After talking with James, they both agreed they should end the pregnancy. 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. Whether terminating an ectopic pregnancy is legal will depend on individual state laws. Things did go fairly smooth at first. Eventually, she found a clinic near Seattle that provides specialty care for patients who have decided to terminate due to lethal fetal abnormalities. Elizabeth and James keep remembrances of their baby in a picture frame at home. Supporters of the law say their goal is to save the life of every embryo, regardless of the circumstances of conception. And quickly. I think most people would give tremendously leeway to that. Even in Texas, whose "heartbeat bill" was one . "And that may mean in certain circumstances protecting the mother in this situation and the child passing away.". A doctor she had never met entered the room. judicial order, all other provisions of Texas law regulating or A Texas judge's decision that could revoke the FDA's approval of abortion drugs is expected soon. Sometimes patients don't realize that they have lost the pregnancy until they come in for a checkup and no cardiac activity can be detected, said Dr. Emily Briggs, a family physician who delivers babies in New Braunfels, Texas. The Texas law, which is also called Senate Bill 8, carves out an exception for termination in a medical emergency, which is defined in the states health code as a life-threatening physical condition caused or aggravated by pregnancy that places the woman in danger of death or a serious risk of substantial impairment of a major bodily function.. Which sounds extreme, but Roe had just been overturned. Everyone was thrilled, buying them car seats and baby clothes. She said Houston Methodist had convened an ethics panel of doctors, but her doctor didn't seem very optimistic. When they learned they were having a girl, Hall and her husband even picked out a name: Amelia. Texas Health and Safety Code, Chapter 171. A few days later, she went out to celebrate a friends birthday and was raped on her way home. Join us for Texas biggest politics and policy event when you buy your tickets today. Grumet: Fears over Texas' abortion laws interfere with urgent, life-saving care. For some, that's too difficult, given the emotions surrounding the pregnancy loss, she said. And so they don't even know what the rules are.". See the growing speaker list and buy tickets. They don't want to get sucked into a legal morass. 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. Post-Roe v. Wade, abortion bans may keep doctors from providing timely, necessary care. It was just the most tender moment, she said. In some cases, the infection can become severe or life-threatening, leading to sepsis, hysterectomy or even death. Misoprostol is used to help prevent stomach ulcers, but it can induce abortions, particularly if taken along with mifepristone. If the lawsuit is successful, plaintiffs can receive up to $10,000. "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.". Before they drove off, Elizabeth paused to do something. If Elizabeth exhibited enough of them, then it would be possible to document the encroaching infection, and therefore terminate the pregnancy under the law's "medical emergency" clause, he said. KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Texas Attorney General Ken Paxton quickly sued the Biden administration over the federal guidance. Those can be acute life-threatening emergencies, she said. Because the state has made it very clear that if you talk about this, you're vulnerable to being sued," she added. They had bought a house in Kingwood, a lakeside development in Houston. Many doctors say they are unable to discuss the procedure as an option until the patients condition deteriorates and her life is at risk. 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. "They can absolutely do that.". 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. It doesnt take a huge leap to see that our rates of complications will go up because we have a selection bias on who is going to have to continue more complicated pregnancies.. 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. Texas' abortion restrictions a ban that prohibits most abortions after about six weeks of pregnancy, as well as a law passed last year that will ban nearly all abortions, plus older statutes . hide caption. The other miscarriage treatment is a procedure described as surgical uterine evacuation to remove the pregnancy tissue the same approach as for an abortion. Immediately, they sensed hesitation from the doctor. I'm trying to mentally survive this.". She was due just a few days before Christmas. And Ogburn, who noted that he was speaking personally and not for the medical school, worries that fears about the Texas laws have already delayed care. But the hospital staff told her that those weren't the right symptoms, yet, of a growing infection in her uterus. And they're telling me to think of the positives. But there is no definition for that term in the statute. But as has been true in Texas and in many of the 12 other states where abortion is banned . James rushed home from work and drove Elizabeth to the nearby Woodlands Hospital, part of the Houston Methodist hospital system. Elizabeth was 18 weeks pregnant. If I offer the patient the standard of care, I could be sued for aiding and abetting, he said. Since the Texas laws include a stipulation that there must be intent to induce an abortion, Mayo said that he'd advise physicians and other clinicians to closely document the rationale for medical care, whether it's to treat a miscarriage or an ectopic pregnancy. But the most confusing development involves the exemptions that exist for the woman's life or health, or because of a "medical emergency." You dont get a lot of time to respond, and if you dont respond quickly enough, your patient expires.. The law makes no exceptions for nonviable pregnancies in which the fetus has no chance of survival. Her mental health spiraled to the point that she considered checking herself into the hospital. Texas Health and Safety Code, Chapter 245. Doctors in Texas say they cannot head off life-threatening medical crises in pregnant women if abortions cannot be offered or even discussed. For the women, expectant management after premature rupture of membranes comes with its own health risks. Pregnancy is dangerous, and there are many potential risks for a fatalityectopic pregnancy, severe preeclampsia, cancer, heart conditionsall things that would drive a person to seek an abortion. Julia Robinson for NPR The hospital where she works pays me to have these conversations with patients, but theres not necessarily any guarantee they would have my back should someone decide to list my name on a lawsuit, she said. The staff remained vague about what came next, Elizabeth recalls. Hall went on to become a nurse and, together with her husband, created a life in the same town where they both grew up. Methotrexate, another abortion-inducing medication, is used to treat ectopic pregnancies as well as rheumatic illnesses, inflammatory bowel disease, psoriasis and cancer. They had savings to fund this last-minute trip, and because her company is based in Illinois, her insurance covered the procedure. Hall and her husband would like to try again at some point. One option was to end the pregnancy; that's called "a termination for medical reasons." Crescenda Uhles, a genetic counselor in Dallas, said the Texas law puts people like her in a bind when advising patients. It was someone else at Methodist Hospital, perhaps a clerk, calling to go over some paperwork. But things can be murkier when it comes to treating miscarriages, she said. I couldnt do that.. It went into effect on Sept. 1. Not doing so can, in some circumstances, kill all of the fetuses. Ilana Panich-Linsman for The New York Times. Right away, she ran into obstacles because of the Texas law. Confusion around the laws has caused issues for patients outside of emergencies. And she goes 'I'm so sorry, I'm so sorry, I didn't know.'". But Prager believes that the laws in Texas and perhaps elsewhere soon could boost physicians' vulnerability to medical malpractice lawsuits. When you join us at The Texas Tribune Festival Sept. 22-24 in downtown Austin, youll hear from changemakers who are driving innovation, lawmakers who are taking charge with new policies, industry leaders who are pushing Texas forward and so many others. Its our 10th year participating in Amplify, and to celebrate, weve got $15,000 in matching funds from four generous Tribune supporters. After all, she didnt need an abortion she needed convenient pregnancy care. Elizabeth and James Weller at their home in Houston two months after losing their baby girl due to a premature rupture of membranes. "Because I didn't want anybody to tell me they did not believe me," she says. SB 8, which was signed into law by Texas Gov. But the Wellers and 28 million other Texans had already been living under a de facto abortion ban for 8 months, since September 2021. A fertilized egg can't survive an ectopic pregnancy and can result in life-threatening bleeding, according to the Mayo Clinic. An ectopic pregnancy, which occurs when a fertilized egg . hide caption. Enough to make her retch. But then an overwhelming sense of calm washed over her. . 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. That is a pregnancy that occurs outside the uterus. Nitashia Johnson for The New York Times. "It's terrible," says Dr. Alan Peaceman, a professor of maternal-fetal medicine at Northwestern University's Feinberg School of Medicine. You have to suddenly leave for a medical procedure, and you dont know whats going to happen, so despite everything that made me leave, it was a relief to be back home, she said. Another patient in Dallas was denied a surgical procedure for a miscarriage, according to The New York Times, and a Texas woman told CNN she had to carry her dead fetus for two weeks until she could find an OB-GYN willing to remove it. One reason is that amniotic fluid plays a key role in fetal lung development. Hall shelled out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. Elizabeth and James keep remembrances of their baby in a picture frame at home. "I remember hearing her, from my room, speaking loudly about how nothing is being done here.". 9:42 AM on Jul 1, 2022 CDT. Took no time at all.. And for a few tense . I would consider what I experienced that weekend a medical emergency.. AUSTIN (KXAN) Amanda and Josh Zurawski have been trying to have a baby for more than a year now. They now had some of the symptoms they needed to show the infection was getting worse. They had to call their OB/GYN repeatedly to get the $500 delivery deposit refunded. Coming back to Texas a few days later only amplified those feelings. For example, in rare cases an infection can make the amniotic sac rupture before the fetus is viable. ", Later on, Elizabeth said she realized that her anger at Methodist was misplaced. The emotional toll was what worried Hall most of all. And a tubal ectopic pregnancy, let's say, is clearly excluded. DEFINITIONS. ", Her waters had broken, launching her into what she calls a "dystopian nightmare" of "physical, emotional and mental anguish." 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. The ethics panel had reached a decision, the doctor told them. Every OB-GYN has cared for someone who has died from a hemorrhage, she said. The patient lost liters of blood and had to be put on a breathing machine because of the 24-hour delay in care. Wade and the return of laws governing abortion legality to the states. "This poor woman had no idea what she was telling me. I have seen cases where the woman has gone from completely normal to septic shock in less than an hour, Dr. Carpenter said. 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. I couldnt do that., by Eleanor Klibanoff If she had any physical ailments, I would never abort her for that issue. Photograph: Esteban Flix/AP Because the providers have a choice whether to provide and the patients are the ones who need the care. We do what we can to honor each of those cases.. 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. Pregnant people are now required to just wait, endangering their own lives with no hope of ever bringing home a baby. "It's not just the fear that it could happen again, but also the added fear of what if it happens again and I can't get help? care provider and intended to remove an ectopic pregnancy that . But the new Texas law has profoundly affected his ability to practice. 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. Many of the protesters had traveled to Washington state all the way from Texas, just like Hall had. "He and I kept telling each other 'What is the whole point of the Hippocratic oath to do no harm?'" It's an emotional and legal dilemma that potentially faces not just obstetricians and midwives, but also family physicians, emergency physicians, pharmacists, and anyone else who might become involved with pregnancy care. Due to her history of hemorrhaging, Seewald added that passing the pregnancy at home didn't seem like a good option. Cedar River offers specialty care for patients facing lethal fetal abnormalities like anencephaly. The women who will be forced to carry these babies are the women with less resources, he said. 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. Either way, she saw nothing ahead but fear and grief prolonged, delayed, amplified. Medical v. legal . Aborting the embryo is often the best treatment for an ectopic . Or, like Hall, they can shell out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. The pregnancy made it impossible to remove the device, Dr. Thoppil said. SHORT TITLE. With it in place, his patient faces a pregnancy rife with potential medical problems. For patients who are not pregnant, it can also open up the cervix and make surgeries safer, Crawford 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. And surprisingly, both of their families sent money to help pay for the trip, despite their anti-abortion sentiments. 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. But as has been true in Texas and in many of the 12 other states where abortion is currently . You smell it yourself. Elizabeth and James look at clothes that were meant for their baby, whom they lost in the second trimester of pregnancy. 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. Or what if the pregnancy wasnt viable? 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. To the extent anybody is delaying or denying care for ectopic pregnancy, they are simply misunderstanding the law, Grossman said. Because once they reached Methodist, while they were still checking in at the emergency room, her doctor called. Elizabeth touches the urn of her daughter. But two of those drugs, misoprostol and mifepristone, are the only drugs recommended in the American College of Obstetricians and Gynecologists guidelines for treating a patient after an early pregnancy loss. But she did not know who the biological father was. 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 . But the lack of clarity accompanying the threat of jail time and six-figure fines for medical professionals has led some hospitals and doctors in the state to deny or delay care for pregnancy complications, according to multiple reports. After one conversation, the doctor returned to her bedside. I had not been put in the crossroads of this issue.". At 18 weeks, the watery, protective cushion of amniotic fluid was gone. But the incentives are all very strong for those providers to err on the side of not providing care.. Texas never repealed its original law prohibiting abortion except when the life of the mother was in danger after Roe. 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. Updated: Oct. 24, 2022. It is not currently possible in any way to 'reimplant' an ectopic pregnancy. 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. "The care providers are treading on eggshells. Recently passed laws make abortion illegal after about six weeks into a pregnancy. Their conundrum became painfully, distressingly clear: wait to get sicker, or wait until the fetal heartbeat ceased. On Saturday, May 14, about 2 a.m., she gave birth. This is already incredibly difficult news that someone receives, Thoppil said. 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. The associations say these women should be given the option of termination if they become pregnant. Texas law reflects this important distinction. That's when a new state law banned all abortions after fetal cardiac activity is detected usually at about six weeks of pregnancy. Pregnancies can be complicated by any number of medical conditions. Sometimes theyre the primary caregiver. 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. "I said 'Well, is there a heartbeat still?' Under Texas law, doctors can be sued by almost anyone for performing an abortion. So we look at them like a ticking time bomb and wait for the complications to develop.. That's not a good thing. 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. At 6 weeks, many people . The only way to stop the heavy bleeding is to end the pregnancy and contract the uterus, Dr. Moayedi said. 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. One Texas law passed last year lists several medications as abortion-inducing drugs and largely bars their use for abortion after the seventh week of pregnancy. "And if you leave it up to individuals, you're going to get uncertainty and people unwilling to make decisions. 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