I'm actually headed home right now because I have to await my dead baby's delivery.' "I was just laying in bed, you know, wondering: Am I pregnant or am I not pregnant? But for patients facing a medical emergency, or low-income or uninsured Texans, seeking a second opinion may not be possible. An ectopic pregnancy is when a fertilized egg implants outside the uterus, typically in one of the woman's fallopian tubes. Hall had to travel to Washington state for an abortion after receiving a lethal fetal diagnosis, for which Texas abortion laws make no exception. You smell it yourself. . Some people experience loss of pregnancy at home and don't require additional care, other than emotional support, said Dr. Tony Ogburn, who chairs the OB-GYN department at the University of Texas-Rio Grande Valley School of Medicine. And she says 'Yes. 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. Abortion bans in Mississippi, North Dakota and Wyoming go into effect after the attorney . If I offer the patient the standard of care, I could be sued for aiding and abetting, he 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. Immediately, they sensed hesitation from the doctor. "He and I kept telling each other 'What is the whole point of the Hippocratic oath to do no harm?'" As Hall learned the hard way, the law makes no exception for lethal fetal anomalies. They had bought a house in Kingwood, a lakeside development in Houston. The only way to stop the heavy bleeding is to end the pregnancy and contract the uterus, Dr. Moayedi said. And how can I be so sure I'm not going to get too sick to the point where that's it now you can't have kids. Selective reductions are forbidden under the new state law. Anyone can bring that civil action, posing a quandary for physicians and other providers. Since September 1, 2021, Texas Senate Bill 8 (SB8) has prohibited abortions after the detection of embryonic cardiac activity, which occurs around 6 weeks after a person's last menstrual period . ), 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 . But now in Texas, the new laws are creating uncertainties that may deter some doctors and other providers from offering optimal miscarriage treatment. So I'm here to call you to register for your delivery on October 5th, so I can collect all your insurance information. Most recently, the Oklahoma Senate passed six abortion-limiting bills , including one that would ban abortions after 30 days from a woman's last . Outcomes from expectant management vary greatly depending on when the waters break. They were just all shocked, like, Surely, theres an exception for this, Hall said. Another area of Texas law that Seago cited provides an exception to the state's abortion restrictions if the mother's life is in danger or she's at "serious risk of substantial impairment of a major bodily function" unless an abortion is performed. 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. I couldn't give you life. James rushed home from work and drove Elizabeth to the nearby Woodlands Hospital, part of the Houston Methodist hospital system. The Wellers were pleasantly surprised when they got pregnant early in 2022. About 10% to 20% of confirmed . But he did not address the question of lethal fetal anomalies, which are fatal for the fetus during pregnancy or shortly after birth. ", Elizabeth thought of abortion rights in broad terms: "I have said throughout my life I believe that women should have the access to the right to an abortion. 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. Many Texans facing this same set of circumstances wont have the means to leave the state, Thoppil said, contributing to the states high rates of maternal morbidity and mortality, particularly among communities of color. "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. 8, which encourages private citizens to file lawsuits against anyone who facilitates an abortion, will proliferate, giving self-appointed vigilantes no shortage of . Sometimes theyre the primary caregiver. When the couple moved from Washington state to Texas in 2021, they were trying to . Whether an ectopic pregnancy is legal will depend on individual state laws. 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. 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. Now she wants those sentiments translated into action. "The pharmacy has said, 'We don't know whether or not you might be using this medication for the purposes of abortion,'" she said. But there was a vibe immediately. Hall shelled out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. 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. It was just too hard, as she navigated a complicated mix of relief and grief. Took no time at all.. It is the Cedar River Clinics in Renton, Washington, not the Cedar River Clinic in Seattle. John Seago, legislative director for Texas Right to Life, described this type of hesitation as "an awful misunderstanding of the law." Double your gift when you give by 6 p.m. Thursday. Its our 10th year participating in Amplify, and to celebrate, weve got $15,000 in matching funds from four generous Tribune supporters. ", The Wellers do want to try again, but first they need to get to a "mentally healthier place," Elizabeth says. But in cases of unviable pregnancies in which fetal cardiac activity can still be detected, treatment to remove the expected miscarriage could be considered illegal under Texas laws, Grossman said. I couldn't give you life. 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. Earlier this month, Gov. "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.". An ectopic pregnancy is 100% fatal if . Or in cases of rape or incest? forbids dispensing and shipping abortion-inducing medications, rheumatic illnesses, inflammatory bowel disease, psoriasis and cancer. We see patients from many different religions and cultures, and how they grieve is unique to each patient, Sanchez said. 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. In fact, no abortion law in any state in America prevents lifesaving treatment for women with ectopic pregnancies and other life-threatening conditions . Everyone was thrilled, buying them car seats and baby clothes. We want to keep you safe.. The color was darker and the odor was foul. At least several OB-GYNs in the Austin area received a letter from a pharmacy in late 2021 saying it would no longer fill the drug methotrexate in the case of ectopic pregnancy, citing the recent Texas laws, said Dr. Charlie Brown, an Austin-based obstetrician-gynecologist who provided a copy to KHN. And she just recklessly and negligently goes out and gets abortions all willy-nilly, left and right," she says. Everyone was so scared.. It is just possible that chemical abortions more than half of all U.S. abortions soon could be outlawed nationwide. There was an infection, and she did need treatment. The ob-gyn, who said she could not speak to the media, laid out two options, according to Elizabeth. Thankfully, I think theres still plenty of pharmacies that understand the proper utilization of some of the medications we use for nonelective [pregnancy] terminations.. "I said 'Well, is there a heartbeat still?' For doctors treating such patients, the Texas law creates quite a conundrum, Dr. Snyder said. Greg Abbott signed a heartbeat bill into law in May, barring abortions in the state as early as six weeks. No one really knows what the legislature means by that, and they are afraid of overstepping. Under Texas' Senate Bill 8, abortions are banned after six weeks of pregnancy, and the only exception is if a doctor determines a patient will face a "medical emergency" if the procedure isn't . 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. 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. Because once they reached Methodist, while they were still checking in at the emergency room, her doctor called. 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. Things did go fairly smooth at first. 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. 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. One persons emergency may not be another persons emergency, said Dr. Robert Carpenter Jr., an obstetrician in Houston. Anyone can read what you share. If an ectopic pregnancy has ruptured, the pregnant person needs care immediately because they could start bleeding and lose up to 2 liters up blood very quickly. Not doing so can, in some circumstances, kill all of the fetuses. This can occur as early as two weeks after a missed period, when most women do not yet know they are pregnant. State House Bill 2709, filed Thursday, would penalize individuals for the use of medication to cause abortion in the state of Texas, whether the pills were acquired at a local pharmacy or . The new law in Texas bans abortion at 6 weeks when a fetal "heartbeat" can be detected. "It's this woman who was saying 'Hi Miss Weller, you're at the 19 week mark. Sec. 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. Double your gift when you give by 6 p.m. Thursday. And not only can they not provide it, but they can't talk to you about it," Cavazos says. But the Wellers and 28 million other Texans had already been living under a de facto abortion ban for 8 months, since September 2021. Hall went on to become a nurse and, together with her husband, created a life in the same town where they both grew up. And I screamed because that's when I knew something wrong was happening. And I told her 'No, ma'am. 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. Today, abortion is also illegal in Texas under an old 1925 law that the state's Attorney General Ken Paxton declared to be in effect after Roe was overturned. Idaho, Tennessee and Texas will implement abortion bans in 30 days, according to the text of the laws. 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. A fertilized egg can't survive an ectopic pregnancy and can result in life-threatening bleeding, according to the Mayo Clinic. 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. An IUD can make menstruation irregular, and she did not realize she had conceived until after the six-week mark. And that's a big part of this problem, when we as physicians are trying to relieve patients' suffering. Under another new Texas abortion law, someone who "aids or abets" an abortion after cardiac activity can be detected typically around six weeks can be subject to at least a $10,000 fine per occurrence. After one conversation, the doctor returned to her bedside. And she goes 'I'm so sorry, I'm so sorry, I didn't know.'". She and her husband booked outrageously expensive last-minute flights, got a hotel and, four days after they got the news that upended their world, flew out of Dallas/Fort Worth International Airport. 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. These cases are only going to grow until the law is either repealed or clarified. 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. All you can do now is just hope and pray that things go well.". But the patient was past six weeks gestation, and under the new law, an abortion was not an option in Texas because the woman was not immediately facing a life-threatening medical crisis or risk of permanent disability. 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. 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. 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. It was May 10, 2022. Unnamed, unknown doctors somewhere had come to an agreement that Elizabeth could be induced that night. Find a complete list of them here. The crisis the Wellers endured is emblematic of the vast and perhaps unintended medical impacts of the criminalization of abortion in Republican-led states. Ectopic pregnancy develops in an estimated 2% of reported pregnancies. I'm so sorry,'" Elizabeth says. 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. That is a pregnancy that occurs outside the uterus. Since that time, thousands of women have left Texas to obtain abortions in other states. When they learned they were having a girl, Hall and her husband even picked out a name: Amelia. "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. 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. Recently passed laws make abortion illegal after about six weeks into a pregnancy. Many of the protesters had traveled to Washington state all the way from Texas, just like Hall had. Halls fetus was diagnosed with anencephaly, a neural tube defect in which the brain, skull and scalp do not develop properly in the womb. She would either have to get sick enough for . In Texas, a 2021 law made it easier to sue anyone who helps a person get an abortion after about six weeks of pregnancy. 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. 245.002. Elizabeth touches the urn of her daughter. Dr. Jennifer Liedtke, a family physician in Sweetwater, Texas, who delivers about 175 babies annually, no longer sends misoprostol prescriptions to the local Walmart. 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. To Elizabeth, it seemed obvious that things were deteriorating. You're trying to understand exactly what's going on. Because the alternative was hell.". Elizabeth was induced late Friday night, and the labor became painful enough that she had to get an epidural. 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. 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 . And theyve had to navigate complicated politics when sharing their news. Sept. 1, 1989. It is disingenuous to allege that this law prevents obstetricians from following the medical standard of care, she said. Just a few months before the Texas legislature passed the new law, Dr. Robert Gunby Jr., an obstetrician in Dallas, was caring for a pregnant newlywed who suddenly started losing weight. 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. pursuant to the preliminary injunction in texas v. becerra, no. Miscarriage It includes laws about. AUSTIN The Texas Medical Association wants regulators to step in after hospitals reportedly refused to treat patients with serious pregnancy complications for fear . After she got through the first trimester, Hall and her husband both heaved a sigh of relief and got to work telling their friends and family. ", State abortion laws are complicating other types of obstetric care. "This poor woman had no idea what she was telling me. I had not been put in the crossroads of this issue.". Once inside the car, they both burst into tears, for their baby and the terrible choices they were now left to navigate. Once she made her way through the clinics stringent security, the nurses took her into a private room. hide caption. "It is a pro-life position to allow physicians to make those life-and-death decisions," Seago said. Or, like Hall, they can shell out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. 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. "partial-birth" abortions, medical abortions, the stage of a pregnancy at which an abortion can be performed, and informed consent related to abortions. July 20, 20225 PM Central. Pro-Life policies in Texas do not prevent doctors from treating an ectopic pregnancy. Amplify your impact and donate now. When Roe v. Wade fell in June, Elizabeth's pain and anger surged up again. It was just the most tender moment, she said. In Texas' anti-abortion . 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