I'm so sorry.". 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. 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 . The laws supporters say that it provides sufficient leeway for physicians to act if a mothers life or bodily functions are compromised, and they insist those cases are rare. 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. The abortion clinic is less than a mile from Texas, where abortion is illegal. a letter from the Texas Medical Association. In 2012, a woman died in Ireland after her waters broke at 17 weeks and doctors refused to give her an abortion. Quite the opposite, many state laws explicitly exempt treatment of ectopic pregnancy from their definitions of abortion. In a sudden obstetrical emergency, a termination might be the least risky option, clinically. If youre having severe pain, if youre getting a fever, you need to keep your medical team in the loop, Crawford said. "The care providers are treading on eggshells. Sept. 20, 2022 She was through with being dismissed, being told to wait. Grumet: Fears over Texas' abortion laws interfere with urgent, life-saving care. The pregnancy made it impossible to remove the device, Dr. Thoppil said. But when membranes rupture earlier in pregnancy, particularly before 24 weeks, the chance of a fetus surviving plummets. They also had an anatomy scan, which revealed no problems. The associations say these women should be given the option of termination if they become pregnant. 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 . Texas new measure was intended to impose stringent limits on abortion. ABACA. Pro-Life policies in Texas do not prevent doctors from treating an ectopic pregnancy. Texas' new abortion laws . Texas has a trigger law on the books that will outlaw abortion almost universally beginning 30 days after the Supreme Court . Whether an ectopic pregnancy is legal will depend on individual state laws. "Ectopic pregnancies can kill people," said Brown, a district chair for the American College of Obstetricians and Gynecologists, representing Texas. I'm actually headed home right now because I have to await my dead baby's delivery.' It was just too hard, as she navigated a complicated mix of relief and grief. judicial order, all other provisions of Texas law regulating or 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 . Elizabeth and James keep remembrances of their baby in a picture frame at home. "I told her 'Look, Doctor, people around me are telling me to keep hope. Elizabeth Weller never dreamed that her own hopes for a child would become ensnared in the web of Texas abortion law. 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. How theyd told their families, picked out a name, built a crib and bought pink sheets. She wanted them to experience the agony she felt when she learned that her fetus was developing without a skull or a brain, a condition her doctors told her was incompatible with life.. As a result, she was checked into a hospital and underwent a D&C. However, after the overturn of Roe v. Wade in June 2022, abortion laws and restrictions are now implemented by state, resulting in trigger laws or complete bans. "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.". He said the association has been in communication with some pharmacy leaders to help clarify proper interpretation of the rules.. I couldnt do that.. They had bought a house in Kingwood, a lakeside development in Houston. To Elizabeth, it seemed obvious that things were deteriorating. Texas is the state weve seen the biggest increase from, Sanchez said. The result has been disarray and confusion for doctors and hospitals in multiple states, and risky delays and complications for patients facing obstetrical conditions such as ectopic pregnancies, incomplete miscarriages, placental problems, and premature rupture of membanes. Hall has struggled with depression, and as the weekend wore on, her mental health deteriorated. And they're telling me to think of the positives. An ectopic pregnancy is when a fertilized egg implants outside the uterus, typically in one of the woman's fallopian tubes. The holidays are going to be especially hard. ", 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. I have a code of ethics to uphold, and that is making sure I discuss with my patients all of their options, regardless of what is available in their area, Ms. Uhles said. Cheng did not treat Hall, but has counseled patients facing similar situations. And I told her 'No, ma'am. 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. 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. ", "Let's say I do have to go through this situation again. Texas' "trigger" law, which outlaws abortion "wholly or partly", is set to be in effect 30 days following . Hall managed not to scream any of this at the protesters, instead just silently flipping them off. I was losing my mind, Hall said. "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. You open it. I would consider what I experienced that weekend a medical emergency.. The fetus had a rare neural tube defect. A fertilized egg can't survive an ectopic pregnancy and can result in life-threatening bleeding, according to the Mayo Clinic. In Poland, protests over that countrys abortion laws erupted this year after a 30-year-old pregnant woman died of septic shock. For doctors treating such patients, the Texas law creates quite a conundrum, Dr. Snyder said. Among other risks, both the fetus and Elizabeth were now highly vulnerable to a uterine infection called chorioamnionitis. However, if the ectopic pregnancy is located in the cervix or on the scar tissue from a cesarean section, the treatment could be the same as an abortion, according to Addante. Treatment of ectopic pregnancy is not prohibited by Texas' abortion laws. She knew the doctors at the practice were both proud members of the American Association of Pro-Life Obstetricians and Gynecologists, but she waved it off. "It's terrible," says Dr. Alan Peaceman, a professor of maternal-fetal medicine at Northwestern University's Feinberg School of Medicine. 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. James and Elizabeth cried out their thanks to the doctor. Depending on the medical circumstances, one of those options may be abortion. 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. Sign up for The Brief, our daily newsletter that keeps readers up to speed on the most essential Texas news. The emotional toll was what worried Hall most of all. Hall went on to become a nurse and, together with her husband, created a life in the same town where they both grew up. . Confusion around the laws has caused issues for patients outside of emergencies. "And that may mean in certain circumstances protecting the mother in this situation and the child passing away.". After talking with James, they both agreed they should end the pregnancy. In one case, a central Texas hospital reportedly told a physician not to treat an ectopic pregnancy until it ruptured, the letter said. You're not going to tell me that what I'm experiencing isn't real, again.". And it's this stupid, like, distinction that you're just making in this grief. She said Houston Methodist had convened an ethics panel of doctors, but her doctor didn't seem very optimistic. "We skipped over the genetic testing offered in the first trimester," 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. 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. Elizabeth chose to go home rather than wait to get sick at the hospital. 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. And theyve had to navigate complicated politics when sharing their news. 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. Or, like Hall, they can shell out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. After she got through the first trimester, Hall and her husband both heaved a sigh of relief and got to work telling their friends and family. Hall, raised in a conservative Christian family outside Dallas, felt like she had whiplash from the sudden and tragic events that had brought her to an abortion clinic halfway across the country. This chapter may be cited as the Texas Abortion Facility Reporting and Licensing Act. The case spurred a movement that led to the overturning of Ireland's abortion ban in 2018. "The pharmacy has said, 'We don't know whether or not you might be using this medication for the purposes of abortion,'" she said. "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?". Growing up outside Dallas, Hall often heard that abortion was murder and, perhaps worse, interfering with Gods plan. "It's this woman who was saying 'Hi Miss Weller, you're at the 19 week mark. 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. 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 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.. If a woman's life is in danger, she will be able to have an abortion. Texas Gov. 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. 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. Yet under the new law, Dr. Thoppil felt he could not counsel her on terminating the pregnancy. Doctors can clearly legally save a woman's . Anyone can bring that civil action, posing a quandary for physicians and other providers. Once she made her way through the clinics stringent security, the nurses took her into a private room. The new law does not apply to removing ectopic pregnancies that implant outside the uterus, which are not considered abortions under state law. These are the patients that are the most affected.. They have jobs and multiple children to take care of and they dont have the finances to take four or five days to go to a different state. One reason is that amniotic fluid plays a key role in fetal lung development. Since the Supreme Court ruling of June 24, 2022 that overturned Roe v. Wade, many states have banned abortion, or severely restricted abortion access. 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. But interpretation of the laws is still causing challenges to care. 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. . 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. "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?". A recently scanned monitor shows a patients ultrasound at the Family Birth Center at Beaumont Hospital in Royal Oak, Michigan, in February 2022. Another pending ban, a so-called "trigger law" passed by Texas in 2021, is expected to go into effect within weeks. But the hospital staff told her that those weren't the right symptoms, yet, of a growing infection in her uterus. But Prager believes that the laws in Texas and perhaps elsewhere soon . 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. Down in the kitchen, images from recent scans and ultrasounds were stuck to the fridge. 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. The patient ended up driving 15 hours to New Mexico for life-saving treatment after no one in Texas would help her. To Elizabeth, termination also felt like the most merciful option for her fetus. At 18 weeks, the watery, protective cushion of amniotic fluid was gone. She had cramps, and was passing clots of blood. Elizabeth stood up to get some lunch. 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. Doctors in Texas say they cannot head off life-threatening medical crises in pregnant women if abortions cannot be offered or even discussed. "Because I didn't want anybody to tell me they did not believe me," she says. It was someone else at Methodist Hospital, perhaps a clerk, calling to go over some paperwork. Ectopic pregnancy develops in an estimated 2% of reported pregnancies. Many offer no exemptions for rape, incest or fetal anomolies. These dismissals only increase the sense of isolation, stigma and shame. I need you to give me the facts.'". The Wellers were pleasantly surprised when they got pregnant early in 2022. hide caption. A clinical battle begins behind the scenes. Treatments for miscarriages and ectopic pregnancies are still legal under Texas abortion ban. 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. If I offer the patient the standard of care, I could be sued for aiding and abetting, he said. Abortion bans in Mississippi, North Dakota and Wyoming go into effect after the attorney . You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 988. It is just possible that chemical abortions more than half of all U.S. abortions soon could be outlawed nationwide. Or the judge could at least nullify FDA decisions in 2016 and 2021 that allowed at-home and mail-order chemical abortions. To Dr. Peaceman at Northwestern, it sounded like the hospital's clinicians were using the most common clinical signs of chorioamnionitis as a guideline. At that point, the patient can opt to wait until the bleeding starts and the pregnancy tissue is naturally released, Briggs 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. Hall was in her second trimester when the U.S. Supreme Court overturned Roe v. Wade. 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. 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. "The penalties are quite draconian," he said, noting that someone could be convicted of a felony. Maybe they could get the abortion in Denver or Albuquerque. To deal with the increased demand, Cedar River has reopened a previously shuttered location, enhanced its telemedicine services and worked to find ways to help patients pay for travel and procedures. Those can be acute life-threatening emergencies, she said. It is life-threatening to the mother and is not viable and needs to be removed. 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. 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. Sept. 1, 1989. For example, in rare cases an infection can make the amniotic sac rupture before the fetus is viable. This current law excludes treatment for miscarriage or ectopic pregnancy. So when Roe v . Other times patients don't report the problem and miscarry on their own, she said, but without medication they risk additional bleeding. At the office, her ob-gyn turned down the ultrasound volume so they wouldn't have to hear. "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. This law will prohibit almost all abortions. She and her husband immediately jumped into planning mode, scheduling an appointment at one of the only OB-GYN practices in town. First she said, I cant, I want this baby so badly, Dr. Gunby recalled. You can reach them at 212-255-9252. "Being pregnant in a state like Texas is a dangerous . 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. An attendee holds her child during A Texas Rally for Abortion Rights at Discovery Green in Houston, Texas, on May 7. SB 8, which was signed into law by Texas Gov. There are currently no abortion laws that outlaw treatment of ectopic pregnancy. Still, states like Missouri could put this pro-abortion talking point to rest by protecting treatment of ectopic pregnancy explicitly in the law. And I screamed because that's when I knew something wrong was happening. "He and I kept telling each other 'What is the whole point of the Hippocratic oath to do no harm?'" In a joint statement, Maureen G. Phipps, MD, MPH, FACOG, ACOG chief executive officer and Eugene Toy, MD, FACOG, chair of ACOG District XI (Texas), stated, "By allowing third . You cant even mention what someones choices would be, because of fear that talking about options would be considered aiding and abetting someone getting an abortion, he said. Julia Robinson for NPR Methotrexate also is listed in the Texas law passed last year. 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. In fact, no abortion law in any state in America prevents lifesaving treatment for women with ectopic pregnancies and other life-threatening conditions . Treatments for miscarriages and ectopic pregnancies are still legal under the states abortion ban, according to state law and legal experts. 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. 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. Nitashia Johnson for The New York Times. 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 first, shes focused on her mental health and getting through the next few months. Seventeen weeks into the pregnancy, they learned they were expecting a girl. 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 recalls looking at her baby's little hands and crying. 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. But Im still so angry I had to leave.. 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. "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.". Outcomes from expectant management vary greatly depending on when the waters break. All you can do now is just hope and pray that things go well.". And for a few tense . And I told her 'I'm so sorry. Texas Attorney General Ken Paxton quickly sued the Biden administration over the federal guidance. 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. A doctor hugs a patient at an abortion clinic in Santa Teresa, New Mexico, on 13 January 2023. Texas' "trigger" law, which outlaws abortion "wholly or partly", is set to be in effect 30 days following the . If patients run into trouble filling prescriptions, Thoppil and Crawford say they should try to find another pharmacy or talk to their health care provider. I'm so sorry,'" Elizabeth says. As Friday dragged on, Elizabeth started wondering if maybe the heartbeat had stopped. Due to her history of hemorrhaging, Seewald added that passing the pregnancy at home didn't seem like a good option. A doctor sat down and told her: "There's very little amniotic fluid left. Texas Health and Safety Code, Chapter 171. Starting last September, when the [ban on abortions after about six weeks of pregnancy] went into effect, we started getting calling from Texas and it hasnt stopped.. October 22, 2021. I couldn't give you life. The one exception is a medical emergency, but the law requires doctors to document the reasons for the exception with great specificity. Back at home, the Wellers got more serious about their travel plans and started booking tickets. Rather than warmth and sympathy, she was met with fear, hesitation and, worst of all, silence. Most recently, the Oklahoma Senate passed six abortion-limiting bills , including one that would ban abortions after 30 days from a woman's last . So I'm here to call you to register for your delivery on October 5th, so I can collect all your insurance information. The bill makes no exceptions for pregnancies that resulted from rape or incest. Recently passed laws make abortion illegal after about six weeks into a pregnancy. 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. ", "Because that doesn't really exist right now," he added. And she goes 'I'm so sorry, I'm so sorry, I didn't know.'". 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. 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. 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. Miscarriage 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. hide caption. If someone is hemorrhaging while miscarrying, how long do I have to wait?. But the womans condition can quickly deteriorate, which is why physicians often prefer to offer an abortion. 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. 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. 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 was just laying in bed, you know, wondering: Am I pregnant or am I not pregnant? KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Everyone was so scared.. If you do something to prevent that, you might be in fact performing an illegal abortion.. I had not been put in the crossroads of this issue.". But she was too scared to tell health care providers what was going on for fear that they would know she was considering an abortion. 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. "Later they laid down this beautiful baby girl in my arms. An attendee holds her child during A Texas Rally for Abortion Rights at Discovery Green in Houston, Texas, on May 7. For some, that's too difficult, given the emotions surrounding the pregnancy loss, she said. 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