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Despite the tragedy she was facing, Hall knew she was one of the lucky ones. They had bought a house in Kingwood, a lakeside development in Houston. James and Elizabeth cried out their thanks to the doctor. The Wellers were pleasantly surprised when they got pregnant early in 2022. Down in the kitchen, images from recent scans and ultrasounds were stuck to the fridge. Lauren Hall stands for a portrait on Sept. 10, 2022, in the room that she and her husband had prepared as a nursery. The Biden administration last week told hospitals they must treat pregnant patients who need an abortion to stabilize a life-threatening condition. If she is developed enough to be menstruating and become pregnant, and reached sexual maturity, she can safely give birth to a baby, Dr. Skop said. On Friday, when she woke up, she was still passing blood and discharge, still feeling sick, and feeling strange things in her uterus. AUSTIN (KXAN) Amanda and Josh Zurawski have been trying to have a baby for more than a year 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. 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. 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. 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. Find a complete list of them here. More often than not, they just say they lost the baby. 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. I'm trying to mentally survive this.". It is the Cedar River Clinics in Renton, Washington, not the Cedar River Clinic in Seattle. I'm so sorry,'" Elizabeth says. It was someone else at Methodist Hospital, perhaps a clerk, calling to go over some paperwork. I couldn't give you life. by Mara Mndez We physically watched her get sicker and sicker and sicker, he told the AP. The new abortion bans or the old laws being resurrected in a post-Roe world are rigidly written and untested in the courts. 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. "To them my life was not in danger enough.". "I told her 'I'm so sorry. I'm trying to understand. Austin woman trying for baby says Texas abortion law nearly caused her death. 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. Her husband took over, asking the doctor what, if anything, they could do. Double your gift when you give by 6 p.m. Thursday. "And yet we were. Hall and her husband left the specialists office in a daze. 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. Texas' "trigger" law, which outlaws abortion "wholly or partly", is set to be in effect 30 days following the . If the lawsuit is successful, plaintiffs can receive up to $10,000. At that point, the patient can opt to wait until the bleeding starts and the pregnancy tissue is naturally released, Briggs said. Under Texas law, doctors can be sued by almost anyone for performing an abortion. Dr. Ghazaleh Moayedi, an obstetrician/gynecologist and abortion provider in Texas, said the new law leaves unclear whether a physician can act when a woman has a spontaneous miscarriage and is bleeding heavily, but the fetus has not passed. The new law in Texas bans abortion at 6 weeks when a fetal "heartbeat" can be detected. 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 . We both have good jobs, weve got a house and we were at a place where if it happens, it happens, she said. Hall and her husband would like to try again at some point. ", The Wellers do want to try again, but first they need to get to a "mentally healthier place," Elizabeth says. Recently passed laws make abortion illegal after about six weeks into a pregnancy. "It's hard to form a relationship to say, 'Hey look, I'm not using this for an elective abortion,'" she said. 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 . An ultrasound confirmed that she had suffered premature rupture of membranes, which affects about 3% of pregnancies. 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. 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. 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. An IUD can make menstruation irregular, and she did not realize she had conceived until after the six-week mark. If I offer the patient the standard of care, I could be sued for aiding and abetting, he said. But Im still so angry I had to leave.. CONROE, Texas (KTRK) -- A Conroe woman who suffered a miscarriage says the state's restrictive abortion laws forced her into a dangerous health situation. ", State abortion laws are complicating other types of obstetric care. Laws modelled on Texas's S.B. The bill . 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. 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. Treatments for miscarriages and ectopic pregnancies are still legal under Texas' abortion ban.<br/> By: By Mara Mndez, The Texas Tribune Posted at 10:06 PM, Jul 20, 2022 Health & Safety Code 245.002(1)(A)-(C). But then an overwhelming sense of calm washed over her. Unnamed, unknown doctors somewhere had come to an agreement that Elizabeth could be induced that night. hide caption. 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. I'm so sorry,'" Elizabeth says. 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.. 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 . But Prager believes that the laws in Texas and perhaps elsewhere soon . But the incentives are all very strong for those providers to err on the side of not providing care.. Its our 10th year participating in Amplify, and to celebrate, weve got $15,000 in matching funds from four generous Tribune supporters. They're not allowed to do that in Texas. You smell it yourself. KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. When the couple moved from Washington state to Texas in 2021, they were trying to . 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 when she called, they told her that nausea and vomiting weren't among the symptoms they were looking for. Correction, Oct. 24, 2022 at 4:12 p.m.: 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 . But when membranes rupture earlier in pregnancy, particularly before 24 weeks, the chance of a fetus surviving plummets. But the new Texas law has profoundly affected his ability to practice. Or hell honestly it shouldn't even get to the point where you're having to save a woman's life. One reason is that amniotic fluid plays a key role in fetal lung development. A few days later, she went out to celebrate a friends birthday and was raped on her way home. Federal law typically trumps state laws, but it will now be up to courts to decide whether that will be the case in this instance. A doctor sat down and told her: "There's very little amniotic fluid left. 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. "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. If I dont provide my patient the standard of care, which they are due, I could be sued.. Last month, an Austin woman had the medical equivalent of a ticking time bomb in her body. "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. AUSTIN The Texas Medical Association wants regulators to step in after hospitals reportedly refused to treat patients with serious pregnancy complications for fear . And that's a big part of this problem, when we as physicians are trying to relieve patients' suffering. Eventually, she found a clinic near Seattle that provides specialty care for patients who have decided to terminate due to lethal fetal abnormalities. Enough to make her retch. 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. Because the state has made it very clear that if you talk about this, you're vulnerable to being sued," she added. Losing a pregnancy is a particular kind of loss, one that tends to make other people even health professionals uncomfortable. Miscarriages occur in roughly 1 out of 10 pregnancies. She was so tiny. 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. Researchers with the Texas Policy Evaluation Project at the University of Texas at Austin documented several cases in which doctors waited to treat pregnancy complications until a patients health had deteriorated to the point that their life was in danger. 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 midway through her pregnancy. 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 . It was just too hard, as she navigated a complicated mix of relief and grief. 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. 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. Dr. Ingrid Skop, an obstetrician in San Antonio who belongs to the American Association of Pro-Life Obstetricians and Gynecologists, said that even a girl as young as 9 or 10, impregnated by a father or a brother, could carry a baby to term without health risks. Wade and the return of laws governing abortion legality to the states. With it in place, his patient faces a pregnancy rife with potential medical problems. Sometimes theyre the primary caregiver. This represents more confusion around state policy. Julia Robinson for NPR The only way to stop the heavy bleeding is to end the pregnancy and contract the uterus, Dr. Moayedi said. Miscarriage 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. 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. 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. But the National Advocates for Pregnant Women provide free legal assistance to women who have been charged with a crime because of a pregnancy loss like a miscarriage. 8, which encourages private citizens to file lawsuits against anyone who facilitates an abortion, will proliferate, giving self-appointed vigilantes no shortage of . And she goes 'I'm so sorry, I'm so sorry, I didn't know.'". "Any law that creates a hesitancy for physicians to uphold the standard of care for a patient has a cascade of harmful effects both for the patient but also for everyone else," said Esplin. 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.. The color was darker and the odor was foul. Texas Gov. 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 . "And yet we're being pulled through this.". 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. Growing up outside Dallas, Hall often heard that abortion was murder and, perhaps worse, interfering with Gods plan. "Ectopic pregnancies can kill people," said Brown, a district chair for the American College of Obstetricians and Gynecologists, representing Texas. And I screamed because that's when I knew something wrong was happening. 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. For Elizabeth, that tragic conversation was just "the beginning of the hell that was going to ensue" for the rest of the week. You're trying to understand exactly what's going on. 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. Financial supporters play no role in the Tribune's journalism. In Poland, protests over that countrys abortion laws erupted this year after a 30-year-old pregnant woman died of septic shock. The case spurred a movement that led to the overturning of Ireland's abortion ban in 2018. It is just possible that chemical abortions more than half of all U.S. abortions soon could be outlawed nationwide. After one conversation, the doctor returned to her bedside. The law, which still remains in effect, does contain one exception for a "medical emergency." Or you wait till your baby's heartbeat stops.'". 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. The earliest time that any genetic testing could be done would be at seven weeks, Dr. Palmer said, so the patient decided to terminate her pregnancy before the six-week mark, in Texas. The emotional toll was what worried Hall most of all. If a woman's life is in danger, she will be able to have an abortion. A previous version of this story incorrectly reported the name and location of a clinic. 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. Frustrated with her experience on hormonal birth control, she and her husband decided it was time for her to get off of it. Many of these lethal fetal abnormalities come to light at an anatomy scan performed later in pregnancy. And so they don't even know what the rules are.". Another patient in Dallas was denied a surgical procedure for a miscarriage, according to The New York Times, and a Texas woman told CNN she had to carry her dead fetus for two weeks until she could find an OB-GYN willing to remove it. You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 988. So we look at them like a ticking time bomb and wait for the complications to develop, Dr. Palmer said of her patients. Immediately, they sensed hesitation from the doctor. Sec. John Seago, legislative director for Texas Right to Life, described this type of hesitation as "an awful misunderstanding of the law." Among other risks, both the fetus and Elizabeth were now highly vulnerable to a uterine infection called chorioamnionitis. Texas new measure was intended to impose stringent limits on abortion. Texas' new abortion laws . "The pharmacy has said, 'We don't know whether or not you might be using this medication for the purposes of abortion,'" she said. Nitashia Johnson for The New York Times. Depending on the medical circumstances, one of those options may be abortion. But the statutes dont account for complicated miscarriages, and confusion has led some providers to delay or deny care for patients in Texas. Texas is the state weve seen the biggest increase from, Sanchez said. These dismissals only increase the sense of isolation, stigma and shame. 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. When they called the doctor's office back, they were told to go straight to the emergency room. Today, abortion is also illegal in Texas under an old 1925 law that the state's Attorney General Ken Paxton declared to be in effect after Roe was overturned. Find a complete list of them here. Those can be acute life-threatening emergencies, she said. This chapter contains a variety of laws related to abortion. Instead, the patient may choose medication or a surgical evacuation procedure, which Briggs said may prove necessary anyway to avoid a patient becoming septic if some of the tissue remains in the uterus. They also have abortion is permitted to protect the life of the mother or her from serious bodily harm that would result if an abortion is not performed. This current law excludes treatment for miscarriage or ectopic pregnancy. 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. Walmart officials did not respond to multiple requests for comment. SB 8, which was signed into law by Texas Gov. Hall was in her second trimester when the U.S. Supreme Court overturned Roe v. Wade. And she says 'Yes. 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. Elizabeth touches the urn of her daughter. Other times patients don't report the problem and miscarry on their own, she said, but without medication they risk additional bleeding. 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.. Crescenda Uhles, a genetic counselor in Dallas, said the Texas law puts people like her in a bind when advising patients. The Supreme Court is expected to rule soon on whether abortion providers and the Biden administration may challenge the law notwithstanding its novel structure. The patient ended up driving 15 hours to New Mexico for life-saving treatment after no one in Texas would help her. 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. Eventually, she laid out their options: Keep carrying the pregnancy or leave Texas to get an abortion. For doctors treating such patients, the Texas law creates quite a conundrum, Dr. Snyder said. I would consider what I experienced that weekend a medical emergency.. But now in Texas, the new laws are creating uncertainties that may deter some doctors and other providers from offering optimal miscarriage treatment. Maybe they could get the abortion in Denver or Albuquerque. The next day, Elizabeth's ob-gyn came to the hospital to arrange the procedure. Just a reminder here that in 2019 an Ohio Republican proposed a bill requiring that in the event of an ectopic pregnancy the zygote must be removed from the fallopian and reimplanted in the uterus or the physician should face murder charges. 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. Elizabeth and James Weller at their home in Houston two months after losing their baby girl due to a premature rupture of membranes. "They can absolutely do that.". "I told her 'I'm so sorry. Greg Abbott said there were some things that we need to work on to ensure patients can get treatment for miscarriages and ectopic pregnancies. For example, last year's Texas Heartbeat Law incorporated Texas' Health & Safety Code 245.002, which states (emphasis added): You can reach them at 212-255-9252. It was just a matter of time before the baby died, or maybe Id have to go through the trauma of carrying to term knowing I wasnt bringing a baby home, she said. And 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. But some health conditions can jeopardize a womans health in the long term but not necessarily constitute an immediate threat to her life. First she said, I cant, I want this baby so badly, Dr. Gunby recalled. The slew of anti-abortion legislation comes on the heels of a Texas law, passed in June, which banned abortions after about six weeks into a pregnancybefore most people realize they are pregnant. Under Texas' Senate Bill 8, abortions are banned after six weeks of pregnancy, and the only exception is if a doctor determines a patient will face a "medical emergency" if the procedure isn't . 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. In one case, a central Texas hospital reportedly told a physician not to treat an ectopic pregnancy until it ruptured, the letter said. area received a letter from a pharmacy in late 2021 saying it would no longer fill the drug methotrexate in the case of ectopic pregnancy, citing the recent Texas laws . As Friday dragged on, Elizabeth started wondering if maybe the heartbeat had stopped. Even if the mothers life is saved, Dr. Moayedi added, she could require an emergency hysterectomy, or removal of the uterus, which would leave her infertile. Which sounds extreme, but Roe had just been overturned. In the nursery upstairs, they had already stashed some baby clothes and new cans of paint. And how can I be so sure I'm not going to get too sick to the point where that's it now you can't have kids. 245.001. An attendee holds her child during A Texas Rally for Abortion Rights at Discovery Green in Houston, Texas, on May 7. But the Wellers and 28 million other Texans had already been living under a de facto abortion ban for 8 months, since September 2021. In the medical profession, doctors will continue to grapple with the new legal restrictions, and the resultant dilemmas in obstetrical care, says Dr. Peaceman. But Prager believes that the laws in Texas and perhaps elsewhere soon could boost physicians' vulnerability to medical malpractice lawsuits. But as has been true in Texas and in many of the 12 other states where abortion is currently . If youre having severe pain, if youre getting a fever, you need to keep your medical team in the loop, Crawford said. Amplify your impact and donate now. But the most confusing development involves the exemptions that exist for the woman's life or health, or because of a "medical emergency." Treatment of ectopic pregnancy is not prohibited by Texas' abortion laws. But those numbers have skyrocketed since Roe v. Wade was overturned. 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