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, said 27-year-old Lauren Hall. Texas laws banning abortions make narrow exceptions only to save the life of a pregnant patient or prevent substantial impairment of major bodily function. And lawmakers in recent years have clarified state statutes to say treatments for miscarriages, known as spontaneous abortions in medicine, and ectopic pregnancies, in which a fertilized egg grows outside of the uterus and becomes unviable, do not count as abortions. But he did not address the question of lethal fetal anomalies, which are fatal for the fetus during pregnancy or shortly after birth. Julia Robinson for NPR "And that may mean in certain circumstances protecting the mother in this situation and the child passing away.". Financial supporters play no role in the Tribune's journalism. Recently passed laws make abortion illegal after about six weeks into a pregnancy. But now in Texas, the new laws are creating uncertainties that may deter some doctors and other providers from offering optimal miscarriage treatment. But as has been true in Texas and in many of the 12 other states where abortion is banned . So when Roe v . An oncologist urged the woman to start treatment immediately, but the chemotherapy regimen would have been toxic to the fetus. Texas' "trigger" law, which outlaws abortion "wholly or partly", is set to be in effect 30 days following the . 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. But she was barely out the door, still in the parking lot, when her phone rang. To Elizabeth, termination also felt like the most merciful option for her fetus. 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. "I told her 'I'm so sorry. An ultrasound confirmed that she had suffered premature rupture of membranes, which affects about 3% of pregnancies. I couldn't give you life. I looked at her little hands and I just cried. And theyve had to navigate complicated politics when sharing their news. Sept. 20, 2022 KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. pursuant to the preliminary injunction in texas v. becerra, no. But Im still so angry I had to leave.. There have been no criminal charges against providers since the U.S. Supreme Courts decision in late June to overturn the constitutional right to abortion access that was protected by Roe v. Wade, but anti-abortion groups and state lawmakers have threatened to ramp up the pressure against abortion providers and their allies. For a fetus at 18 weeks, the chance of survival in that state is almost nonexistent, according to Peaceman: "This is probably about as close to zero as you'll ever get in medicine.". Seek help right away for signs of ectopic pregnancy your doctor can talk you through next steps. 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 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. This current law excludes treatment for miscarriage or ectopic pregnancy. "At first I was really enraged at the hospital and administration," she says. Rather than warmth and sympathy, she was met with fear, hesitation and, worst of all, silence. 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. 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. 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. Its our 10th year participating in Amplify, and to celebrate, weve got $15,000 in matching funds from four generous Tribune supporters. Or what if the pregnancy wasnt viable? she said. 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.. 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. ", 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. She was due just a few days before Christmas. 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. 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. Either way, she saw nothing ahead but fear and grief prolonged, delayed, amplified. You're not going to tell me that what I'm experiencing isn't real, again.". Because the alternative was hell.". "And she starts to cry and she tells me: 'They're not going to touch you.' And it's strong. 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. 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. 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. 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. Enough to make her retch. "He and I kept telling each other 'What is the whole point of the Hippocratic oath to do no harm?'" You can reach them at 212-255-9252. Their daughter, as expected, was stillborn. "I was born with a physical disability. Carrying the pregnancy to term would be emotionally grueling and would also raise the mothers risk of blood clots and severe postpartum bleeding, the doctor warned. But the National Advocates for Pregnant Women provide free legal assistance to women who have been charged with a crime because of a pregnancy loss like a miscarriage. She was so tiny. Her discharge was yellow and smelled weird. James rushed home from work and drove Elizabeth to the nearby Woodlands Hospital, part of the Houston Methodist hospital system. One reason is that amniotic fluid plays a key role in fetal lung development. Since September 1, 2021, Texas Senate Bill 8 (SB8) has prohibited abortions after the detection of embryonic cardiac activity, which occurs around 6 weeks after a person's last menstrual period . The Texas abortion "trigger law" will be effective on August 25th, 2022. Elizabeth could not receive the medical care she needed until several days later because of a Texas law that banned abortion after six weeks. 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. Halls entire vision of this pregnancy giving birth, becoming a mom, watching her daughter grow up evaporated in an instant. I had not been put in the crossroads of this issue.". 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. She recalls looking at her baby's little hands and crying. 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. It was just too hard, as she navigated a complicated mix of relief and grief. "I ripped my organs out" to avoid that, she said. 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. "I wouldn't say this is true for our practice," he said. The other miscarriage treatment is a procedure described as surgical uterine evacuation to remove the pregnancy tissue the same approach as for an abortion. This represents more confusion around state policy. After talking with James, they both agreed they should end the pregnancy. Selective reductions are forbidden under the new state law. "'I'm just using this because this is not a viable pregnancy.'". We see patients from many different religions and cultures, and how they grieve is unique to each patient, Sanchez said. Double your gift when you give by 6 p.m. Thursday. 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. It went into effect on Sept. 1. Laws modelled on Texas's S.B. We physically watched her get sicker and sicker and sicker, he told the AP. She said Houston Methodist had convened an ethics panel of doctors, but her doctor didn't seem very optimistic. Marlena Stell always wanted a big family. Elizabeth and James Weller at their home in Houston two months after losing their baby girl due to a premature rupture of membranes. About 10% to 20% of confirmed pregnancies end in miscarriages, but estimates are as high as 30% to 50% for all pregnancies, including those in which a person may not know of the pregnancy. They stood up in the middle of the ER and embraced. She called her doctor and begged to get in. 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. The American College of Obstetricians and Gynecologists has information on early pregnancy loss, finding an OB-GYN and having better conversations with your doctor. This law will prohibit almost all abortions. Cheng did not treat Hall, but has counseled patients facing similar situations. If I dont provide my patient the standard of care, which they are due, I could be sued.. If she wanted to stay in Texas, Halls only choice was to continue with a pregnancy that would not yield a healthy, living baby. not include an abortion that uses suction to dismember the body of an unborn child by sucking pieces of the unborn child into a . [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 . "To them my life was not in danger enough.". And I told her 'I'm so sorry. 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. Halls fetus was diagnosed with anencephaly, a neural tube defect in which the brain, skull and scalp do not develop properly in the womb. Such a rupture can be life-threatening. An ectopic pregnancy is 100% fatal if . 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. The Biden administration last week told hospitals they must treat pregnant patients who need an abortion to stabilize a life-threatening condition. The ob-gyn, who said she could not speak to the media, laid out two options, according to Elizabeth. And they're telling me to think of the positives. Greg Abbott said there were some things that we need to work on to ensure patients can get treatment for miscarriages and ectopic pregnancies. More often than not, they just say they lost the baby. Then Elizabeth felt another sudden, forceful gush of fluid leave her body. Treatments for miscarriages and ectopic pregnancies are still legal under the states abortion ban, according to state law and legal experts. "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?". You dont get a lot of time to respond, and if you dont respond quickly enough, your patient expires.. But the statutes dont account for complicated miscarriages, and confusion has led some providers to delay or deny care for patients in Texas. Thankfully, I think theres still plenty of pharmacies that understand the proper utilization of some of the medications we use for nonelective [pregnancy] terminations.. the U.S. that have trigger laws in place banning abortion in the . "Being pregnant in a state like Texas is a dangerous . The maternal fetal medicine specialist at the University of Texas Southwestern Medical Center in Dallas published a blog post last August to inform patients that treatment for cesarean scar ectopic pregnancies are legal under Texas's abortion law. Back at home, the Wellers got more serious about their travel plans and started booking tickets. This chapter may be cited as the Texas Abortion Facility Reporting and Licensing Act. But for patients facing a medical emergency, or low-income or uninsured Texans, seeking a second opinion may not be possible. You're trying to understand exactly what's going on. It just didnt occur to them that a ban would include cases like this.. UPDATE: The Supreme Court voted 5-4 to deny an emergency appeal from abortion providers and reproductive rights groups to block the " Texas Heartbeat Act ," or Senate Bill 8 (SB 8). "It's terrible," says Dr. Alan Peaceman, a professor of maternal-fetal medicine at Northwestern University's Feinberg School of Medicine. 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. At 18 weeks, the watery, protective cushion of amniotic fluid was gone. 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. Thats what recently caused Dr. Jessian Munoz, an OB-GYN in San Antonio, to wait a day to treat a patient who had started to miscarry and developed a womb infection, according to the Associated Press. I think most people would give tremendously leeway to that. Disclosure: Southern Methodist University, Texas Medical Association and New York Times 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. And quickly. Texas providers are still adjusting to other ripple effects that affect patient care. The holidays are going to be especially hard. Methotrexate or surgery are the only two options listed in the medical guidelines to prevent the fallopian tubes from rupturing and causing dangerous bleeding. A previous version of this story incorrectly reported the name and location of a clinic. About 10% to 20% of confirmed . Methotrexate, another abortion-inducing medication, is used to treat ectopic pregnancies as well as rheumatic illnesses, inflammatory bowel disease, psoriasis and cancer. "And if you leave it up to individuals, you're going to get uncertainty and people unwilling to make decisions. Family members hold photos of Olga Reyes, a 22-year-old law student who died of an untreated ectopic pregnancy in Nicaragua in 2007. Doctors in Texas say they cannot head off life-threatening medical crises in pregnant women if abortions cannot be offered or even discussed. I would always say, What if it was necessary to save the life of the mother? Yet under the new law, Dr. Thoppil felt he could not counsel her on terminating the pregnancy. Hall and her husband left the specialists office in a daze. care provider and intended to remove an ectopic pregnancy that . All you can do now is just hope and pray that things go well.". . Im a nurse. Its been a difficult few weeks since the procedure. 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