Last month, an Austin woman had the medical equivalent of a ticking time bomb in her body. Supporters of the law say their goal is to save the life of every embryo, regardless of the circumstances of conception. The patient ended up driving 15 hours to New Mexico for life-saving treatment after no one in Texas would help her. 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. Financial supporters play no role in the Tribune's journalism. There was still a fetal heartbeat, but it could stop at any moment. Texas never repealed its original law prohibiting abortion except when the life of the mother was in danger after Roe. But she was too scared to tell health care providers what was going on for fear that they would know she was considering an abortion. 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. 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? To deal with the increased demand, Cedar River has reopened a previously shuttered location, enhanced its telemedicine services and worked to find ways to help patients pay for travel and procedures. The other miscarriage treatment is a procedure described as surgical uterine evacuation to remove the pregnancy tissue the same approach as for an abortion. If a woman's life is in danger, she will be able to have an abortion. She wanted to tell these strangers about the day she ran into her husbands home office, pants still around her ankles, waving that positive pregnancy test. This is already incredibly difficult news that someone receives, Thoppil said. 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. Julia Robinson for NPR It is not currently possible in any way to 'reimplant' an ectopic pregnancy. Their conundrum became painfully, distressingly clear: wait to get sicker, or wait until the fetal heartbeat ceased. "I told her 'I'm so sorry. She recalls looking at her baby's little hands and crying. You're not going to tell me that what I'm experiencing isn't real, again.". Since Sept. 1, abortion has been illegal in Texas after six weeks gestation, with one exception: If a doctor determines that a patient will face a " medical emergency " if the pregnancy continues, they can perform an abortion later on without breaking the law. "I told her 'Look, Doctor, people around me are telling me to keep hope. October 22, 2021. 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. The new abortion bans or the old laws being resurrected in a post-Roe world are rigidly written and untested in the courts. I'm so sorry,'" Elizabeth says. Such testing is done late in pregnancy, beyond the six-week limit, noted Crescenda Uhles, a genetic counselor in Dallas. In the medical profession, doctors will continue to grapple with the new legal restrictions, and the resultant dilemmas in obstetrical care, says Dr. Peaceman. It also sets out civil, criminal, and professional penalties for abortion providers who violate the law. 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. Elizabeth could not receive the medical care she needed until several days later because of a Texas law that banned abortion after six weeks. 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. Texas Gov. 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. And not only can they not provide it, but they can't talk to you about it," Cavazos says. It was like an evidence bag. Midnight came and went in a blur. But Prager believes that the laws in Texas and perhaps elsewhere soon . "It's terrible," says Dr. Alan Peaceman, a professor of maternal-fetal medicine at Northwestern University's Feinberg School of Medicine. 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. 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 . 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. Such a rupture can be life-threatening. "I was born with a physical disability. But in early May, not long after the uneventful anatomy scan, the Wellers suddenly arrived at that crossroads. We both have good jobs, weve got a house and we were at a place where if it happens, it happens, she said. I couldn't give you life. To Elizabeth, termination also felt like the most merciful option for her fetus. In Poland, protests over that countrys abortion laws erupted this year after a 30-year-old pregnant woman died of septic shock. 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. And I told her 'I'm so sorry. 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. The women who will be forced to carry these babies are the women with less resources, he said. Idaho, Tennessee and Texas will implement abortion bans in 30 days, according to the text of the laws. For Elizabeth, that tragic conversation was just "the beginning of the hell that was going to ensue" for the rest of the week. Yet under the new law, Dr. Thoppil felt he could not counsel her on terminating the pregnancy. The risks to Elizabeth's health were simply too high. I couldn't give you life. And surprisingly, both of their families sent money to help pay for the trip, despite their anti-abortion sentiments. But Texas's medical exception is narrower, and less defined . A previous version of this story incorrectly reported the name and location of a clinic. "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. Texas new measure was intended to impose stringent limits on abortion. 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. In the meantime, Grossman said the delay and denial of care will likely become more common. forbids dispensing and shipping abortion-inducing medications, rheumatic illnesses, inflammatory bowel disease, psoriasis and cancer. Ectopic pregnancy develops in an estimated 2% of reported pregnancies. 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. oral contrace ptives." The term "abortion" in Texas law does not apply when these acts are done to "(A) save the life or preserve the health of an unborn child; (B) remove a dead, unborn child whose death was caused by spontaneous abortion; or (C) remove an ectopic pregnancy." Tex. And now the Texas abortion law has created an additional bind, Cavazos explains. Since the Supreme Court ruling of June 24, 2022 that overturned Roe v. Wade, many states have banned abortion, or severely restricted abortion access. Miscarriage Hall went on to become a nurse and, together with her husband, created a life in the same town where they both grew up. In a sudden obstetrical emergency, a termination might be the least risky option, clinically. An IUD can make menstruation irregular, and she did not realize she had conceived until after the six-week mark. Quite the opposite, many state laws explicitly exempt treatment of ectopic pregnancy from their definitions of abortion. All you can do now is just hope and pray that things go well.". But as has been true in Texas and in many of the 12 other states where abortion is currently . Find a complete list of them here. Elizabeth has been sharing her story, and has found that whatever the political affiliation of the listener, they all agree her experience was horrible. "I just cried and screamed in the parking lot," she recalls. Crescenda Uhles, a genetic counselor in Dallas, said the Texas law puts people like her in a bind when advising patients. As Friday dragged on, Elizabeth started wondering if maybe the heartbeat had stopped. Consider the patient whose miscarriage care is delayed and develops a serious infection and other complications, Prager said. 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. 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 Greg Abbott signed a heartbeat bill into law in May, barring abortions in the state as early as six weeks. In one case, a central Texas hospital reportedly told a physician not to treat an ectopic pregnancy until it ruptured, the letter said. Things did go fairly smooth at first. And a tubal ectopic pregnancy, let's say, is clearly excluded. "Abortion and pregnancy outcomes are under a microscopein a way we . Family members hold photos of Olga Reyes, a 22-year-old law student who died of an untreated ectopic pregnancy in Nicaragua in 2007. "'I'm just using this because this is not a viable pregnancy.'". 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 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. But in other situations, he said, providers may need to intervene to stop bleeding and make sure no pregnancy tissue remains, as a guard against infection. At the same time, she was searching for abortion clinics. Those can be acute life-threatening emergencies, she said. 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.. If the lawsuit is successful, plaintiffs can receive up to $10,000. . They don't want to get sucked into a legal morass. It is a horrible gamble that we are making Texas women go through.". tex. These cases are only going to grow until the law is either repealed or clarified. You can reach them at 212-255-9252. An attendee holds her child during A Texas Rally for Abortion Rights at Discovery Green in Houston, Texas, on May 7. The holidays are going to be especially hard. Coming back to Texas a few days later only amplified those feelings. She had cramps, and was passing clots of blood. Elizabeth and James Weller at their home in Houston two months after losing their baby girl due to a premature rupture of membranes. In September, the justices turned down an emergency request to block the law. In some cases, the infection can become severe or life-threatening, leading to sepsis, hysterectomy or even death. But when she called, they told her that nausea and vomiting weren't among the symptoms they were looking for. Pro-Life policies in Texas do not prevent doctors from treating an ectopic pregnancy. 1, eff. Her discharge was yellow and smelled weird. 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. For the women, expectant management after premature rupture of membranes comes with its own health risks. Now she wants those sentiments translated into action. Thankfully, I think theres still plenty of pharmacies that understand the proper utilization of some of the medications we use for nonelective [pregnancy] terminations.. She said Houston Methodist had convened an ethics panel of doctors, but her doctor didn't seem very optimistic. Texas' "trigger" law, which outlaws abortion "wholly or partly", is set to be in effect 30 days following . 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. Hall and her husband left the specialists office in a daze. How theyd told their families, picked out a name, built a crib and bought pink sheets. Hall was 18 weeks along when she went in for hers on a Friday afternoon. We do what we can to honor each of those cases.. ", 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. 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.. And she just recklessly and negligently goes out and gets abortions all willy-nilly, left and right," she says. Dr. John Thoppil, an obstetrician in Austin, doesnt perform abortions, providing prenatal care and delivering babies. After Hall made it through the protesters and the clinics security screening, the clinic itself was an oasis, she said. A doctor sat down and told her: "There's very little amniotic fluid left. Methotrexate or surgery are the only two options listed in the medical guidelines to prevent the fallopian tubes from rupturing and causing dangerous bleeding. The case spurred a movement that led to the overturning of Ireland's abortion ban in 2018. Sec. 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. Maybe they could get the abortion in Denver or Albuquerque. You dont get a lot of time to respond, and if you dont respond quickly enough, your patient expires.. For doctors treating such patients, the Texas law creates quite a conundrum, Dr. Snyder said. Halls entire vision of this pregnancy giving birth, becoming a mom, watching her daughter grow up evaporated in an instant. "We shouldn't have been celebrating," Elizabeth says. The ob-gyn, who said she could not speak to the media, laid out two options, according to Elizabeth. 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. Julia Robinson for NPR An oncologist urged the woman to start treatment immediately, but the chemotherapy regimen would have been toxic to the fetus. KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. We usually have our moms register for delivery at this point. But even from a young age, she had a lot of questions about what she saw as a deeply unforgiving idea. Elizabeth was in graduate school for political science, and James taught middle-school math. Or you wait till your baby's heartbeat stops.'". But the incentives are all very strong for those providers to err on the side of not providing care.. 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