Instead, the patient may choose medication or a surgical evacuation procedure, which Briggs said may prove necessary anyway to avoid a patient becoming septic if some of the tissue remains in the uterus. Hall and her husband left the specialists office in a daze. "I said 'Well, is there a heartbeat still?' July 20, 20225 PM Central. This article originally appeared on Austin American-Statesman: Here's what current Texas abortion laws say, plus birth control info 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. And surprisingly, both of their families sent money to help pay for the trip, despite their anti-abortion sentiments. An oncologist urged the woman to start treatment immediately, but the chemotherapy regimen would have been toxic to the fetus. The definition of abortion in Texas Health and Safety Code explicitly states an act that is done to "remove an ectopic pregnancy" is not defined as an abortion. Dr. Jennifer Liedtke, a family physician in Sweetwater, Texas, who delivers about 175 babies annually, no longer sends misoprostol prescriptions to the local Walmart. Sign up for The Brief, our daily newsletter that keeps readers up to speed on the most essential Texas news. The case spurred a movement that led to the overturning of Ireland's abortion ban in 2018. ABACA. 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. If I dont provide my patient the standard of care, which they are due, I could be sued.. 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. Elizabeth chose to go home rather than wait to get sick at the hospital. "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. judicial order, all other provisions of Texas law regulating or James rushed home from work and drove Elizabeth to the nearby Woodlands Hospital, part of the Houston Methodist hospital system. 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. "'I'm just using this because this is not a viable pregnancy.'". "He and I kept telling each other 'What is the whole point of the Hippocratic oath to do no harm?'" Recently passed laws make abortion illegal after about six weeks into a pregnancy. But the language is ambiguous, and travel can be expensive and onerous for pregnant women, especially if they are unwell. "It's hard to form a relationship to say, 'Hey look, I'm not using this for an elective abortion,'" she said. But even from a young age, she had a lot of questions about what she saw as a deeply unforgiving idea. "We skipped over the genetic testing offered in the first trimester," Elizabeth says. 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. Under Texas law, doctors can be sued by almost anyone for performing an abortion. 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. 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.". 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. ", Later on, Elizabeth said she realized that her anger at Methodist was misplaced. They don't want to get sucked into a legal morass. 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. How do they follow the latest guidelines when numerous other people from other medical professionals to friends and family members can question their intent: Are they helping care for a miscarriage or facilitating an abortion? Those can be acute life-threatening emergencies, she said. Most of these pregnancies end in miscarriage or stillbirth. But now were forcing someone to continue the pregnancy and go through all the risks of a potentially term delivery and all those potential complications for a pregnancy that has no chance of surviving. "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. But Texas's medical exception is narrower, and less defined . On September 1, 2021, Texas Senate Bill 8 (SB 8) went into effect, banning virtually all abortions and medical counseling and support related to abortion after six weeks. 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. ), hhs may not enforce the following interpretations contained in the july 11, 2022, cms guidance (and the corresponding letter sent the same day by hhs secretary becerra): (1) hhs may not enforce the guidance and letter's interpretation that texas abortion laws are preempted by emtala; and (2) hhs may . She was through with being dismissed, being told to wait. 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. You open it. And I told her 'No, ma'am. Elizabeth has been sharing her story, and has found that whatever the political affiliation of the listener, they all agree her experience was horrible. That is a pregnancy that occurs outside the uterus. Methotrexate also is listed in the Texas law passed last year. I'm so sorry.". The new law in Texas bans abortion at 6 weeks when a fetal "heartbeat" can be detected. Elizabeth's experience amounts to a kind of medical trauma, which is layered on top of the grief of pregnancy loss, says Elaine Cavazos, a psychotherapist specializing in the perinatal period, and the chief clinical officer of Reproductive Psychiatry and Counseling in Austin. 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. There was an infection, and she did need treatment. Every OB-GYN has cared for someone who has died from a hemorrhage, she said. . Lauren Hall, 27, fought the urge to scream back and tell them just how badly she wished life was a choice she could have made. Once inside the car, they both burst into tears, for their baby and the terrible choices they were now left to navigate. 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. 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. a letter from the Texas Medical Association. That's not a good thing. See the growing speaker list and buy tickets. After all, she didnt need an abortion she needed convenient pregnancy care. Most recently, the Oklahoma Senate passed six abortion-limiting bills , including one that would ban abortions after 30 days from a woman's last . "I told her 'I'm so sorry. And that's a big part of this problem, when we as physicians are trying to relieve patients' suffering. 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. The risks to Elizabeth's health were simply too high. 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. Health & Safety Code 245.002(1)(A)-(C). She felt lost and confused. Family members hold photos of Olga Reyes, a 22-year-old law student who died of an untreated ectopic pregnancy in Nicaragua in 2007. 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. Julie Ann Nitsch, a sexual assault survivor and community college trustee in Austin, Texas, is among many women in states with restrictive abortion laws who are taking drastic steps. Back at home, the Wellers got more serious about their travel plans and started booking tickets. I couldnt do that.. And for a few tense . We do what we can to honor each of those cases.. In September, the justices turned down an emergency request to block the law. Sept. 20, 2022 forbids dispensing and shipping abortion-inducing medications, rheumatic illnesses, inflammatory bowel disease, psoriasis and cancer. One reason is that amniotic fluid plays a key role in fetal lung development. Depending on the medical circumstances, one of those options may be abortion. Miscarriages occur in roughly 1 out of 10 pregnancies. Everyone was thrilled, buying them car seats and baby clothes. 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. "I was born with a physical disability. 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.. 245.001. Another pending ban, a so-called "trigger law" passed by Texas in 2021, is expected to go into effect within weeks. She called her doctor and begged to get in. Thats why Crawford said its important for patients to quickly seek medical care if they notice their pregnancy isnt progressing normally or they are bleeding. This is already incredibly difficult news that someone receives, Thoppil said. "And yet we're being pulled through this.". Whether terminating an ectopic pregnancy is legal will depend on individual state laws. 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 . AUSTIN The Texas Medical Association wants regulators to step in after hospitals reportedly refused to treat patients with serious pregnancy complications for fear . If she wanted to stay in Texas, Halls only choice was to continue with a pregnancy that would not yield a healthy, living baby. Texas never repealed its original law prohibiting abortion except when the life of the mother was in danger after Roe. The ob-gyn, who said she could not speak to the media, laid out two options, according to Elizabeth. Texas Health and Safety Code, Chapter 171. Because the providers have a choice whether to provide and the patients are the ones who need the care. One option was to end the pregnancy; that's called "a termination for medical reasons." 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. 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 Biden administration last week told hospitals they must treat pregnant patients who need an abortion to stabilize a life-threatening condition. The fetus had a rare neural tube defect. We see patients from many different religions and cultures, and how they grieve is unique to each patient, Sanchez said. An ectopic pregnancy is 100% fatal if . 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. Texas' "trigger" law, which outlaws abortion "wholly or partly", is set to be in effect 30 days following the . They had bought a house in Kingwood, a lakeside development in Houston. She said Houston Methodist had convened an ethics panel of doctors, but her doctor didn't seem very optimistic. All you can do now is just hope and pray that things go well.". Elizabeth and James keep remembrances of their baby in a picture frame at home. 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.. The ethics panel had reached a decision, the doctor told them. These provisions are in Chapter 170A of the Texas Health & Safety Code, which was enacted by House Bill 1280 in 2021. Abortion is permitted in Texas after six weeks only when a woman is facing a life-threatening or disabling medical emergency linked to her pregnancy. But its not just the physical changes, but the emotional toll of knowing their baby is not going to survive and just waiting for something to happen so they can get the care they need.. Its one of the most egregious invasions of the physician-patient relationship that weve ever seen, said Dr. Rick Snyder, a cardiologist in Dallas who is chair of the board of trustees of the Texas Medical Association. If a woman's life is in danger, she will be able to have an abortion. Its also had to heighten security since Roe was overturned, Sanchez said, the clinics have seen more and more aggressive protesters, including people from out-of-state like those Hall faced. But for patients facing a medical emergency, or low-income or uninsured Texans, seeking a second opinion may not be possible. "It's going to take a while before the medical community comes to some kind of consensus on where you draw this line, and where you say enough is enough. 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. Yet under the new law, Dr. Thoppil felt he could not counsel her on terminating the pregnancy. And it's strong. Methotrexate or surgery are the only two options listed in the medical guidelines to prevent the fallopian tubes from rupturing and causing dangerous bleeding. But Im still so angry I had to leave.. "I remember hearing her, from my room, speaking loudly about how nothing is being done here.". Her discharge had to be darker. other than an abortion performed due to a medical emergency as defined by Section 171.002, Health and Safety Code]. Patients experiencing miscarriage have also struggled to get prescriptions filled for misoprostol, which is used both to treat miscarriages and induce abortions. So when Roe v . Greg Abbott said there were some things that we need to work on to ensure patients can get treatment for miscarriages and ectopic pregnancies. 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. "To them my life was not in danger enough.". But now "your medical provider says that it's illegal and they can't provide it. Texas' "trigger" law, which outlaws abortion "wholly or partly", is set to be in effect 30 days following . SB 8, which was signed into law by Texas Gov. 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 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 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. The way the system is going to work is that the patients are going to always pay the price, Grossman said. Cheng did not treat Hall, but has counseled patients facing similar situations. If she is developed enough to be menstruating and become pregnant, and reached sexual maturity, she can safely give birth to a baby, Dr. Skop said. 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. That's when she felt something "shift" in her uterus, down low, and then "this burst of water just falls out of my body. But now in Texas, the new laws are creating uncertainties that may deter some doctors and other providers from offering optimal miscarriage treatment. 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. A Texas judge's decision that could revoke the FDA's approval of abortion drugs is expected soon. "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.". 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. Amplify your impact and donate now. 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. Right away, she ran into obstacles because of the Texas law. 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. Coming back to Texas a few days later only amplified those feelings. So I'm here to call you to register for your delivery on October 5th, so I can collect all your insurance information. Or, like Hall, they can shell out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. But the Wellers and 28 million other Texans had already been living under a de facto abortion ban for 8 months, since September 2021. Because once they reached Methodist, while they were still checking in at the emergency room, her doctor called. The next day, a Thursday, she started throwing up. One of the most painful parts was trying to reach her medical team. Doctors in Texas say they cannot head off life-threatening medical crises in pregnant women if abortions cannot be offered or even discussed. Elizabeth touches the urn of her daughter. And I screamed because that's when I knew something wrong was happening. A doctor hugs a patient at an abortion clinic in Santa Teresa, New Mexico, on 13 January 2023. In the nursery upstairs, they had already stashed some baby clothes and new cans of paint. Not doing so can, in some circumstances, kill all of the fetuses. A previous version of this story incorrectly reported the name and location of a clinic. Im a nurse. But there was a vibe immediately. Because at this point, I'm in survival mode. Hall declined those services. They now had some of the symptoms they needed to show the infection was getting worse. Outcomes from expectant management vary greatly depending on when the waters break. It is a horrible gamble that we are making Texas women go through.". 5:22-cv-185-h (n.d. Time is of the essence. Medical v. legal . "Later they laid down this beautiful baby girl in my arms. I'm so sorry,'" Elizabeth says. 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. 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. The Supreme Court is expected to rule soon on whether abortion providers and the Biden administration may challenge the law notwithstanding its novel structure. Tom Mayo, a professor of law at Southern Methodist University's Dedman School of Law in Dallas, understands why some in Texas' pharmacy community might be nervous. Financial supporters play no role in the Tribune's journalism. But those numbers have skyrocketed since Roe v. Wade was overturned. Treatment of ectopic pregnancy is not prohibited by Texas' abortion laws. 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. Her mental health spiraled to the point that she considered checking herself into the hospital. CONROE, Texas (KTRK) -- A Conroe woman who suffered a miscarriage says the state's restrictive abortion laws forced her into a dangerous health situation. Elizabeth could not receive the medical care she needed until several days later because of a Texas law that banned abortion after six weeks. Down in the kitchen, images from recent scans and ultrasounds were stuck to the fridge. She recalls looking at her baby's little hands and crying. This chapter may be cited as the Texas Abortion Facility Reporting and Licensing Act. And I told her 'I'm so sorry. Took no time at all.. That's when a new state law banned all abortions after fetal cardiac activity is detected usually at about six weeks of pregnancy. I'm trying to understand. 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. To Elizabeth, it seemed obvious that things were deteriorating. You dont get a lot of time to respond, and if you dont respond quickly enough, your patient expires.. "This poor woman had no idea what she was telling me. To Elizabeth, termination also felt like the most merciful option for her fetus. Miscarriage 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. If the lawsuit is successful, plaintiffs can receive up to $10,000. 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. You're not going to tell me that what I'm experiencing isn't real, again.". But as has been true in Texas and in many of the 12 other states where abortion is currently . Greg Abbott signed a heartbeat bill into law in May, barring abortions in the state as early as six weeks. Her discharge was yellow and smelled weird. Doctors and experts also worry that patients with pregnancy complications may be too afraid of being accused of inducing an abortion to seek care. Post-Roe v. Wade, abortion bans may keep doctors from providing timely, necessary care. 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.. Confusion around the laws has caused issues for patients outside of emergencies. "And they decide to sue for malpractice," she said. 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. The law makes no exceptions for nonviable pregnancies in which the fetus has no chance of survival. They also had an anatomy scan, which revealed no problems. Restrictive abortion laws in more states are likely to lead to more cases of patients with ectopic pregnancy being unable to secure timely, and life-saving, care. There was still a fetal heartbeat, but it could stop at any moment. Or you wait till your baby's heartbeat stops.'". The earliest time that any genetic testing could be done would be at seven weeks, Dr. Palmer said, so the patient decided to terminate her pregnancy before the six-week mark, in Texas. 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. Even before the passage of the two bills, existing Texas law stated that the act is not an abortion if it involves the treatment of an ectopic pregnancy which most commonly occurs when the pregnancy grows in the fallopian tube or to "remove a dead, unborn child whose death was caused by spontaneous abortion," he said, pointing to the statute. Greg Abbott, who signed it, and on the inflamed political rhetoric, which Elizabeth says only sees abortion "as one thing, a black-and-white issue, when abortion has all of these gray areas. "It's this woman who was saying 'Hi Miss Weller, you're at the 19 week mark. 678, Sec. 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