ABACA. And I told her 'No, ma'am. SB 8, which was signed into law by Texas Gov. 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? James rushed home from work and drove Elizabeth to the nearby Woodlands Hospital, part of the Houston Methodist hospital system. The other miscarriage treatment is a procedure described as surgical uterine evacuation to remove the pregnancy tissue the same approach as for an abortion. She was so tiny. They had bought a house in Kingwood, a lakeside development in Houston. Many physicians disagree, pointing out that the law can disrupt care for pregnant women who have underlying health problems that are not immediately life-threatening, such as pulmonary hypertension or certain types of cancer. Under Texas law, doctors can be sued by almost anyone for performing an abortion. And quickly. At that point, the patient can opt to wait until the bleeding starts and the pregnancy tissue is naturally released, Briggs said. Correction, Oct. 24, 2022 at 4:12 p.m.: It just didnt occur to them that a ban would include cases like this.. Find a complete list of them here. Texas law reflects this important distinction. Because once they reached Methodist, while they were still checking in at the emergency room, her doctor called. Even if the mothers life is saved, Dr. Moayedi added, she could require an emergency hysterectomy, or removal of the uterus, which would leave her infertile. 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. It was like an evidence bag. But the statutes dont account for complicated miscarriages, and confusion has led some providers to delay or deny care for patients in Texas. 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. But the new Texas law has profoundly affected his ability to practice. After holding it together all morning, Hall burst into tears. The bill . An ectopic pregnancy, which occurs when a fertilized egg . Disclosure: Texas Medical Association and University of Texas at Austin have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. 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. And she goes 'I'm so sorry, I'm so sorry, I didn't know.'". Depending on the medical circumstances, one of those options may be abortion. The patient ended up driving 15 hours to New Mexico for life-saving treatment after no one in Texas would help her. "He and I kept telling each other 'What is the whole point of the Hippocratic oath to do no harm?'" 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. Financial supporters play no role in the Tribune's journalism. You open it. A clinical battle begins behind the scenes. She had the proof. 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. But the hospital staff told her that those weren't the right symptoms, yet, of a growing infection in her uterus. I was so excited for this appointment because its so good to see her in there, she 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 . Most recently, the Oklahoma Senate passed six abortion-limiting bills , including one that would ban abortions after 30 days from a woman's last . Sometimes theyre the primary caregiver. Crescenda Uhles, a genetic counselor in Dallas, said the Texas law puts people like her in a bind when advising patients. She places the blame for the ensuing medical trauma on the Republican legislators who passed the state's anti-abortion law, on Texas Gov. Now she wants those sentiments translated into action. I couldn't give you life. (Texas Hospital Licensing Law); (3) an institution required to be licensed under . Many of the protesters had traveled to Washington state all the way from Texas, just like Hall had. The risks to Elizabeth's health were simply too high. Elizabeth and James look at clothes that were meant for their baby, whom they lost in the second trimester of pregnancy. He said the association has been in communication with some pharmacy leaders to help clarify proper interpretation of the rules.. A doctor she had never met entered the room. Her doctor said she had been calling other hospitals, but none of them would help. I'm so sorry,'" Elizabeth says. 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. They also had an anatomy scan, which revealed no problems. In the meantime, Grossman said the delay and denial of care will likely become more common. It is just possible that chemical abortions more than half of all U.S. abortions soon could be outlawed nationwide. 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. She knew the doctors at the practice were both proud members of the American Association of Pro-Life Obstetricians and Gynecologists, but she waved it off. 678, Sec. 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. Although distraught and heartbroken at this news, Elizabeth forced herself to think it through. But as has been true in Texas and in many of the 12 other states where abortion is banned . 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. 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. 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 . If you do something to prevent that, you might be in fact performing an illegal abortion.. 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 midway through her pregnancy. 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 . ", Her waters had broken, launching her into what she calls a "dystopian nightmare" of "physical, emotional and mental anguish." To the extent anybody is delaying or denying care for ectopic pregnancy, they are simply misunderstanding the law, Grossman said. "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. 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. Houston Methodist Hospital declined to comment on the specifics of Elizabeth's care, except to say they follow all state laws and that there's a medical ethics committee that sometimes reviews complex cases. Despite the tragedy she was facing, Hall knew she was one of the lucky ones. At 18 weeks, the watery, protective cushion of amniotic fluid was gone. I'm trying to understand. For some, that's too difficult, given the emotions surrounding the pregnancy loss, she said. Texas new measure was intended to impose stringent limits on abortion. The American College of Obstetricians and Gynecologists has information on early pregnancy loss, finding an OB-GYN and having better conversations with your doctor. Some hesitate to counsel patients about the option of termination, or refer them to doctors in other states, for fear their advice could be interpreted as aiding an abortion. It was just the most tender moment, she said. It was someone else at Methodist Hospital, perhaps a clerk, calling to go over some paperwork. It is the Cedar River Clinics in Renton, Washington, not the Cedar River Clinic in Seattle. But the most confusing development involves the exemptions that exist for the woman's life or health, or because of a "medical emergency." 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. ", As states ban abortion, the Texas bounty law offers a way to survive legal challenges, Texas conservatives have a plan to get around DAs who won't enforce abortion laws. 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. Halls fetus was diagnosed with anencephaly, a neural tube defect in which the brain, skull and scalp do not develop properly in the womb. Treatments for miscarriages and ectopic pregnancies are still legal under Texas abortion ban. Not doing so can, in some circumstances, kill all of the fetuses. Its our 10th year participating in Amplify, and to celebrate, weve got $15,000 in matching funds from four generous Tribune supporters. Miscarriage 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. And surprisingly, both of their families sent money to help pay for the trip, despite their anti-abortion sentiments. She would either have to get sick enough for . Financial supporters play no role in the Tribune's journalism. Her husband took over, asking the doctor what, if anything, they could do. It went into effect on Sept. 1. 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. An ectopic pregnancy is when a fertilized egg implants outside the uterus, typically in one of the woman's fallopian tubes. But in early May, not long after the uneventful anatomy scan, the Wellers suddenly arrived at that crossroads. We never advocate taking a life of an unborn child unless it is necessary to protect the life of a woman, said Joe Pojman, executive director of the Texas Alliance for 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. Confusion around the laws has caused issues for patients outside of emergencies. "partial-birth" abortions, medical abortions, the stage of a pregnancy at which an abortion can be performed, and informed consent related to abortions. "Because I didn't want anybody to tell me they did not believe me," she says. Elizabeth says. Eventually, she laid out their options: Keep carrying the pregnancy or leave Texas to get an abortion. Quite the opposite, many state laws explicitly exempt treatment of ectopic pregnancy from their definitions of abortion. 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. Such testing is done late in pregnancy, beyond the six-week limit, noted Crescenda Uhles, a genetic counselor in Dallas. 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. Many of these lethal fetal abnormalities come to light at an anatomy scan performed later in pregnancy. 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. The Supreme Court is expected to rule soon on whether abortion providers and the Biden administration may challenge the law notwithstanding its novel structure. Among other risks, both the fetus and Elizabeth were now highly vulnerable to a uterine infection called chorioamnionitis. Her mental health spiraled to the point that she considered checking herself into the hospital. Researchers with the Texas Policy Evaluation Project at the University of Texas at Austin documented several cases in which doctors waited to treat pregnancy complications until a patients health had deteriorated to the point that their life was in danger. 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. AUSTIN The Texas Medical Association wants regulators to step in after hospitals reportedly refused to treat patients with serious pregnancy complications for fear . Things did go fairly smooth at first. 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. "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.". Sept. 1, 1989. "'I'm just using this because this is not a viable pregnancy.'". The one exception is a medical emergency, but the law requires doctors to document the reasons for the exception with great specificity. 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. Its our 10th year participating in Amplify, and to celebrate, weve got $15,000 in matching funds from four generous Tribune supporters. A doctor sat down and told her: "There's very little amniotic fluid left. Treatment of ectopic pregnancy is not prohibited by Texas' abortion laws. 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. And that's a big part of this problem, when we as physicians are trying to relieve patients' suffering. The emotional toll was what worried Hall most of all. 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. 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. 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. But interpretation of the laws is still causing challenges to care. We usually have our moms register for delivery at this point. The patient lost liters of blood and had to be put on a breathing machine because of the 24-hour delay in care. One of the most painful parts was trying to reach her medical team. 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. Elizabeth was in graduate school for political science, and James taught middle-school math. 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. It was because of the state law which forbids termination of a pregnancy as long as there is fetal cardiac activity. 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. But the womans condition can quickly deteriorate, which is why physicians often prefer to offer an abortion. Julia Robinson for NPR 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. James and Elizabeth cried out their thanks to the doctor. 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. No problems, on Texas Gov they were still checking in at the emergency,... 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