But the incentives are all very strong for those providers to err on the side of not providing care.. Double your gift when you give by 6 p.m. Thursday. 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. 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. Another pending ban, a so-called "trigger law" passed by Texas in 2021, is expected to go into effect within weeks. 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. These terms are left vague or undefined. 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. 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. Another area of Texas law that Seago cited provides an exception to the state's abortion restrictions if the mother's life is in danger or she's at "serious risk of substantial impairment of a major bodily function" unless an abortion is performed. 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. One of the most painful parts was trying to reach her medical team. It was because of the state law which forbids termination of a pregnancy as long as there is fetal cardiac activity. But there is no definition for that term in the statute. After one conversation, the doctor returned to her bedside. This chapter contains a variety of laws related to abortion. Her doctor said she had been calling other hospitals, but none of them would help. She felt lost and confused. Right away, she ran into obstacles because of the Texas law. Sign up for The Brief, our daily newsletter that keeps readers up to speed on the most essential Texas news. We see patients from many different religions and cultures, and how they grieve is unique to each patient, Sanchez said. How do they follow the latest guidelines when numerous other people from other medical professionals to friends and family members can question their intent: Are they helping care for a miscarriage or facilitating an abortion? 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. 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. 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'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. Doctors and experts also worry that patients with pregnancy complications may be too afraid of being accused of inducing an abortion to seek care. Doctors can clearly legally save a woman's . After all, she didnt need an abortion she needed convenient pregnancy care. After Hall made it through the protesters and the clinics security screening, the clinic itself was an oasis, she said. But as has been true in Texas and in many of the 12 other states where abortion is currently . "This poor woman had no idea what she was telling me. Even if it had, the Wellers were determined to proceed. 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. forbids dispensing and shipping abortion-inducing medications, rheumatic illnesses, inflammatory bowel disease, psoriasis and cancer. It is not currently possible in any way to 'reimplant' an ectopic pregnancy. 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. 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.". Most recently, the Oklahoma Senate passed six abortion-limiting bills , including one that would ban abortions after 30 days from a woman's last . An ectopic pregnancy occurs when the fertilized egg is implanted outside the uterus, most commonly in a fallopian tube. Things did go fairly smooth at first. Seek help right away for signs of ectopic pregnancy your doctor can talk you through next steps. "Ectopic pregnancy" means the implantation of a fertilized egg or embryo outside of the uterus. Recently passed laws make abortion illegal after about six weeks into a pregnancy. 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. To Elizabeth, termination also felt like the most merciful option for her fetus. Texas is the state weve seen the biggest increase from, Sanchez said. 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 is legal under Texas's abortion law. Updated: Oct. 24, 2022. Cedar River offers specialty care for patients facing lethal fetal abnormalities like anencephaly. 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.. "I said 'Well, is there a heartbeat still?' This article originally appeared on Austin American-Statesman: Here's what current Texas abortion laws say, plus birth control info "The care providers are treading on eggshells. Because at this point, I'm in survival mode. Some supporters of the law say that it does not forbid a doctor to counsel a woman about abortion or refer her to an abortion provider outside Texas. 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 . Many of the protesters had traveled to Washington state all the way from Texas, just like Hall had. 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. Find a complete list of them here. "Abortions are sometimes needed out of an act of an emergency, out of an act of saving a woman's life. 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. Losing a pregnancy is a particular kind of loss, one that tends to make other people even health professionals uncomfortable. Hall and her husband would like to try again at some point. 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 And now the Texas abortion law has created an additional bind, Cavazos explains. It is a horrible gamble that we are making Texas women go through.". 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 . Texas Attorney General Ken Paxton quickly sued the Biden administration over the federal guidance. 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 . It was like an evidence bag. 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. An ectopic pregnancy, which occurs when a fertilized egg . These dismissals only increase the sense of isolation, stigma and shame. 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. 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. '", "It was devastating to hear that," Elizabeth says. But Texas's medical exception is narrower, and less defined . Other times patients don't report the problem and miscarry on their own, she said, but without medication they risk additional bleeding. Every OB-GYN has cared for someone who has died from a hemorrhage, she said. tex. 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. 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 . A more common scenario also raises difficult questions, said Dr. Ghazaleh Moayedi, an obstetrician and gynecologist in Texas who provides abortions. Most of these pregnancies end in miscarriage or stillbirth. She said Houston Methodist had convened an ethics panel of doctors, but her doctor didn't seem very optimistic. 678, Sec. "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?". KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Elizabeth and James look at clothes that were meant for their baby, whom they lost in the second trimester of pregnancy. 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.'". Since the Supreme Court ruling of June 24, 2022 that overturned Roe v. Wade, many states have banned abortion, or severely restricted abortion access. And so they don't even know what the rules are.". They had to call their OB/GYN repeatedly to get the $500 delivery deposit refunded. But the most confusing development involves the exemptions that exist for the woman's life or health, or because of a "medical emergency." 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. ABACA. I knew something was wrong.. At 18 weeks, the watery, protective cushion of amniotic fluid was gone. 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. Even with the slim chance of survival to 24 weeks, the newborn would face intense physical challenges and aggressive medical interventions. "partial-birth" abortions, medical abortions, the stage of a pregnancy at which an abortion can be performed, and informed consent related to abortions. It was just too hard, as she navigated a complicated mix of relief and grief. Treatments for certain pregnancy complications are distinct from abortions under Texas laws, experts say, but confusion has already limited some patients access to life-saving procedures and medicines. If a woman's life is in danger, she will be able to have an abortion. 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.. "It's this woman who was saying 'Hi Miss Weller, you're at the 19 week mark. The Supreme Court is expected to rule soon on whether abortion providers and the Biden administration may challenge the law notwithstanding its novel structure. 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. He said the association has been in communication with some pharmacy leaders to help clarify proper interpretation of the rules.. Texas' current heartbeat ban enables private citizens to sue anyone who helps someone get an abortion after about six weeks. 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. Elizabeth and James look at clothes that were meant for their baby, whom they lost in the second trimester of pregnancy. Julia Robinson for NPR You dont get a lot of time to respond, and if you dont respond quickly enough, your patient expires.. She wished she could make them answer for the states near-total ban on abortions after the overturning of Roe v. Wade just a few weeks prior. Such testing is done late in pregnancy, beyond the six-week limit, noted Crescenda Uhles, a genetic counselor in Dallas. A Texas judge's decision that could revoke the FDA's approval of abortion drugs is expected soon. The way the system is going to work is that the patients are going to always pay the price, Grossman said. Pro-Life policies in Texas do not prevent doctors from treating an ectopic pregnancy. Its been a difficult few weeks since the procedure. It is an editorially independent operating program of KFF (Kaiser Family Foundation). I'm trying to understand. I would always say, What if it was necessary to save the life of the mother? Texas' "trigger" law, which outlaws abortion "wholly or partly", is set to be in effect 30 days following the . 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. hide caption. For the women, expectant management after premature rupture of membranes comes with its own health risks. So we look at them like a ticking time bomb and wait for the complications to develop, Dr. Palmer said of her patients. 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. For example, in rare cases an infection can make the amniotic sac rupture before the fetus is viable. And she goes 'I'm so sorry, I'm so sorry, I didn't know.'". "Not because I wanted my baby to die, but because I needed this hell to end. AUSTIN The Texas Medical Association wants regulators to step in after hospitals reportedly refused to treat patients with serious pregnancy complications for fear . 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. "It's hard to form a relationship to say, 'Hey look, I'm not using this for an elective abortion,'" she said. October 22, 2021. ", Her waters had broken, launching her into what she calls a "dystopian nightmare" of "physical, emotional and mental anguish." Frustrated with her experience on hormonal birth control, she and her husband decided it was time for her to get off of it. "Ectopic pregnancies can kill people," said Brown, a district chair for the American College of Obstetricians and Gynecologists, representing Texas. Many offer no exemptions for rape, incest or fetal anomolies. It went into effect on Sept. 1. Amplify your impact and donate now. The American College of Obstetricians and Gynecologists has information on early pregnancy loss, finding an OB-GYN and having better conversations with your doctor. ", And at this particular point in her life, pregnant for the first time at age 26, it was still somewhat abstract: "I had not been put in a position to where I had to weigh the real nuances that went into this situation. by Mara Mndez For doctors treating such patients, the Texas law creates quite a conundrum, Dr. Snyder said. 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. For some, that's too difficult, given the emotions surrounding the pregnancy loss, she said. Lauren Hall stands for a portrait on Sept. 10, 2022, in the room that she and her husband had prepared as a nursery. "I just cried and screamed in the parking lot," she recalls. But interpretation of the laws is still causing challenges to care. Time is of the essence. 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. 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 . So when Roe v . She had the proof. You're not going to tell me that what I'm experiencing isn't real, again.". There was an infection, and she did need treatment. Elizabeth and James keep remembrances of their baby in a picture frame at home. Eventually, she laid out their options: Keep carrying the pregnancy or leave Texas to get an abortion. ", "Because that doesn't really exist right now," he added. Elizabeth was 18 weeks pregnant. 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 . Elizabeth Weller never dreamed that her own hopes for a child would become ensnared in the web of Texas abortion law. Treatments for miscarriages and ectopic pregnancies are still legal under the states abortion ban, according to state law and legal experts. The patient lost liters of blood and had to be put on a breathing machine because of the 24-hour delay in care. "And they decide to sue for malpractice," she said. Texas Health and Safety Code, Chapter 171. (Texas Hospital Licensing Law); (3) an institution required to be licensed under . 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. 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. "Later they laid down this beautiful baby girl in my arms. Since Sept. 1, abortion has been illegal in Texas after six weeks gestation, with one exception: If a doctor determines that a patient will face a " medical emergency " if the pregnancy continues, they can perform an abortion later on without breaking the law. "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. Texas never repealed its original law prohibiting abortion except when the life of the mother was in danger after Roe. Hall shelled out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. But when membranes rupture earlier in pregnancy, particularly before 24 weeks, the chance of a fetus surviving plummets. 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. In Poland, protests over that countrys abortion laws erupted this year after a 30-year-old pregnant woman died of septic shock. Maybe they could get the abortion in Denver or Albuquerque. SB 8, which was signed into law by Texas Gov. One reason is that amniotic fluid plays a key role in fetal lung development. Elizabeth touches the urn of her daughter. At the office, her ob-gyn turned down the ultrasound volume so they wouldn't have to hear. Recently passed laws make abortion illegal after about six weeks into a pregnancy. If you do something to prevent that, you might be in fact performing an illegal abortion.. I personally would never get one. It is life-threatening to the mother and is not viable and needs to be removed. And I screamed because that's when I knew something wrong was happening. But the statutes dont account for complicated miscarriages, and confusion has led some providers to delay or deny care for patients in Texas. Missouri legislators held a hearing on a bill that, if signed into law, would make it a felony to "perform or induce an abortion" to treat ectopic pregnancy. The fetus had a rare neural tube defect. She recalls looking at her baby's little hands and crying. 8, which encourages private citizens to file lawsuits against anyone who facilitates an abortion, will proliferate, giving self-appointed vigilantes no shortage of . 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. 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. How theyd told their families, picked out a name, built a crib and bought pink sheets. If youre having severe pain, if youre getting a fever, you need to keep your medical team in the loop, Crawford said. Which sounds extreme, but Roe had just been overturned. Elizabeth and James keep remembrances of their baby in a picture frame at home. 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 never had to use that bag. 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