You're trying to understand exactly what's going on. Recently passed laws make abortion illegal after about six weeks into a pregnancy. The protesters outside a Seattle-area abortion clinic waved pictures of bloody fetuses, shouting that she was a baby killer and begging her to choose life. 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. Or you wait till your baby's heartbeat stops.'". "We skipped over the genetic testing offered in the first trimester," Elizabeth says. Even in Texas, whose "heartbeat bill" was one . The law makes no exceptions for nonviable pregnancies in which the fetus has no chance of survival. She recalls looking at her baby's little hands and crying. They now had some of the symptoms they needed to show the infection was getting worse. If she had any physical ailments, I would never abort her for that issue. How are you doing, and are you excited for the delivery?'". 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. She ate a healthy breakfast, went for a walk outside and came back home. She and her husband booked outrageously expensive last-minute flights, got a hotel and, four days after they got the news that upended their world, flew out of Dallas/Fort Worth International Airport. However, Mayo said that his reading of the law allows for the use of methotrexate to treat an ectopic pregnancy. 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. If someone is hemorrhaging while miscarrying, how long do I have to wait?. But when membranes rupture earlier in pregnancy, particularly before 24 weeks, the chance of a fetus surviving plummets. . Doctors in Texas say they cannot head off life-threatening medical crises in pregnant women if abortions cannot be offered or even discussed. After her initial miscarriage in 2018, Stell and her husband had their first child, a daughter, in April 2020. "I was born with a physical disability. But that comes with the same significant risks that accompany a viable pregnancy, said Dr. CeCe Cheng, a high-risk OB-GYN in San Antonio. You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 988. Elizabeth knows it was just a terrible coincidence, an awful bureaucratic oversight, and yet it drove home to her how powerless she was, how alone, in that vast medical system of rules, legal regulations and revenue. Elizabeth and James look at clothes that were meant for their baby, whom they lost in the second trimester of pregnancy. Her husband took over, asking the doctor what, if anything, they could do. Enough to make her retch. 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. The way the system is going to work is that the patients are going to always pay the price, Grossman said. Texas is the state weve seen the biggest increase from, Sanchez said. For the women, expectant management after premature rupture of membranes comes with its own health risks. 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. I was so excited for this appointment because its so good to see her in there, she said. It is a horrible gamble that we are making Texas women go through.". I'm so sorry,'" Elizabeth says. Anyone who aids and abets the procedure can also be sued, and the law promises plaintiffs $10,000 and legal fees if they win the lawsuit. The associations say these women should be given the option of termination if they become pregnant. Texas' "trigger" law, which outlaws abortion "wholly or partly", is set to be in effect 30 days following the . 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. In Texas' anti-abortion . 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. Thaxton, who supervises the obstetrics-gynecology residents who have seen these patients, said sometimes the prescribing clinic will intervene, but it takes the patient longer to get the medication. Texas Attorney General Ken Paxton quickly sued the Biden administration over the federal guidance. The other miscarriage treatment is a procedure described as surgical uterine evacuation to remove the pregnancy tissue the same approach as for an abortion. And she goes 'I'm so sorry, I'm so sorry, I didn't know.'". Pregnant people are now required to just wait, endangering their own lives with no hope of ever bringing home a baby. Methotrexate or surgery are the only two options listed in the medical guidelines to prevent the fallopian tubes from rupturing and causing dangerous bleeding. Even if it had, the Wellers were determined to proceed. But the most confusing development involves the exemptions that exist for the woman's life or health, or because of a "medical emergency." "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.". "It's hard to form a relationship to say, 'Hey look, I'm not using this for an elective abortion,'" she said. 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. Another pending ban, a so-called "trigger law" passed by Texas in 2021, is expected to go into effect within weeks. Hall was 18 weeks along when she went in for hers on a Friday afternoon. Elizabeth chose to go home rather than wait to get sick at the hospital. The staff remained vague about what came next, Elizabeth recalls. If she wanted to stay in Texas, Halls only choice was to continue with a pregnancy that would not yield a healthy, living baby. 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 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. In addition, he said, other Texas laws and the Roe v. Wade decision provide an exception to permit abortion if a pregnant person's life is in danger. About 10% to 20% of confirmed . 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. Outcomes from expectant management vary greatly depending on when the waters break. She said Houston Methodist had convened an ethics panel of doctors, but her doctor didn't seem very optimistic. Elizabeth says. I couldnt do that.. 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. 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. 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. The only way to stop the heavy bleeding is to end the pregnancy and contract the uterus, Dr. Moayedi said. 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. 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. "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. Growing up outside Dallas, Hall often heard that abortion was murder and, perhaps worse, interfering with Gods plan. Everyone was so scared.. Consider the patient whose miscarriage care is delayed and develops a serious infection and other complications, Prager said. KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. I couldnt do that., by Eleanor Klibanoff It was because of the state law which forbids termination of a pregnancy as long as there is fetal cardiac activity. Julia Robinson for NPR 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 . Because the providers have a choice whether to provide and the patients are the ones who need the care. Or the judge could at least nullify FDA decisions in 2016 and 2021 that allowed at-home and mail-order chemical abortions. 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. A miscarriage is generally defined as the loss of a fetus before the 20th week of pregnancy typically because of complications outside of a patients control. They stood up in the middle of the ER and embraced. These cases are only going to grow until the law is either repealed or clarified. Because once they reached Methodist, while they were still checking in at the emergency room, her doctor called. It was like an evidence bag. "You have to ask yourself, would I put any living thing through the pain, and the horrors, of having to try to fight for their life the minute that they're born?". This chapter may be cited as the Texas Abortion Facility Reporting and Licensing Act. Miscarriages occur in roughly 1 out of 10 pregnancies. The patient lost liters of blood and had to be put on a breathing machine because of the 24-hour delay in care. Took no time at all.. Sign up for The Brief, our daily newsletter that keeps readers up to speed on the most essential Texas news. But there is no definition for that term in the statute. October 22, 2021. 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. Hall declined those services. 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. Misoprostol is used to help prevent stomach ulcers, but it can induce abortions, particularly if taken along with mifepristone. 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. 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. She was admitted to the hospital, and later that night, when her own obstetrician called, she begged her for information. Because the state has made it very clear that if you talk about this, you're vulnerable to being sued," she added. Cheng did not treat Hall, but has counseled patients facing similar situations. 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. Texas Gov. But the statutes dont account for complicated miscarriages, and confusion has led some providers to delay or deny care for patients in Texas. 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. . An IUD can make menstruation irregular, and she did not realize she had conceived until after the six-week mark. But she did not know who the biological father was. A more common scenario also raises difficult questions, said Dr. Ghazaleh Moayedi, an obstetrician and gynecologist in Texas who provides abortions. 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. Selective reductions are forbidden under the new state law. not include an abortion that uses suction to dismember the body of an unborn child by sucking pieces of the unborn child into a . Elizabeth Weller never dreamed that her own hopes for a child would become ensnared in the web of Texas abortion law. They were just all shocked, like, Surely, theres an exception for this, Hall said. Recently passed laws make abortion illegal after about six weeks into a pregnancy. Under Texas law, doctors can be sued by almost anyone for performing an abortion. The Ohio state legislature, which introduced a bill in 2019 requiring doctors to "reimplant an ectopic pregnancy" into the uterus, or face charges of "abortion murder," despite the fact . The Biden administration last week told hospitals they must treat pregnant patients who need an abortion to stabilize a life-threatening condition. Houston Methodist Hospital declined to comment on the specifics of Elizabeth's care, except to say they follow all state laws and that there's a medical ethics committee that sometimes reviews complex cases. She had to go two days in a row and both times the staff gave her the support, sympathy and care shed been missing in Texas. The ethics panel had reached a decision, the doctor told them. '", "It was devastating to hear that," Elizabeth says. But studies show that pregnant teenagers are more prone than older women to developing a dangerous condition called pre-eclampsia, and they are more likely to have preterm deliveries, small babies and stillbirths. 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. John Seago, legislative director for Texas Right to Life, described this type of hesitation as "an awful misunderstanding of the law." Under the current text, any doctor who removes an ectopic pregnancy that is not actively causing the patient to bleed to death faces dire consequences. Treatments for miscarriages and ectopic pregnancies are still legal under Texas abortion ban. ", Elizabeth thought of abortion rights in broad terms: "I have said throughout my life I believe that women should have the access to the right to an abortion. Texas Health and Safety Code, Chapter 245. And I knew my baby was suffering, I knew I was suffering, I knew my husband was suffering.". [1/2] Pro-choice and anti-abortion both demonstrate outside the United States Supreme Court as the court hears arguments over a challenge to a Texas law that bans abortion after six weeks in . When Roe v. Wade fell in June, Elizabeth's pain and anger surged up again. Halls entire vision of this pregnancy giving birth, becoming a mom, watching her daughter grow up evaporated in an instant. "I said 'Well, is there a heartbeat still?' 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. Halls maternal-fetal medicine specialist laid out the best-case scenario: If she managed to carry to term and deliver a live baby, with miracles of medicine, science and technology, they might be able to keep her alive for a few weeks, tied to machines and without hope of recovery. Julia Robinson for NPR 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. Palmer, the obstetrician in Fort Worth, said that one of her patients was trying to get pregnant after the new law went into effect, and she had consensual sex with her partner. 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. Or in cases of rape or incest? Given the states severe penalties, Grossman said medical professionals and their legal teams might err on the side of caution in regard to the law, even if it puts patients at risk. Other complications that occur when a woman is carrying twins or multiples can be resolved by a selective reduction, or abortion, of one of the fetuses so that the other has a better chance to live. And so they don't even know what the rules are.". It is the Cedar River Clinics in Renton, Washington, not the Cedar River Clinic in Seattle. It just seems cruel and unusual.. Financial supporters play no role in the Tribune's journalism. These dismissals only increase the sense of isolation, stigma and shame. 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.. You open it. That's when a new state law banned all abortions after fetal cardiac activity is detected usually at about six weeks of pregnancy. A doctor sat down and told her: "There's very little amniotic fluid left. Cheng, in San Antonio, said that even as she cautiously points her patients to their options out-of-state, shes well aware that many of them struggle to even make it to their appointments in-state. Im a nurse. Methotrexate also is listed in the Texas law passed last year. "At first I was really enraged at the hospital and administration," she says. Find a complete list of them here. She considered Colorado and New Mexico, the nearest states without a total ban, but both states are being inundated with patients from Texas and elsewhere. (Texas Hospital Licensing Law); (3) an institution required to be licensed under . "Not because I wanted my baby to die, but because I needed this hell to end. the U.S. that have trigger laws in place banning abortion in the . Other times patients don't report the problem and miscarry on their own, she said, but without medication they risk additional bleeding. So we look at them like a ticking time bomb and wait for the complications to develop, Dr. Palmer said of her patients. The bill . Abortion bans in Mississippi, North Dakota and Wyoming go into effect after the attorney . It is just possible that chemical abortions more than half of all U.S. abortions soon could be outlawed nationwide. They also had an anatomy scan, which revealed no problems. And it had to smell foul, really bad. The fetus had a rare neural tube defect. And a tubal ectopic pregnancy, let's say, is clearly excluded. In Texas it's literally written in the law that an act is not an abortion to remove an ectopic pregnancy. Whether an ectopic pregnancy is legal will depend on individual state laws. In 2012, a woman died in Ireland after her waters broke at 17 weeks and doctors refused to give her 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. 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. An attendee holds her child during A Texas Rally for Abortion Rights at Discovery Green in Houston, Texas, on May 7. Correction, Oct. 24, 2022 at 4:12 p.m.: How Every State Pro-Life Law Handles Ectopic Pregnancy and Miscarriage Texas police separate anti-abortion protestors from abortion supporters during the nationwide Women's March in Austin, Texas . These terms are left vague or undefined. "It might even be scary for you to reach out and seek support even mental health support. "And they decide to sue for malpractice," she said. "To them my life was not in danger enough.". And quickly. 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. Rupturing and causing dangerous bleeding a mom, watching her daughter grow up evaporated in instant... Doctor what, if anything, they could do has counseled patients facing similar situations and! Are only going to always pay the price, Grossman said bill & quot ; heartbeat bill quot... 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