Miscarriage As Hall learned the hard way, the law makes no exception for lethal fetal anomalies. James and Elizabeth cried out their thanks to the doctor. But when membranes rupture earlier in pregnancy, particularly before 24 weeks, the chance of a fetus surviving plummets. I'm so sorry.". Time is of the essence. The risks to Elizabeth's health were simply too high. 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 . For some, that's too difficult, given the emotions surrounding the pregnancy loss, she said. Financial supporters play no role in the Tribune's journalism. They were just all shocked, like, Surely, theres an exception for this, Hall said. Halls fetus was diagnosed with anencephaly, a neural tube defect in which the brain, skull and scalp do not develop properly in the womb. I couldn't give you life. After one conversation, the doctor returned to her bedside. 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. About 10% to 20% of confirmed . Enough to make her retch. Her husband took over, asking the doctor what, if anything, they could do. Then Elizabeth felt another sudden, forceful gush of fluid leave her body. And it just occurred to me that the people Ive been told my whole life are going to hell for their actions were the most kind and angelic individuals through this whole thing.. But the most confusing development involves the exemptions that exist for the woman's life or health, or because of a "medical emergency." And she says 'Yes. The next day, a Thursday, she started throwing up. Dr. Palmer, the obstetrician in Fort Worth, said that one of her patients was trying to get pregnant after the new law went into effect, and she had consensual sex with her partner. 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. We havent seen a large issue, but there are certainly anecdotes, Thoppil said. 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 . First she said, I cant, I want this baby so badly, Dr. Gunby recalled. 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. "Ectopic pregnancies can kill people," said Brown, a district chair for the American College of Obstetricians and Gynecologists, representing Texas. The holidays are going to be especially hard. Methotrexate or surgery are the only two options listed in the medical guidelines to prevent the fallopian tubes from rupturing and causing dangerous bleeding. It was May 10, 2022. But the womans condition can quickly deteriorate, which is why physicians often prefer to offer an abortion. I have seen cases where the woman has gone from completely normal to septic shock in less than an hour, Dr. Carpenter said. Many of the patients that we see in my practice already have to drive so far away to get basic prenatal care, Cheng said. There is no treatment to stop a miscarriage once it has started, and miscarriages can become life-threatening to the pregnant patient if complications are untreated. But it is also affecting women who have no desire for termination but are experiencing medically risky pregnancies. They're not allowed to do that in Texas. The crisis the Wellers endured is emblematic of the vast and perhaps unintended medical impacts of the criminalization of abortion in Republican-led states. In fact, no abortion law in any state in America prevents lifesaving treatment for women with ectopic pregnancies and other life-threatening conditions . I couldnt do that., by Eleanor Klibanoff 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. 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. 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. You open it. "Abortions are sometimes needed out of an act of an emergency, out of an act of saving a woman's life. 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. Consider the patient whose miscarriage care is delayed and develops a serious infection and other complications, Prager said. Treatments for miscarriages and ectopic pregnancies are still legal under Texas abortion ban. You can reach them at 212-255-9252. Earlier this month, Gov. 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 . An ectopic pregnancy occurs when the fertilized egg is implanted outside the uterus, most commonly in a fallopian tube. "It might even be scary for you to reach out and seek support even mental health support. "And yet we were. 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. It went into effect on Sept. 1. A Texas judge's decision that could revoke the FDA's approval of abortion drugs is expected soon. 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.. . Amplify your impact and donate now. Texas Health and Safety Code, Chapter 171. 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.". But for patients facing a medical emergency, or low-income or uninsured Texans, seeking a second opinion may not be possible. 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 . But Texas's medical exception is narrower, and less defined . "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. She places the blame for the ensuing medical trauma on the Republican legislators who passed the state's anti-abortion law, on Texas Gov. "I just cried and screamed in the parking lot," she recalls. That's when a new state law banned all abortions after fetal cardiac activity is detected usually at about six weeks of pregnancy. There was still a fetal heartbeat, but it could stop at any moment. Idaho, Tennessee and Texas will implement abortion bans in 30 days, according to the text of the laws. This current law excludes treatment for miscarriage or ectopic pregnancy. CONROE, Texas (KTRK) -- A Conroe woman who suffered a miscarriage says the state's restrictive abortion laws forced her into a dangerous health situation. Growing up outside Dallas, Hall often heard that abortion was murder and, perhaps worse, interfering with Gods plan. Many Texans facing this same set of circumstances wont have the means to leave the state, Thoppil said, contributing to the states high rates of maternal morbidity and mortality, particularly among communities of color. In Texas, a 2021 law made it easier to sue anyone who helps a person get an abortion after about six weeks of pregnancy. Medical v. legal . Still, states like Missouri could put this pro-abortion talking point to rest by protecting treatment of ectopic pregnancy explicitly in the law. In the meantime, Grossman said the delay and denial of care will likely become more common. 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. Marlena Stell always wanted a big family. "Ectopic pregnancy" means the implantation of a fertilized egg or embryo outside of the uterus. But I need you to tell me the truth, because I don't think all the positive things that they're telling me are real. 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. Many doctors say they are unable to discuss the procedure as an option until the patients condition deteriorates and her life is at risk. They have jobs and multiple children to take care of and they dont have the finances to take four or five days to go to a different state. The emotional toll was what worried Hall most of all. "And if they didn't believe me, I was going to show it to them and say "Look! 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. Elizabeth stood up to get some lunch. Once inside the car, they both burst into tears, for their baby and the terrible choices they were now left to navigate. Elizabeth was induced late Friday night, and the labor became painful enough that she had to get an epidural. "It's terrible," says Dr. Alan Peaceman, a professor of maternal-fetal medicine at Northwestern University's Feinberg School of Medicine. A previous version of this story incorrectly reported the name and location of a clinic. And that's a big part of this problem, when we as physicians are trying to relieve patients' suffering. Her discharge was yellow and smelled weird. 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. She said Houston Methodist had convened an ethics panel of doctors, but her doctor didn't seem very optimistic. We do what we can to honor each of those cases.. That's not a good thing. Texas' new abortion laws . 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. Although distraught and heartbroken at this news, Elizabeth forced herself to think it through. But the Wellers and 28 million other Texans had already been living under a de facto abortion ban for 8 months, since September 2021. And quickly. "I told her 'I'm so sorry. 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. It is an editorially independent operating program of KFF (Kaiser Family Foundation). Find a complete list of them here. A doctor sat down and told her: "There's very little amniotic fluid left. These provisions are in Chapter 170A of the Texas Health & Safety Code, which was enacted by House Bill 1280 in 2021. How are you doing, and are you excited for the delivery?'". 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 . For example, last year's Texas Heartbeat Law incorporated Texas' Health & Safety Code 245.002, which states (emphasis added): "At first I was really enraged at the hospital and administration," she says. The Wellers were pleasantly surprised when they got pregnant early in 2022. But now in Texas, the new laws are creating uncertainties that may deter some doctors and other providers from offering optimal miscarriage treatment. Thaxton, who supervises the obstetrics-gynecology residents who have seen these patients, said sometimes the prescribing clinic will intervene, but it takes the patient longer to get the medication. "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. I think most people would give tremendously leeway to that. Many offer no exemptions for rape, incest or fetal anomolies. After holding it together all morning, Hall burst into tears. Elizabeth and James look at clothes that were meant for their baby, whom they lost in the second trimester of pregnancy. The women who will be forced to carry these babies are the women with less resources, he said. She was admitted to the hospital, and later that night, when her own obstetrician called, she begged her for information. To the extent anybody is delaying or denying care for ectopic pregnancy, they are simply misunderstanding the law, Grossman said. The staff remained vague about what came next, Elizabeth recalls. The Texas Tribune Festival is almost here! 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 . Many state laws with new restrictions on abortion make exceptions for ectopics, but uncertainties can arise if a fetus implants on Caesarean scar tissue on the uterus wall or if it cannot be . hide caption. 9:42 AM on Jul 1, 2022 CDT. Rather than warmth and sympathy, she was met with fear, hesitation and, worst of all, silence. And they're telling me to think of the positives. 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. Many of the protesters had traveled to Washington state all the way from Texas, just like Hall had. The Biden administration last week told hospitals they must treat pregnant patients who need an abortion to stabilize a life-threatening condition. She was so tiny. A doctor hugs a patient at an abortion clinic in Santa Teresa, New Mexico, on 13 January 2023. And theyve had to navigate complicated politics when sharing their news. Abortion bans in Mississippi, North Dakota and Wyoming go into effect after the attorney . Pregnancies can be complicated by any number of medical conditions. 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. Whether terminating an ectopic pregnancy is legal will depend on individual state laws. Sept. 20, 2022 Texas has a trigger law on the books that will outlaw abortion almost universally beginning 30 days after the Supreme Court . Methotrexate, another abortion-inducing medication, is used to treat ectopic pregnancies as well as rheumatic illnesses, inflammatory bowel disease, psoriasis and cancer. Texas' "trigger" law, which outlaws abortion "wholly or partly", is set to be in effect 30 days following the . If I offer the patient the standard of care, I could be sued for aiding and abetting, he said. Because the providers have a choice whether to provide and the patients are the ones who need the care. So when Roe v . 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. Or, like Hall, they can shell 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. But two of those drugs, misoprostol and mifepristone, are the only drugs recommended in the American College of Obstetricians and Gynecologists guidelines for treating a patient after an early pregnancy loss. Miscarriages occur in roughly 1 out of 10 pregnancies. hide caption. 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. Or in cases of rape or incest? 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. "Abortion and pregnancy outcomes are under a microscopein a way we . We both have good jobs, weve got a house and we were at a place where if it happens, it happens, she said. After her initial miscarriage in 2018, Stell and her husband had their first child, a daughter, in April 2020. These situations can create significant moral distress for patients and providers, said Bryn Esplin, a bioethicist and assistant professor of medical education at the University of North Texas Health Science Center in Fort Worth. Hall and her husband would like to try again at some point. 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. Aborting the embryo is often the best treatment for an ectopic . Seventeen weeks into the pregnancy, they learned they were expecting a girl. 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. "He and I kept telling each other 'What is the whole point of the Hippocratic oath to do no harm?'" "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.". 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. ", State abortion laws are complicating other types of obstetric care. It also sets out civil, criminal, and professional penalties for abortion providers who violate the law. "We skipped over the genetic testing offered in the first trimester," Elizabeth says. 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. They don't want to get sucked into a legal morass. She ate a healthy breakfast, went for a walk outside and came back home. Ectopic pregnancy develops in an estimated 2% of reported pregnancies. There has been apprehension by doctors about dealing with both of those two issues, Abbott told Fox 4 News. Immediately, they sensed hesitation from the doctor. 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. Doctors in Texas say they cannot head off life-threatening medical crises in pregnant women if abortions cannot be offered or even discussed. And I knew my baby was suffering, I knew I was suffering, I knew my husband was suffering.". We see patients from many different religions and cultures, and how they grieve is unique to each patient, Sanchez said. Your donation keeps our trusted reporting free and accessible for all Texans and during a legislative session when lawmakers are set to tackle issues from school choice for K-12 students to school safety improvements to changes in property taxes, its critical that Texans know what lawmakers decisions mean for their futures. 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. A fight began, which Elizabeth first became aware of as her doctor paced the hall outside her room, talking on her phone. Austin woman trying for baby says Texas abortion law nearly caused her death. In some cases, the infection can become severe or life-threatening, leading to sepsis, hysterectomy or even death. Now she wants those sentiments translated into action. It was because of the state law which forbids termination of a pregnancy as long as there is fetal cardiac activity. "It is a pro-life position to allow physicians to make those life-and-death decisions," Seago said. So we look at them like a ticking time bomb and wait for the complications to develop.. 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, it seemed obvious that things were deteriorating. The hospital where she works pays me to have these conversations with patients, but theres not necessarily any guarantee they would have my back should someone decide to list my name on a lawsuit, she said. Her discharge had to be darker. I'm trying to understand. 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. All you can do now is just hope and pray that things go well.". 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. "And she starts to cry and she tells me: 'They're not going to touch you.' But the statutes dont account for complicated miscarriages, and confusion has led some providers to delay or deny care for patients in Texas. The bill makes no exceptions for pregnancies that resulted from rape or incest. Walmart officials did not respond to multiple requests for comment. 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.. When Roe v. Wade fell in June, Elizabeth's pain and anger surged up again. Its our 10th year participating in Amplify, and to celebrate, weve got $15,000 in matching funds from four generous Tribune supporters. Not doing so can, in some circumstances, kill all of the fetuses. 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. Took no time at all.. Updated: Oct. 24, 2022. Thankfully, I think theres still plenty of pharmacies that understand the proper utilization of some of the medications we use for nonelective [pregnancy] terminations.. Hall managed not to scream any of this at the protesters, instead just silently flipping them off. Anyone can bring that civil action, posing a quandary for physicians and other providers. 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. 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. At the same time, she was searching for abortion clinics. A fertilized egg can't survive an ectopic pregnancy and can result in life-threatening bleeding, according to the Mayo Clinic. They had to call their OB/GYN repeatedly to get the $500 delivery deposit refunded. 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 . 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. 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. 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. Down in the kitchen, images from recent scans and ultrasounds were stuck to the fridge. pursuant to the preliminary injunction in texas v. becerra, no. Before they drove off, Elizabeth paused to do something. 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. Cedar River offers specialty care for patients facing lethal fetal abnormalities like anencephaly. Everyone was thrilled, buying them car seats and baby clothes. The patient ended up driving 15 hours to New Mexico for life-saving treatment after no one in Texas would help her. Even with the slim chance of survival to 24 weeks, the newborn would face intense physical challenges and aggressive medical interventions. Hall and her husband left the specialists office in a daze. The only way to stop the heavy bleeding is to end the pregnancy and contract the uterus, Dr. Moayedi said. They now had some of the symptoms they needed to show the infection was getting worse. At 6 weeks, many people . Frustrated with her experience on hormonal birth control, she and her husband decided it was time for her to get off of it. 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. 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 . And it had to smell foul, really bad. The law, which still remains in effect, does contain one exception for a "medical emergency." It was just too hard, as she navigated a complicated mix of relief and grief. As Elizabeth recalled hearing, it was one particular doctor who had argued her case: "They found a doctor from East Texas who spoke up and was so patient forward, so patient advocating, that he said 'This is ridiculous.'". I personally would never get one. 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. An ultrasound confirmed that she had suffered premature rupture of membranes, which affects about 3% of pregnancies. They had bought a house in Kingwood, a lakeside development in Houston. And I told her 'I'm so sorry. Once she made her way through the clinics stringent security, the nurses took her into a private room. If you do something to prevent that, you might be in fact performing an illegal abortion.. Many physicians disagree, pointing out that the law can disrupt care for pregnant women who have underlying health problems that are not immediately life-threatening, such as pulmonary hypertension or certain types of cancer. An ectopic pregnancy, which occurs when a fertilized egg . Or what if the pregnancy wasnt viable? she said. Julia Robinson for NPR Those can be acute life-threatening emergencies, she said. If she wanted to stay in Texas, Halls only choice was to continue with a pregnancy that would not yield a healthy, living baby. She felt lost and confused. 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. 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