Another pending ban, a so-called "trigger law" passed by Texas in 2021, is expected to go into effect within weeks. Although distraught and heartbroken at this news, Elizabeth forced herself to think it through. Because once they reached Methodist, while they were still checking in at the emergency room, her doctor called. . Methotrexate also is listed in the Texas law passed last year. 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. This can occur as early as two weeks after a missed period, when most women do not yet know they are pregnant. Elizabeth Weller never dreamed that her own hopes for a child would become ensnared in the web of Texas abortion law. Julia Robinson for NPR 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 . 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. 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. The crisis the Wellers endured is emblematic of the vast and perhaps unintended medical impacts of the criminalization of abortion in Republican-led states. 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. 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. Elizabeth was in graduate school for political science, and James taught middle-school math. "I told her 'I'm so sorry. And she just recklessly and negligently goes out and gets abortions all willy-nilly, left and right," she says. I have a code of ethics to uphold, and that is making sure I discuss with my patients all of their options, regardless of what is available in their area, Ms. Uhles said. I personally would never get one. This represents more confusion around state policy. Hall has struggled with depression, and as the weekend wore on, her mental health deteriorated. This law will prohibit almost all abortions. The staff remained vague about what came next, Elizabeth recalls. Marlena Stell always wanted a big family. Its also had to heighten security since Roe was overturned, Sanchez said, the clinics have seen more and more aggressive protesters, including people from out-of-state like those Hall faced. Whether terminating an ectopic pregnancy is legal will depend on individual state laws. Still, states like Missouri could put this pro-abortion talking point to rest by protecting treatment of ectopic pregnancy explicitly in the law. But Texas's medical exception is narrower, and less defined . And now the Texas abortion law has created an additional bind, Cavazos explains. "It's hard to form a relationship to say, 'Hey look, I'm not using this for an elective abortion,'" she said. First she said, I cant, I want this baby so badly, Dr. Gunby recalled. In Texas, a 2021 law made it easier to sue anyone who helps a person get an abortion after about six weeks of pregnancy. "It might even be scary for you to reach out and seek support even mental health support. Sign up for The Brief, our daily newsletter that keeps readers up to speed on the most essential Texas news. An ectopic pregnancy is when a fertilized egg implants outside the uterus, typically in one of the woman's fallopian tubes. The abortion clinic is less than a mile from Texas, where abortion is illegal. "And she starts to cry and she tells me: 'They're not going to touch you.' "The penalties are quite draconian," he said, noting that someone could be convicted of a felony. The Biden administration last week told hospitals they must treat pregnant patients who need an abortion to stabilize a life-threatening condition. We both have good jobs, weve got a house and we were at a place where if it happens, it happens, she said. 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. At the same time, she was searching for abortion clinics. DEFINITIONS. KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Many of the patients that we see in my practice already have to drive so far away to get basic prenatal care, Cheng said. 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. To deal with the increased demand, Cedar River has reopened a previously shuttered location, enhanced its telemedicine services and worked to find ways to help patients pay for travel and procedures. Join us for Texas biggest politics and policy event when you buy your tickets today. How theyd told their families, picked out a name, built a crib and bought pink sheets. Sec. 245.001. After all, she didnt need an abortion she needed convenient pregnancy care. These are the patients that are the most affected.. So I'm here to call you to register for your delivery on October 5th, so I can collect all your insurance information. Its our 10th year participating in Amplify, and to celebrate, weve got $15,000 in matching funds from four generous Tribune supporters. Maybe they could get the abortion in Denver or Albuquerque. They had to call their OB/GYN repeatedly to get the $500 delivery deposit refunded. While another law enacted last year forbids dispensing and shipping abortion-inducing medications like misoprostol, mifepristone and methotrexate past seven weeks of a pregnancy, it makes exceptions for when the drugs are used for other medical reasons.. "And yet we're being pulled through this.". This chapter may be cited as the Texas Abortion Facility Reporting and Licensing Act. [1/2] Pro-choice and anti-abortion both demonstrate outside the United States Supreme Court as the court hears arguments over a challenge to a Texas law that bans abortion after six weeks in . "It is a pro-life position to allow physicians to make those life-and-death decisions," Seago said. 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. Treatments for miscarriages and ectopic pregnancies are still legal under the states abortion ban, according to state law and legal experts. 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. Julia Robinson for NPR But now in Texas, the new laws are creating uncertainties that may deter some doctors and other providers from offering optimal miscarriage treatment. Anyone can read what you share. Greg Abbott said there were some things that we need to work on to ensure patients can get treatment for miscarriages and ectopic pregnancies. Texas' "trigger" law, which outlaws abortion "wholly or partly", is set to be in effect 30 days following . Right away, she ran into obstacles because of the Texas law. The women who will be forced to carry these babies are the women with less resources, he said. In the nursery upstairs, they had already stashed some baby clothes and new cans of paint. Or the judge could at least nullify FDA decisions in 2016 and 2021 that allowed at-home and mail-order chemical abortions. Julia Robinson for NPR ", As states ban abortion, the Texas bounty law offers a way to survive legal challenges, Texas conservatives have a plan to get around DAs who won't enforce abortion laws. He said the association has been in communication with some pharmacy leaders to help clarify proper interpretation of the rules.. 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. AUSTIN (KXAN) Amanda and Josh Zurawski have been trying to have a baby for more than a year now. She wanted them to experience the agony she felt when she learned that her fetus was developing without a skull or a brain, a condition her doctors told her was incompatible with life.. Family members hold photos of Olga Reyes, a 22-year-old law student who died of an untreated ectopic pregnancy in Nicaragua in 2007. The case spurred a movement that led to the overturning of Ireland's abortion ban in 2018. I was losing my mind, Hall said. "I can tell that she's been beat down, because she has been trying to fight for me all day, advocating on my behalf," 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. Mark Felix/AFP via Getty Images Seventeen weeks into the pregnancy, they learned they were expecting a girl. 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 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. One Texas law passed last year lists several medications as abortion-inducing drugs and largely bars their use for abortion after the seventh week of pregnancy. She was through with being dismissed, being told to wait. The law, which still remains in effect, does contain one exception for a "medical emergency." 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. "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. For doctors treating such patients, the Texas law creates quite a conundrum, Dr. Snyder said. She felt lost and confused. Find a complete list of them here. The one exception is a medical emergency, but the law requires doctors to document the reasons for the exception with great specificity. Pregnant people are now required to just wait, endangering their own lives with no hope of ever bringing home a baby. 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. tex. No one really knows what the legislature means by that, and they are afraid of overstepping. "I was just laying in bed, you know, wondering: Am I pregnant or am I not pregnant? 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.". I think most people would give tremendously leeway to that. In some cases, the infection can become severe or life-threatening, leading to sepsis, hysterectomy or even death. She and her husband began trying in late 2021. As the Supreme Court appears poised to return abortion regulation to the states, recent experience in Texas illustrates that medical care for miscarriages and dangerous ectopic pregnancies would also be threatened if restrictions become more widespread. She took a swipe of the new discharge, and placed the toilet paper in a Ziploc bag to carry with her. "Because I didn't want anybody to tell me they did not believe me," she says. 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. a letter from the Texas Medical Association. I'm trying to understand. by Mara Mndez 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. not include an abortion that uses suction to dismember the body of an unborn child by sucking pieces of the unborn child into a . 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. Depending on the medical circumstances, one of those options may be abortion. For example, last year's Texas Heartbeat Law incorporated Texas' Health & Safety Code 245.002, which states (emphasis added): I'm actually headed home right now because I have to await my dead baby's delivery.' Its been a difficult few weeks since the procedure. "And that may mean in certain circumstances protecting the mother in this situation and the child passing away.". 8, which encourages private citizens to file lawsuits against anyone who facilitates an abortion, will proliferate, giving self-appointed vigilantes no shortage of . But when membranes rupture earlier in pregnancy, particularly before 24 weeks, the chance of a fetus surviving plummets. They don't want to get sucked into a legal morass. Pregnancies can be complicated by any number of medical conditions. Nitsch says she chose sterilization at age 36 rather than risk getting pregnant by another rapist. Texas Health and Safety Code, Chapter 245. She was so tiny. There are currently no abortion laws that outlaw treatment of ectopic pregnancy. All you can do now is just hope and pray that things go well.". 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 . ", The Wellers do want to try again, but first they need to get to a "mentally healthier place," Elizabeth says. 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. Dr. John Thoppil, an obstetrician in Austin, doesnt perform abortions, providing prenatal care and delivering babies. The new abortion bans or the old laws being resurrected in a post-Roe world are rigidly written and untested in the courts. Hall declined those services. She was bereft, unable to even process the news. And it's strong. An IUD can make menstruation irregular, and she did not realize she had conceived until after the six-week mark. Yet under the new law, Dr. Thoppil felt he could not counsel her on terminating the pregnancy. A recent study also reported 28 women with dangerous pregnancies at two Texas hospitals faced delays for care because fetal cardiac activity was detected, according to the AP. To Elizabeth, it seemed obvious that things were deteriorating. 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. These dismissals only increase the sense of isolation, stigma and shame. Once inside the car, they both burst into tears, for their baby and the terrible choices they were now left to navigate. She took a pregnancy test soon after she missed her period and found out that she had conceived. Greg Abbott last year, not only bans abortion after six weeks of pregnancy but also deputizes citizens to enforce it, allowing any person to bring a . An oncologist urged the woman to start treatment immediately, but the chemotherapy regimen would have been toxic to the fetus. And for a few tense . 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. The American College of Obstetricians and Gynecologists has information on early pregnancy loss, finding an OB-GYN and having better conversations with your doctor. (Texas Hospital Licensing Law); (3) an institution required to be licensed under . It is not currently possible in any way to 'reimplant' an ectopic pregnancy. I was so excited for this appointment because its so good to see her in there, she said. 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.. 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. 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. Her doctor said she had been calling other hospitals, but none of them would help. And I knew my baby was suffering, I knew I was suffering, I knew my husband was suffering.". A fight began, which Elizabeth first became aware of as her doctor paced the hall outside her room, talking on her phone. I couldn't give you life. Hall and her husband would like to try again at some point. She was diagnosed with an aggressive lymphoma, a cancer of the immune system. Which sounds extreme, but Roe had just been overturned. All too often, Cavazos says, patients are told to get over it, move on, try again. Doctors and experts also worry that patients with pregnancy complications may be too afraid of being accused of inducing an abortion to seek care. 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. Acts 1989, 71st Leg., ch. Texas is the state weve seen the biggest increase from, Sanchez said. 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. You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 988. Since that time, thousands of women have left Texas to obtain abortions in other states. 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. Because the state has made it very clear that if you talk about this, you're vulnerable to being sued," she added. Ilana Panich-Linsman for The New York Times. 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. hide caption. When Roe v. Wade fell in June, Elizabeth's pain and anger surged up again. 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. Hall managed not to scream any of this at the protesters, instead just silently flipping them off. You're not going to tell me that what I'm experiencing isn't real, again.". 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. And at least one Texas pharmacy has let area physicians know that they would no longer dispense methotrexate, the medication used to treat ectopic pregnancy, citing the law. Under Texas law, doctors can be sued by almost anyone for performing an abortion. "Later they laid down this beautiful baby girl in my arms. The Supreme Court is expected to rule soon on whether abortion providers and the Biden administration may challenge the law notwithstanding its novel structure. When they called the doctor's office back, they were told to go straight to the emergency room. 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. Could put this pro-abortion talking point to rest by protecting treatment of ectopic.! 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