texas abortion law ectopic pregnancy
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(Texas Hospital Licensing Law); (3) an institution required to be licensed under . "I told her 'Look, Doctor, people around me are telling me to keep hope. Eventually, she laid out their options: Keep carrying the pregnancy or leave Texas to get an abortion. The Texas abortion "trigger law" will be effective on August 25th, 2022. Among other risks, both the fetus and Elizabeth were now highly vulnerable to a uterine infection called chorioamnionitis. judicial order, all other provisions of Texas law regulating or "I can tell that she's been beat down, because she has been trying to fight for me all day, advocating on my behalf," Elizabeth says. "Not because I wanted my baby to die, but because I needed this hell to end. Financial supporters play no role in the Tribune's journalism. "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.". 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. AUSTIN The Texas Medical Association wants regulators to step in after hospitals reportedly refused to treat patients with serious pregnancy complications for fear . ", "Let's say I do have to go through this situation again. In Poland, protests over that countrys abortion laws erupted this year after a 30-year-old pregnant woman died of septic shock. And for a few tense . Or hell honestly it shouldn't even get to the point where you're having to save a woman's life. Patients experiencing miscarriage have also struggled to get prescriptions filled for misoprostol, which is used both to treat miscarriages and induce abortions. 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 bill . It was someone else at Methodist Hospital, perhaps a clerk, calling to go over some paperwork. Or what if the pregnancy wasnt viable? she said. There they found themselves pinned down, clinically and emotionally, victims of a collision between standard obstetrical practice and the rigid new demands of Texas law. There was an infection, and she did need treatment. So I'm here to call you to register for your delivery on October 5th, so I can collect all your insurance information. 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. Anyone can bring that civil action, posing a quandary for physicians and other providers. 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. After holding it together all morning, Hall burst into tears. It also sets out civil, criminal, and professional penalties for abortion providers who violate the law. In some cases, the infection can become severe or life-threatening, leading to sepsis, hysterectomy or even death. Im a nurse. Photograph: Esteban Flix/AP "They can absolutely do that.". As Friday dragged on, Elizabeth started wondering if maybe the heartbeat had stopped. 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 . hide caption. Sometimes theyre the primary caregiver. Texas' "trigger" law, which outlaws abortion "wholly or partly", is set to be in effect 30 days following . And it had to smell foul, really bad. In Texas, a 2021 law made it easier to sue anyone who helps a person get an abortion after about six weeks of pregnancy. For patients who are not pregnant, it can also open up the cervix and make surgeries safer, Crawford said. For some, that's too difficult, given the emotions surrounding the pregnancy loss, she said. She places the blame for the ensuing medical trauma on the Republican legislators who passed the state's anti-abortion law, on Texas Gov. 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. Miscarriage So we look at them like a ticking time bomb and wait for the complications to develop.. The American College of Cardiology and the American Heart Association, for example, advise women with certain congenital heart conditions to avoid pregnancy altogether, as they are at higher risk of illness or death shortly after giving birth. Texas has a trigger law on the books that will outlaw abortion almost universally beginning 30 days after the Supreme Court . It is just possible that chemical abortions more than half of all U.S. abortions soon could be outlawed nationwide. Halls fetus was diagnosed with anencephaly, a neural tube defect in which the brain, skull and scalp do not develop properly in the womb. 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. These dismissals only increase the sense of isolation, stigma and shame. 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. In fact, no abortion law in any state in America prevents lifesaving treatment for women with ectopic pregnancies and other life-threatening conditions . But I need you to tell me the truth, because I don't think all the positive things that they're telling me are real. hide caption. Julia Robinson for NPR Even if it had, the Wellers were determined to proceed. She felt lost and confused. Everyone was so scared.. 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 American College of Obstetricians and Gynecologists has information on early pregnancy loss, finding an OB-GYN and having better conversations with your doctor. We want to keep you safe.. 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. Sec. While another law enacted last year forbids dispensing and shipping abortion-inducing medications like misoprostol, mifepristone and methotrexate past seven weeks of a pregnancy, it makes exceptions for when the drugs are used for other medical reasons.. 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. 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 . "Abortions are sometimes needed out of an act of an emergency, out of an act of saving a woman's life. Another pending ban, a so-called "trigger law" passed by Texas in 2021, is expected to go into effect within weeks. DEFINITIONS. Her discharge had to be darker. ", And at this particular point in her life, pregnant for the first time at age 26, it was still somewhat abstract: "I had not been put in a position to where I had to weigh the real nuances that went into this situation. However, Mayo said that his reading of the law allows for the use of methotrexate to treat an ectopic pregnancy. 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. She recalls looking at her baby's little hands and crying. These cases are only going to grow until the law is either repealed or clarified. We physically watched her get sicker and sicker and sicker, he told the AP. 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. I couldn't give you life. It was like an evidence bag. But interpretation of the laws is still causing challenges to care. You smell it yourself. It includes laws about. 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. Given the states severe penalties, Grossman said medical professionals and their legal teams might err on the side of caution in regard to the law, even if it puts patients at risk. 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. Elizabeth and James keep remembrances of their baby in a picture frame at home. "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?". Julia Robinson for NPR 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. Hall and her husband would like to try again at some point. Elizabeth and James Weller at their home in Houston two months after losing their baby girl due to a premature rupture of membranes. The way the system is going to work is that the patients are going to always pay the price, Grossman said. 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 . In the nursery upstairs, they had already stashed some baby clothes and new cans of paint. October 22, 2021. Which sounds extreme, but Roe had just been overturned. 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. 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. They had savings to fund this last-minute trip, and because her company is based in Illinois, her insurance covered the procedure. Last month, an Austin woman had the medical equivalent of a ticking time bomb in her body. Time is of the essence. 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. In cases in which a medical provider may be hesitant to conduct a needed treatment, itll be critical for patients to stay informed, seek help or get more than one medical opinion, said Joanna Grossman, a professor at Southern Methodist Universitys Dedman School of Law. Since the new laws took effect, Liedtke said, the pharmacist a handful of times declined to provide the medication, citing the new law despite Liedtke writing the prescription to treat a miscarriage. Methotrexate, another abortion-inducing medication, is used to treat ectopic pregnancies as well as rheumatic illnesses, inflammatory bowel disease, psoriasis and cancer. "I remember hearing her, from my room, speaking loudly about how nothing is being done here.". Confusion around the laws has caused issues for patients outside of emergencies. 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. And she says 'Yes. The Wellers were pleasantly surprised when they got pregnant early in 2022. I'm trying to mentally survive this.". Recently passed laws make abortion illegal after about six weeks into a pregnancy. Depending on the medical circumstances, one of those options may be abortion. 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 . Right there in the office, James pulled out his cell phone, and started looking for flights to states with less restrictive abortion laws. You open it. But there is no definition for that term in the statute. A doctor she had never met entered the room. Although distraught and heartbroken at this news, Elizabeth forced herself to think it through. She was due just a few days before Christmas. Its been a difficult few weeks since the procedure. An ectopic pregnancy is when a fertilized egg implants outside the uterus, typically in one of the woman's fallopian tubes. But it was the only choice they had to save this young woman. She eventually agreed, and the treatment was begun as soon as an abortion was performed. Growing up outside Dallas, Hall often heard that abortion was murder and, perhaps worse, interfering with Gods plan. Texas new measure was intended to impose stringent limits on abortion. The other miscarriage treatment is a procedure described as surgical uterine evacuation to remove the pregnancy tissue the same approach as for an abortion. Dr. Ghazaleh Moayedi, an obstetrician/gynecologist and abortion provider in Texas, said the new law leaves unclear whether a physician can act when a woman has a spontaneous miscarriage and is bleeding heavily, but the fetus has not passed. And that 'you can either stay here and wait to get sick where we can monitor you, or we discharge you and you monitor yourself. Rather than warmth and sympathy, she was met with fear, hesitation and, worst of all, silence. The holidays are going to be especially hard. You're trying to understand exactly what's going on. So we look at them like a ticking time bomb and wait for the complications to develop, Dr. Palmer said of her patients. To Elizabeth, it seemed obvious that things were deteriorating. But studies show that pregnant teenagers are more prone than older women to developing a dangerous condition called pre-eclampsia, and they are more likely to have preterm deliveries, small babies and stillbirths. 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.". Elizabeth and James look at clothes that were meant for their baby, whom they lost in the second trimester of pregnancy. Once she made her way through the clinics stringent security, the nurses took her into a private room. Recently passed laws make abortion illegal after about six weeks into a pregnancy. Then Elizabeth felt another sudden, forceful gush of fluid leave her body. If I dont provide my patient the standard of care, which they are due, I could be sued.. 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. She was bereft, unable to even process the news. other than an abortion performed due to a medical emergency as defined by Section 171.002, Health and Safety Code]. "It's terrible," says Dr. Alan Peaceman, a professor of maternal-fetal medicine at Northwestern University's Feinberg School of Medicine. She and her husband immediately jumped into planning mode, scheduling an appointment at one of the only OB-GYN practices in town. 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. "Later they laid down this beautiful baby girl in my arms. Laws modelled on Texas's S.B. She was through with being dismissed, being told to wait. 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. Earlier this month, Gov. Hall was in her second trimester when the U.S. Supreme Court overturned Roe v. Wade. Elizabeth and James keep remembrances of their baby in a picture frame at home. How Every State Pro-Life Law Handles Ectopic Pregnancy and Miscarriage Texas police separate anti-abortion protestors from abortion supporters during the nationwide Women's March in Austin, Texas . Texas law reflects this important distinction. In 2012, a woman died in Ireland after her waters broke at 17 weeks and doctors refused to give her an abortion. Dr. John Thoppil, president of the Texas Association of Obstetricians and Gynecologists, said doctors usually note a diagnosis when prescribing medicines, and prescription rejections dont appear to be widespread. Nitsch says she chose sterilization at age 36 rather than risk getting pregnant by another rapist. Things did go fairly smooth at first. The facts were grim. "I was just laying in bed, you know, wondering: Am I pregnant or am I not pregnant? On Saturday, May 14, about 2 a.m., she gave birth. It is an editorially independent operating program of KFF (Kaiser Family Foundation). 8, which encourages private citizens to file lawsuits against anyone who facilitates an abortion, will proliferate, giving self-appointed vigilantes no shortage of . Join us for Texas biggest politics and policy event when you buy your tickets today. Initially, the patient may not be in danger, and under the law physicians may be prohibited from taking action, even though the baby will not survive. 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. And she goes 'I'm so sorry, I'm so sorry, I didn't know.'". Because the alternative was hell.". Elizabeth touches the urn of her daughter. Selective reductions are forbidden under the new state law. The Oklahoma Senate last week passed six abortion-limiting bills, including one that mirrors the law passed in Texas and another that would ban abortions after 30 days from a woman's last period . I'm so sorry,'" Elizabeth says. Austin woman trying for baby says Texas abortion law nearly caused her death. Many doctors say they are unable to discuss the procedure as an option until the patients condition deteriorates and her life is at risk. 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. Her discharge was yellow and smelled weird. 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. "Ectopic pregnancies can kill people," said Brown, a district chair for the American College of Obstetricians and Gynecologists, representing Texas. The Ohio state legislature, which introduced a bill in 2019 requiring doctors to "reimplant an ectopic pregnancy" into the uterus, or face charges of "abortion murder," despite the fact . It was just the most tender moment, she said. Pro-Life policies in Texas do not prevent doctors from treating an ectopic pregnancy. Methotrexate also is listed in the Texas law passed last year. In other cases, a pregnant womans medical needs may conflict with those of her fetus. "And yet we were. Hall and her husband left the specialists office in a daze. 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. They have private waiting rooms for these patients and offer grief support, genetic counseling and even bereavement services, including ways to memorialize the lost pregnancy. 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. Their conundrum became painfully, distressingly clear: wait to get sicker, or wait until the fetal heartbeat ceased. For 24/7 mental health support in English or Spanish, call the Substance Abuse and Mental Health Services Administrations free help line at 800-662-4357. Hall went on to become a nurse and, together with her husband, created a life in the same town where they both grew up. 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. 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. I'm so sorry.". I looked at her little hands and I just cried. That's not a good thing. We see patients from many different religions and cultures, and how they grieve is unique to each patient, Sanchez said. Texas Attorney General Ken Paxton quickly sued the Biden administration over the federal guidance. John Seago, legislative director for Texas Right to Life, described this type of hesitation as "an awful misunderstanding of the law." If you do something to prevent that, you might be in fact performing an illegal abortion.. In addition, he said, other Texas laws and the Roe v. Wade decision provide an exception to permit abortion if a pregnant person's life is in danger. But things can be murkier when it comes to treating miscarriages, she said. And I told her 'I'm so sorry. "Abortion and pregnancy outcomes are under a microscopein a way we . "I just cried and screamed in the parking lot," she recalls. But the new Texas law has profoundly affected his ability to practice. If she had any physical ailments, I would never abort her for that issue. I'm actually headed home right now because I have to await my dead baby's delivery.' 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. "I was born with a physical disability. The new abortion bans or the old laws being resurrected in a post-Roe world are rigidly written and untested in the courts. The law, which still remains in effect, does contain one exception for a "medical emergency." The abortion clinic is less than a mile from Texas, where abortion is illegal. 5:22-cv-185-h (n.d. In the medical profession, doctors will continue to grapple with the new legal restrictions, and the resultant dilemmas in obstetrical care, says Dr. Peaceman. "And if you leave it up to individuals, you're going to get uncertainty and people unwilling to make decisions. Or in cases of rape or incest? Updated: Oct. 24, 2022. 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. "He and I kept telling each other 'What is the whole point of the Hippocratic oath to do no harm?'" But then an overwhelming sense of calm washed over her. And that was always the scenario I used to explain what a ban would do, and I never met a self-proclaimed conservative that doesnt think those exceptions should be in place.. She would either have to get sick enough for . A few days later, she went out to celebrate a friends birthday and was raped on her way home. Elizabeth and James look at clothes that were meant for their baby, whom they lost in the second trimester of pregnancy. Elizabeth chose to go home rather than wait to get sick at the hospital. Pregnant people are now required to just wait, endangering their own lives with no hope of ever bringing home a baby. It is a horrible gamble that we are making Texas women go through.". Many offer no exemptions for rape, incest or fetal anomolies. Dr. Jennifer Liedtke, a family physician in Sweetwater, Texas, who delivers about 175 babies annually, no longer sends misoprostol prescriptions to the local Walmart. And surprisingly, both of their families sent money to help pay for the trip, despite their anti-abortion sentiments. There are currently no abortion laws that outlaw treatment of ectopic pregnancy. And I knew my baby was suffering, I knew I was suffering, I knew my husband was suffering.". "Because I didn't want anybody to tell me they did not believe me," she says. 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. 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. Unnamed, unknown doctors somewhere had come to an agreement that Elizabeth could be induced that night. For example, in rare cases an infection can make the amniotic sac rupture before the fetus is viable. Correction, Oct. 24, 2022 at 4:12 p.m.: "Most women would find it extremely difficult and emotionally very challenging. Treatment of ectopic pregnancy is not prohibited by Texas' abortion laws. In Texas, the second-largest state in the nation, legal abortion immediately ceased to be an option except to save the life of the pregnant patient. I couldnt do that.. A clinical battle begins behind the scenes. And they're telling me to think of the positives. 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. 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. "The penalties are quite draconian," he said, noting that someone could be convicted of a felony. But now "your medical provider says that it's illegal and they can't provide it. 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. Medical v. legal . For example, last year's Texas Heartbeat Law incorporated Texas' Health & Safety Code 245.002, which states (emphasis added): 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. Civil action, posing a quandary for physicians and other life-threatening conditions a procedure described as surgical uterine evacuation remove... Save this young woman, she laid out their options: keep carrying the or. Recalls looking at her baby 's little hands and I knew I was,. 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