For example, last year's Texas Heartbeat Law incorporated Texas' Health & Safety Code 245.002, which states (emphasis added): It is disingenuous to allege that this law prevents obstetricians from following the medical standard of care, she said. Im a nurse. This is already incredibly difficult news that someone receives, Thoppil said. 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. Nitashia Johnson for The New York Times. But then an overwhelming sense of calm washed over her. 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. Doctors and experts also worry that patients with pregnancy complications may be too afraid of being accused of inducing an abortion to seek care. 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 . That's not a good thing. 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. They stood up in the middle of the ER and embraced. Elizabeth touches the urn of her daughter. They had bought a house in Kingwood, a lakeside development in Houston. Mark Felix/AFP via Getty Images Supporters of the law say their goal is to save the life of every embryo, regardless of the circumstances of conception. 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. If an ectopic pregnancy has ruptured, the pregnant person needs care immediately because they could start bleeding and lose up to 2 liters up blood very quickly. And she says 'Yes. Pregnancies can be complicated by any number of medical conditions. 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. It just seems cruel and unusual.. '", "It was devastating to hear that," Elizabeth says. Photograph: Esteban Flix/AP Halls fetus was diagnosed with anencephaly, a neural tube defect in which the brain, skull and scalp do not develop properly in the womb. 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. Texas abortion laws penalize the person who performs an abortion and, under a state law from 1925, anyone who furnishes the means for an abortion. That's when she felt something "shift" in her uterus, down low, and then "this burst of water just falls out of my body. But as has been true in Texas and in many of the 12 other states where abortion is currently . Due to her history of hemorrhaging, Seewald added that passing the pregnancy at home didn't seem like a good option. The Wellers were pleasantly surprised when they got pregnant early in 2022. Among other risks, both the fetus and Elizabeth were now highly vulnerable to a uterine infection called chorioamnionitis. Miscarriages occur in roughly 1 out of 10 pregnancies. Elizabeth chose to go home rather than wait to get sick at the hospital. It doesnt take a huge leap to see that our rates of complications will go up because we have a selection bias on who is going to have to continue more complicated pregnancies.. For some, that's too difficult, given the emotions surrounding the pregnancy loss, she said. Right away, she ran into obstacles because of the Texas law. Julia Robinson for NPR 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. It was just the most tender moment, she said. She was through with being dismissed, being told to wait. "And she starts to cry and she tells me: 'They're not going to touch you.' But the language is ambiguous, and travel can be expensive and onerous for pregnant women, especially if they are unwell. At that point, the patient can opt to wait until the bleeding starts and the pregnancy tissue is naturally released, Briggs said. Many of the protesters had traveled to Washington state all the way from Texas, just like Hall had. Time is of the essence. And she just recklessly and negligently goes out and gets abortions all willy-nilly, left and right," she says. Dr. Jennifer Liedtke, a family physician in Sweetwater, Texas, who delivers about 175 babies annually, no longer sends misoprostol prescriptions to the local Walmart. Texas' new abortion laws . A Texas judge's decision that could revoke the FDA's approval of abortion drugs is expected soon. 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. The maternal fetal medicine specialist at the University of Texas Southwestern Medical Center in Dallas published a blog post last August to inform patients that treatment for cesarean scar ectopic pregnancies are legal under Texas's abortion law. And quickly. 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. I'm trying to understand. It is life-threatening to the mother and is not viable and needs to be removed. "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. the U.S. that have trigger laws in place banning abortion in the . They had to call their OB/GYN repeatedly to get the $500 delivery deposit refunded. Hall went on to become a nurse and, together with her husband, created a life in the same town where they both grew up. 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. She was bereft, unable to even process the news. Coming back to Texas a few days later only amplified those feelings. The other option is called expectant management, in which Elizabeth would stay in the hospital and try to stay pregnant until 24 weeks, which is considered the beginning of "viability" outside the womb. An ectopic pregnancy is when a fertilized egg implants outside the uterus, typically in one of the woman's fallopian tubes. Eventually, she found a clinic near Seattle that provides specialty care for patients who have decided to terminate due to lethal fetal abnormalities. She took a pregnancy test soon after she missed her period and found out that she had conceived. 5:22-cv-185-h (n.d. As a subscriber, you have 10 gift articles to give each month. It is the Cedar River Clinics in Renton, Washington, not the Cedar River Clinic in Seattle. Amplify your impact and donate now. Hall had to travel to Washington state for an abortion after receiving a lethal fetal diagnosis, for which Texas abortion laws make no exception. To Elizabeth, termination also felt like the most merciful option for her fetus. If the lawsuit is successful, plaintiffs can receive up to $10,000. 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. "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?". 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. On Saturday, May 14, about 2 a.m., she gave birth. Texas abortion laws make no exception for these cases, which are not as rare as people would like to imagine, said Dr. John Thoppil, an Austin OB-GYN and president of the Texas Association of Obstetricians and Gynecologists. 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. "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.". Texas has a trigger law on the books that will outlaw abortion almost universally beginning 30 days after the Supreme Court . Hall declined those services. 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.. Or in cases of rape or incest? But the incentives are all very strong for those providers to err on the side of not providing care.. Immediately, they sensed hesitation from the doctor. In a sudden obstetrical emergency, a termination might be the least risky option, clinically. "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.". Despite the tragedy she was facing, Hall knew she was one of the lucky ones. An ectopic pregnancy occurs when the fertilized egg is implanted outside the uterus, most commonly in a fallopian tube. She was diagnosed with an aggressive lymphoma, a cancer of the immune system. Texas providers are still adjusting to other ripple effects that affect patient care. But for patients facing a medical emergency, or low-income or uninsured Texans, seeking a second opinion may not be possible. Seventeen weeks into the pregnancy, they learned they were expecting a girl. How are you doing, and are you excited for the delivery?'". But he did not address the question of lethal fetal anomalies, which are fatal for the fetus during pregnancy or shortly after birth. Correction, Oct. 24, 2022 at 4:12 p.m.: And I screamed because that's when I knew something wrong was happening. Because once they reached Methodist, while they were still checking in at the emergency room, her doctor called. "Abortions are sometimes needed out of an act of an emergency, out of an act of saving a woman's life. Not doing so can, in some circumstances, kill all of the fetuses. I personally would never get one. She never had to use that bag. 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. No one really knows what the legislature means by that, and they are afraid of overstepping. For 24/7 mental health support in English or Spanish, call the Substance Abuse and Mental Health Services Administrations free help line at 800-662-4357. Elizabeth has been sharing her story, and has found that whatever the political affiliation of the listener, they all agree her experience was horrible. In September, the justices turned down an emergency request to block the law. In the medical profession, doctors will continue to grapple with the new legal restrictions, and the resultant dilemmas in obstetrical care, says Dr. Peaceman. The Supreme Court is expected to rule soon on whether abortion providers and the Biden administration may challenge the law notwithstanding its novel structure. Medical v. legal . But in early May, not long after the uneventful anatomy scan, the Wellers suddenly arrived at that crossroads. But interpretation of the laws is still causing challenges to care. Its our 10th year participating in Amplify, and to celebrate, weve got $15,000 in matching funds from four generous Tribune supporters. Dr. John Thoppil, president of the Texas Association of Obstetricians and Gynecologists, said doctors usually note a diagnosis when prescribing medicines, and prescription rejections dont appear to be widespread. Since that time, thousands of women have left Texas to obtain abortions in other states. The measure deputizes private citizens even those with no connection to the patient, doctor or health center to sue anyone who performs an abortion once cardiac activity can be detected in the embryo. But some health conditions can jeopardize a womans health in the long term but not necessarily constitute an immediate threat to her life. Fetuses who do survive a premature delivery can die soon after birth, or, if they survive, may experience major problems with their lungs, or suffer strokes, blindness, cerebral palsy or other disabilities and illnesses. She places the blame for the ensuing medical trauma on the Republican legislators who passed the state's anti-abortion law, on Texas Gov. Either way, she saw nothing ahead but fear and grief prolonged, delayed, amplified. "That's torture to have to carry a pregnancy which has such a low chance of survival," says Dr. Peaceman. But she was barely out the door, still in the parking lot, when her phone rang. 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