At least several OB-GYNs in the Austin 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, said Dr. Charlie Brown, an Austin-based obstetrician-gynecologist who provided a copy to KHN. 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 . After her initial miscarriage in 2018, Stell and her husband had their first child, a daughter, in April 2020. ", 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. Ectopic pregnancy develops in an estimated 2% of reported pregnancies. An attendee holds her child during A Texas Rally for Abortion Rights at Discovery Green in Houston, Texas, on May 7. Because the alternative was hell.". At 18 weeks, the watery, protective cushion of amniotic fluid was gone. Things did go fairly smooth at first. These provisions are in Chapter 170A of the Texas Health & Safety Code, which was enacted by House Bill 1280 in 2021. "Because I didn't want anybody to tell me they did not believe me," she says. Still, states like Missouri could put this pro-abortion talking point to rest by protecting treatment of ectopic pregnancy explicitly in the law. '", "It was devastating to hear that," Elizabeth says. 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. They don't want to get sucked into a legal morass. She and her husband immediately jumped into planning mode, scheduling an appointment at one of the only OB-GYN practices in town. "They can absolutely do that.". 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. 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. Her husband took over, asking the doctor what, if anything, they could do. But now "your medical provider says that it's illegal and they can't provide it. 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 was so tiny. That is a pregnancy that occurs outside the uterus. You smell it yourself. Right there in the office, James pulled out his cell phone, and started looking for flights to states with less restrictive abortion laws. They now had some of the symptoms they needed to show the infection was getting worse. The Texas Tribune Festival is almost here! Elizabeth says. "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?". We both have good jobs, weve got a house and we were at a place where if it happens, it happens, she said. other than an abortion performed due to a medical emergency as defined by Section 171.002, Health and Safety Code]. "The pharmacy has said, 'We don't know whether or not you might be using this medication for the purposes of abortion,'" she said. Sometimes theyre the primary caregiver. On Friday, when she woke up, she was still passing blood and discharge, still feeling sick, and feeling strange things in her uterus. The new law in Texas bans abortion at 6 weeks when a fetal "heartbeat" can be detected. A fight began, which Elizabeth first became aware of as her doctor paced the hall outside her room, talking on her phone. We see patients from many different religions and cultures, and how they grieve is unique to each patient, Sanchez 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. The American College of Cardiology and the American Heart Association, for example, advise women with certain congenital heart conditions to avoid pregnancy altogether, as they are at higher risk of illness or death shortly after giving birth. An ultrasound confirmed that she had suffered premature rupture of membranes, which affects about 3% of pregnancies. In the medical profession, doctors will continue to grapple with the new legal restrictions, and the resultant dilemmas in obstetrical care, says Dr. Peaceman. What youre really worried about is that period of time when whats going to be a miscarriage, if you let it take a natural course, might cause severe suffering, and/or death to the mother, to the pregnant person, she said. Texas is the state weve seen the biggest increase from, Sanchez said. Cheng did not treat Hall, but has counseled patients facing similar situations. 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.'". 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 . Time is of the essence. "And yet we're being pulled through this.". not include an abortion that uses suction to dismember the body of an unborn child by sucking pieces of the unborn child into a . Question women in America now have to ask. 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.. 5:22-cv-185-h (n.d. 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. She just put her arms around me and took my hand and she was like, I know you dont want to be here, but youre in good hands. 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. "'I'm just using this because this is not a viable pregnancy.'". At 6 weeks, many people . It is the Cedar River Clinics in Renton, Washington, not the Cedar River Clinic in Seattle. Financial supporters play no role in the Tribune's journalism. Disclosure: Texas Medical Association and University of Texas at Austin 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. It is not currently possible in any way to 'reimplant' an ectopic pregnancy. Maybe they could get the abortion in Denver or Albuquerque. 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. Sometimes, she said, a woman has a spontaneous miscarriage and is heavily bleeding, but the fetus has not passed and cardiac activity can still be detected. The Supreme Court is expected to rule soon on whether abortion providers and the Biden administration may challenge the law notwithstanding its novel structure. It was like an evidence bag. Walmart officials did not respond to multiple requests for comment. With regard to pregnancy-related complications for women of any age, Dr. Skop said, the new law allows doctors to act when necessary and to justify their treatments in court if they are sued. I looked at her little hands and I just cried. She knew she did not have the flexibility to be able to travel out of state for an abortion later on. 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. 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. 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. The law makes no exceptions for nonviable pregnancies in which the fetus has no chance of survival. Eventually, she laid out their options: Keep carrying the pregnancy or leave Texas to get an abortion. Texas' abortion restrictions a ban that prohibits most abortions after about six weeks of pregnancy, as well as a law passed last year that will ban nearly all abortions, plus older statutes . 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. I couldn't give you life. Texas Health and Safety Code, Chapter 171. 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. Texas never repealed its original law prohibiting abortion except when the life of the mother was in danger after Roe. 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. "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 and James Weller at their home in Houston two months after losing their baby girl due to a premature rupture of membranes. Pro-Life policies in Texas do not prevent doctors from treating an ectopic pregnancy. But Texas's medical exception is narrower, and less defined . But as has been true in Texas and in many of the 12 other states where abortion is banned . An ectopic pregnancy, which occurs when a fertilized egg . The color was darker and the odor was foul. hide caption. Sept. 20, 2022 Many offer no exemptions for rape, incest or fetal anomolies. The risks to Elizabeth's health were simply too high. Earlier this month, Gov. 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. Elizabeth and James keep remembrances of their baby in a picture frame at home. 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. 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. So we look at them like a ticking time bomb and wait for the complications to develop.. 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. "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. For some, that's too difficult, given the emotions surrounding the pregnancy loss, she said. 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. 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. 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. The new law does not apply to removing ectopic pregnancies that implant outside the uterus, which are not considered abortions under state law. "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.". 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 . An ectopic pregnancy is when a fertilized egg implants outside the uterus, typically in one of the woman's fallopian tubes. She was due just a few days before Christmas. It was someone else at Methodist Hospital, perhaps a clerk, calling to go over some paperwork. But the new Texas law has profoundly affected his ability to practice. I would consider what I experienced that weekend a medical emergency.. Halls entire vision of this pregnancy giving birth, becoming a mom, watching her daughter grow up evaporated in an instant. Nitashia Johnson for The New York Times. Another pending ban, a so-called "trigger law" passed by Texas in 2021, is expected to go into effect within weeks. 8, which encourages private citizens to file lawsuits against anyone who facilitates an abortion, will proliferate, giving self-appointed vigilantes no shortage of . After all, she didnt need an abortion she needed convenient pregnancy care. She took a pregnancy test soon after she missed her period and found out that she had conceived. Because at this point, I'm in survival mode. To Dr. Peaceman at Northwestern, it sounded like the hospital's clinicians were using the most common clinical signs of chorioamnionitis as a guideline. Lauren Hall stands for a portrait on Sept. 10, 2022, in the room that she and her husband had prepared as a nursery. Consider the patient whose miscarriage care is delayed and develops a serious infection and other complications, Prager said. hide caption. Whether an ectopic pregnancy is legal will depend on individual state laws. 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. Pregnant people are now required to just wait, endangering their own lives with no hope of ever bringing home a baby. An ectopic pregnancy is 100% fatal if . Her doctor said she had been calling other hospitals, but none of them would help. Laws modelled on Texas's S.B. Methotrexate, another abortion-inducing medication, is used to treat ectopic pregnancies as well as rheumatic illnesses, inflammatory bowel disease, psoriasis and cancer. by Mara Mndez Julia Robinson for NPR And I knew my baby was suffering, I knew I was suffering, I knew my husband was suffering.". They also had an anatomy scan, which revealed no problems. The abortion clinic is less than a mile from Texas, where abortion is illegal. The other miscarriage treatment is a procedure described as surgical uterine evacuation to remove the pregnancy tissue the same approach as for an abortion. 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. I personally would never get one. But the point will be made by the Christian Taliban that women have only the value their reading of the Bible ascribed to them and no more. She recalls looking at her baby's little hands and crying. When they called the doctor's office back, they were told to go straight to the emergency room. The Texas abortion "trigger law" will be effective on August 25th, 2022. ABACA. 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. care provider and intended to remove an ectopic pregnancy that . A doctor she had never met entered the room. "I wouldn't say this is true for our practice," he said. 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. "Ectopic pregnancies can kill people," said Brown, a district chair for the American College of Obstetricians and Gynecologists, representing Texas. But the most confusing development involves the exemptions that exist for the woman's life or health, or because of a "medical emergency." "We live in a culture that advocates small government and yet we are allowing states, we are allowing our Texas state government to dictate what women do with their own bodies and to dictate what they think is best, what medical procedures they think is best for them to get.". Despite the tragedy she was facing, Hall knew she was one of the lucky ones. But she was barely out the door, still in the parking lot, when her phone rang. 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. 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.. ", The Wellers do want to try again, but first they need to get to a "mentally healthier place," Elizabeth says. Or, like Hall, they can shell out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. Under Texas law, doctors can be sued by almost anyone for performing an abortion. An IUD can make menstruation irregular, and she did not realize she had conceived until after the six-week mark. Recently passed laws make abortion illegal after about six weeks into a pregnancy. Outcomes from expectant management vary greatly depending on when the waters break. 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.. As Friday dragged on, Elizabeth started wondering if maybe the heartbeat had stopped. Losing a pregnancy is a particular kind of loss, one that tends to make other people even health professionals uncomfortable. 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. Seek help right away for signs of ectopic pregnancy your doctor can talk you through next steps. There has been apprehension by doctors about dealing with both of those two issues, Abbott told Fox 4 News. They told her the signs of a more severe infection would include a fever of 100.4 degrees and chills. Midnight came and went in a blur. Its been a difficult few weeks since the procedure. Right away, she ran into obstacles because of the Texas law. Hall was in her second trimester when the U.S. Supreme Court overturned Roe v. Wade, ending the constitutional protection for abortion and allowing states to set their own laws governing abortion access. 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. These cases are only going to grow until the law is either repealed or clarified. When they learned they were having a girl, Hall and her husband even picked out a name: Amelia. "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. Unnamed, unknown doctors somewhere had come to an agreement that Elizabeth could be induced that night. With it in place, his patient faces a pregnancy rife with potential medical problems. Texas Health and Safety Code, Chapter 245. Their conundrum became painfully, distressingly clear: wait to get sicker, or wait until the fetal heartbeat ceased. But the incentives are all very strong for those providers to err on the side of not providing care.. Even in Texas, whose "heartbeat bill" was one . SB 8, which was signed into law by Texas Gov. The bill makes no exceptions for pregnancies that resulted from rape or incest. "Ectopic pregnancy" means the implantation of a fertilized egg or embryo outside of the uterus. I knew something was wrong.. 7:49 PM on Jul 14, 2022 CDT. Even with the slim chance of survival to 24 weeks, the newborn would face intense physical challenges and aggressive medical interventions. Texas' "trigger" law, which outlaws abortion "wholly or partly", is set to be in effect 30 days following . Elizabeth and James look at clothes that were meant for their baby, whom they lost in the second trimester of pregnancy. "It's this woman who was saying 'Hi Miss Weller, you're at the 19 week mark. Myth 5: Treatment for ectopic pregnancy is considered an abortion, and thus many women will likely die from lack of treatment in states where abortion is illegal. They had bought a house in Kingwood, a lakeside development in Houston. And she goes 'I'm so sorry, I'm so sorry, I didn't know.'". James rushed home from work and drove Elizabeth to the nearby Woodlands Hospital, part of the Houston Methodist hospital system. The ob-gyn, who said she could not speak to the media, laid out two options, according to Elizabeth. 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 when membranes rupture earlier in pregnancy, particularly before 24 weeks, the chance of a fetus surviving plummets. Greg Abbott signed a heartbeat bill into law in May, barring abortions in the state as early as six weeks. But when she called, they told her that nausea and vomiting weren't among the symptoms they were looking for. Its our 10th year participating in Amplify, and to celebrate, weve got $15,000 in matching funds from four generous Tribune supporters. Since the Supreme Court ruling of June 24, 2022 that overturned Roe v. Wade, many states have banned abortion, or severely restricted abortion access. If someone is hemorrhaging while miscarrying, how long do I have to wait?. 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. . James and Elizabeth cried out their thanks to the doctor. How are you doing, and are you excited for the delivery?'". If she wanted to stay in Texas, Halls only choice was to continue with a pregnancy that would not yield a healthy, living baby. I would always say, What if it was necessary to save the life of the mother? "We shouldn't have been celebrating," Elizabeth says. The brain would not develop, and the infant would die at birth or shortly afterward. 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. Its our 10th year participating in Amplify, and to celebrate, weve got $15,000 in matching funds from four generous Tribune supporters. Hall was 18 weeks along when she went in for hers on a Friday afternoon. Texas Attorney General Ken Paxton quickly sued the Biden administration over the federal guidance. But those numbers have skyrocketed since Roe v. Wade was overturned. And they're telling me to think of the positives. Or you wait till your baby's heartbeat stops.'". I'm so sorry,'" Elizabeth says. And not only can they not provide it, but they can't talk to you about it," Cavazos says. (Texas Hospital Licensing Law); (3) an institution required to be licensed under . 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. About 10% to 20% of confirmed . Many of these lethal fetal abnormalities come to light at an anatomy scan performed later in pregnancy. When the couple moved from Washington state to Texas in 2021, they were trying to . Such a rupture can be life-threatening. A few days later, she went out to celebrate a friends birthday and was raped on her way home. There are currently no abortion laws that outlaw treatment of ectopic pregnancy. Later in pregnancy, doctors can try to delay delivery to give the fetus more time to develop, while also warding off infection or other maternal complications such as hemorrhage. The associations say these women should be given the option of termination if they become pregnant. 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. Texas new measure was intended to impose stringent limits on abortion. It is a horrible gamble that we are making Texas women go through.". Miscarriages occur in roughly 1 out of 10 pregnancies. If Elizabeth exhibited enough of them, then it would be possible to document the encroaching infection, and therefore terminate the pregnancy under the law's "medical emergency" clause, he said. Selective reductions are forbidden under the new state law. We havent seen a large issue, but there are certainly anecdotes, Thoppil said. ", "Let's say I do have to go through this situation again. I'm so sorry,'" Elizabeth says. Whether terminating an ectopic pregnancy is legal will depend on individual state laws. Just a few months before the Texas legislature passed the new law, Dr. Robert Gunby Jr., an obstetrician in Dallas, was caring for a pregnant newlywed who suddenly started losing weight. 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 they decide to sue for malpractice," she said. 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. Her discharge had to be darker. ", 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. 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. "Later they laid down this beautiful baby girl in my arms. 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. 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. And I told her 'I'm so sorry. They had savings to fund this last-minute trip, and because her company is based in Illinois, her insurance covered the procedure. But now in Texas, the new laws are creating uncertainties that may deter some doctors and other providers from offering optimal miscarriage treatment. So when Roe v . 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. "I was born with a physical disability. 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. Texas' "trigger" law, which outlaws abortion "wholly or partly", is set to be in effect 30 days following the . But for patients facing a medical emergency, or low-income or uninsured Texans, seeking a second opinion may not be possible. According to a letter from the Texas Medical Association, a physician in Central Texas was instructed not to treat an ectopic pregnancy until it ruptured, which can cause serious medical complications. Elizabeth and James Weller at their home in Houston two months after losing their baby girl due to a premature rupture of membranes. 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. Sept. 1, 1989. Thankfully, I think theres still plenty of pharmacies that understand the proper utilization of some of the medications we use for nonelective [pregnancy] terminations.. As Hall learned the hard way, the law makes no exception for lethal fetal anomalies. She was admitted to the hospital, and later that night, when her own obstetrician called, she begged her for information. 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. About 3 % of pregnancies till your baby 's little hands and I cried. Into planning mode, scheduling an appointment at one of the Houston Methodist Hospital, perhaps a,! 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To Elizabeth me, '' she says come to light at an anatomy scan performed later in pregnancy particularly... Rife with potential medical problems, 2022 CDT home from work and drove Elizabeth to the nearby Woodlands,... That is a procedure described as surgical uterine evacuation to remove the tissue.
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