machine because of the 24-hour delay in care. But as has been true in Texas and in many of the 12 other states where abortion is currently . And not only can they not provide it, but they can't talk to you about it," Cavazos says. In Poland, protests over that countrys abortion laws erupted this year after a 30-year-old pregnant woman died of septic shock. It went into effect on Sept. 1. You can reach them at 212-255-9252. Cheng did not treat Hall, but has counseled patients facing similar situations. But Im still so angry I had to leave.. The Supreme Court is expected to rule soon on whether abortion providers and the Biden administration may challenge the law notwithstanding its novel structure. That's when a new state law banned all abortions after fetal cardiac activity is detected usually at about six weeks of pregnancy. The case spurred a movement that led to the overturning of Ireland's abortion ban in 2018. On September 1, 2021, Texas Senate Bill 8 (SB 8) went into effect, banning virtually all abortions and medical counseling and support related to abortion after six weeks. Under another new Texas abortion law, someone who "aids or abets" an abortion after cardiac activity can be detected typically around six weeks can be subject to at least a $10,000 fine per occurrence. 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. A recently scanned monitor shows a patients ultrasound at the Family Birth Center at Beaumont Hospital in Royal Oak, Michigan, in February 2022. "It wasn't that the Methodist Hospital was refusing to perform a service to me simply because they didn't want to, it was because Texas law put them in a position to where they were intimidated to not perform this procedure.". 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. The only way to stop the heavy bleeding is to end the pregnancy and contract the uterus, Dr. Moayedi said. Grumet: Fears over Texas' abortion laws interfere with urgent, life-saving care. I couldn't give you life. I was so excited for this appointment because its so good to see her in there, she said. 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. Miscarriages occur in roughly 1 out of 10 pregnancies. Texas providers are still adjusting to other ripple effects that affect patient care. These dismissals only increase the sense of isolation, stigma and shame. "It's hard to form a relationship to say, 'Hey look, I'm not using this for an elective abortion,'" she said. See the growing speaker list and buy tickets. 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. 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. 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. July 20, 20225 PM Central. They told her the signs of a more severe infection would include a fever of 100.4 degrees and chills. 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. Or you wait till your baby's heartbeat stops.'". Anencephalic babies born alive will likely survive only for hours or days; they will be unconscious, blind, deaf and will not voluntarily respond to touch or sound, according to the Cleveland Clinic. A doctor hugs a patient at an abortion clinic in Santa Teresa, New Mexico, on 13 January 2023. Elizabeth and James keep remembrances of their baby in a picture frame at home. 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. She had the proof. Elizabeth touches the urn of her daughter. Sometimes theyre the primary caregiver. More often than not, they just say they lost the baby. For doctors treating such patients, the Texas law creates quite a conundrum, Dr. Snyder said. She and her husband immediately jumped into planning mode, scheduling an appointment at one of the only OB-GYN practices in town. Idaho, Tennessee and Texas will implement abortion bans in 30 days, according to the text of the laws. Elizabeth could not receive the medical care she needed until several days later because of a Texas law that banned abortion after six weeks. Double your gift when you give by 6 p.m. Thursday. 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. 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. 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. But some health conditions can jeopardize a womans health in the long term but not necessarily constitute an immediate threat to her life. 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. An ectopic pregnancy is when a fertilized egg implants outside the uterus, typically in one of the woman's fallopian tubes. 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 . hide caption. And that 'you can either stay here and wait to get sick where we can monitor you, or we discharge you and you monitor yourself. But things can be murkier when it comes to treating miscarriages, she said. 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. Other times patients don't report the problem and miscarry on their own, she said, but without medication they risk additional bleeding. But now were forcing someone to continue the pregnancy and go through all the risks of a potentially term delivery and all those potential complications for a pregnancy that has no chance of surviving. But Texas's medical exception is narrower, and less defined . This article originally appeared on Austin American-Statesman: Here's what current Texas abortion laws say, plus birth control info "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?". It just seems cruel and unusual.. Sec. "I said 'Well, is there a heartbeat still?' Eventually, she found a clinic near Seattle that provides specialty care for patients who have decided to terminate due to lethal fetal abnormalities. a letter from the Texas Medical Association. That is a pregnancy that occurs outside the uterus. Outcomes from expectant management vary greatly depending on when the waters break. 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. Updated: Oct. 24, 2022. 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. Coming back to Texas a few days later only amplified those feelings. Financial supporters play no role in the Tribune's journalism. A wait for fetal death, or her own encroaching illness. About 10% to 20% of confirmed . That's not a good thing. Misoprostol is used to help prevent stomach ulcers, but it can induce abortions, particularly if taken along with mifepristone. Hall and her husband left the specialists office in a daze. "It's just really unimaginable to be in a position of having to think: How close to death am I before somebody is going to take action and help me?". Because the providers have a choice whether to provide and the patients are the ones who need the care. 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. Hall shelled out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. So we look at them like a ticking time bomb and wait for the complications to develop, Dr. Palmer said of her patients. 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. 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. The holidays are going to be especially hard. Since the Supreme Court ruling of June 24, 2022 that overturned Roe v. Wade, many states have banned abortion, or severely restricted abortion access. Now she wants those sentiments translated into action. You open it. One persons emergency may not be another persons emergency, said Dr. Robert Carpenter Jr., an obstetrician in Houston. 8, which encourages private citizens to file lawsuits against anyone who facilitates an abortion, will proliferate, giving self-appointed vigilantes no shortage of . Elizabeth chose to go home rather than wait to get sick at the hospital. Frustrated with her experience on hormonal birth control, she and her husband decided it was time for her to get off of it. Hall, raised in a conservative Christian family outside Dallas, felt like she had whiplash from the sudden and tragic events that had brought her to an abortion clinic halfway across the country. All too often, Cavazos says, patients are told to get over it, move on, try again. 5:22-cv-185-h (n.d. Since that time, thousands of women have left Texas to obtain abortions in other states. 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. Such testing is done late in pregnancy, beyond the six-week limit, noted Crescenda Uhles, a genetic counselor in Dallas. 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.. "Because I didn't want anybody to tell me they did not believe me," she says. Aborting the embryo is often the best treatment for an ectopic . Were going to take care of you, and youre going to be OK, Hall remembers. 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 . 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 . But the most confusing development involves the exemptions that exist for the woman's life or health, or because of a "medical emergency." "You know they paint this woman into being this individual that doesn't care about her life, doesn't care about the life of the children she creates or whatever. She said Houston Methodist had convened an ethics panel of doctors, but her doctor didn't seem very optimistic. Greg Abbott said there were some things that we need to work on to ensure patients can get treatment for miscarriages and ectopic pregnancies. The law makes no exceptions for nonviable pregnancies in which the fetus has no chance of survival. If she wanted to stay in Texas, Halls only choice was to continue with a pregnancy that would not yield a healthy, living baby. The emotional toll was what worried Hall most of all. At that point, the patient can opt to wait until the bleeding starts and the pregnancy tissue is naturally released, Briggs said. Methotrexate also is listed in the Texas law passed last year. 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. Eventually, she laid out their options: Keep carrying the pregnancy or leave Texas to get an abortion. 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. 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. The Texas Health and Safety Code allows abortion in cases of an ectopic pregnancy or during a "medical emergency," when a "life-threatening physical condition aggravated by, caused by, or . Dr. Jennifer Liedtke, a family physician in Sweetwater, Texas, who delivers about 175 babies annually, no longer sends misoprostol prescriptions to the local Walmart. "Abortions are sometimes needed out of an act of an emergency, out of an act of saving a woman's life. ), hhs may not enforce the following interpretations contained in the july 11, 2022, cms guidance (and the corresponding letter sent the same day by hhs secretary becerra): (1) hhs may not enforce the guidance and letter's interpretation that texas abortion laws are preempted by emtala; and (2) hhs may . Once she made her way through the clinics stringent security, the nurses took her into a private room. The Texas Tribune Festival is almost here! But in early May, not long after the uneventful anatomy scan, the Wellers suddenly arrived at that crossroads. Texas' "trigger" law, which outlaws abortion "wholly or partly", is set to be in effect 30 days following the . I would consider what I experienced that weekend a medical emergency.. I need you to give me the facts.'". oral contrace ptives." The term "abortion" in Texas law does not apply when these acts are done to "(A) save the life or preserve the health of an unborn child; (B) remove a dead, unborn child whose death was caused by spontaneous abortion; or (C) remove an ectopic pregnancy." Tex. Although distraught and heartbroken at this news, Elizabeth forced herself to think it through. But the language is ambiguous, and travel can be expensive and onerous for pregnant women, especially if they are unwell. It was someone else at Methodist Hospital, perhaps a clerk, calling to go over some paperwork. 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. This chapter may be cited as the Texas Abortion Facility Reporting and Licensing Act. A doctor sat down and told her: "There's very little amniotic fluid left. It is an editorially independent operating program of KFF (Kaiser Family Foundation). Doctors and experts also worry that patients with pregnancy complications may be too afraid of being accused of inducing an abortion to seek care. It is just possible that chemical abortions more than half of all U.S. abortions soon could be outlawed nationwide. And theyve had to navigate complicated politics when sharing their news. Texas Health and Safety Code, Chapter 245. "And if they didn't believe me, I was going to show it to them and say "Look! No one really knows what the legislature means by that, and they are afraid of overstepping. Even with the slim chance of survival to 24 weeks, the newborn would face intense physical challenges and aggressive medical interventions. Or hell honestly it shouldn't even get to the point where you're having to save a woman's life. But the new Texas law has profoundly affected his ability to practice. To Dr. Peaceman at Northwestern, it sounded like the hospital's clinicians were using the most common clinical signs of chorioamnionitis as a guideline. They don't want to get sucked into a legal morass. Supporters of the law say their goal is to save the life of every embryo, regardless of the circumstances of conception. Pregnancy is dangerous, and there are many potential risks for a fatalityectopic pregnancy, severe preeclampsia, cancer, heart conditionsall things that would drive a person to seek an abortion. On Friday, when she woke up, she was still passing blood and discharge, still feeling sick, and feeling strange things in her uterus. The fetus had a rare neural tube defect. "We shouldn't have been celebrating," Elizabeth says. If she had any physical ailments, I would never abort her for that issue. "Ectopic pregnancy" means the implantation of a fertilized egg or embryo outside of the uterus. And a tubal ectopic pregnancy, let's say, is clearly excluded. 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). 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.. Texas' current heartbeat ban enables private citizens to sue anyone who helps someone get an abortion after about six weeks. "That's torture to have to carry a pregnancy which has such a low chance of survival," says Dr. Peaceman. Lauren Hall stands for a portrait on Sept. 10, 2022, in the room that she and her husband had prepared as a nursery. Depending on the medical circumstances, one of those options may be abortion. I couldn't give you life. 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