A new, untested abortion ban has left doctors unsure how to treat some pregnancy complications, leading to life-threatening delays and pushing families to the brink of grief and helplessness.
Elizabeth Weller never dreamed that her hopes for a child would be caught in the web of Texas abortion law.
She and her husband will start trying in late 2021. They bought a house in Kingwood, a lakeside development in Houston. Elizabeth was a graduate student in political science, and James was teaching math in middle school.
The Wellers were pleasantly surprised when she became pregnant in early 2022.
In retrospect, Elizabeth says, their initial joy felt a little naive: “If we conceived so easily, it was almost like a sign to us that this pregnancy was coming to us It’s easy to say.”
At first things really went well. After 17 weeks of pregnancy, they learned they were carrying a girl. Elizabeth also had an autopsy scan and found no problems. Even so, Wellers is determined to keep going.
“We skipped genetic testing offered in the first trimester,” Elizabeth said. “I was born with a physical disability. If she had any physical ailment, I would never have an abortion because of that.”
Elizabeth considered abortion rights broadly: “I’ve said it all my life , I believe women should have the right to have an abortion. The right to abortion. I personally will never get one.”
At this special moment in her life, pregnant for the first time at the age of 26, it Still somewhat abstract: “I’m not put in a position where I have to weigh the real nuances of getting into this situation. I’m not put at the crossroads of this issue.”
But in early May , the Wellers suddenly came to that crossroads shortly after the bland anatomical scan. There, they found themselves clinically and emotionally victims of a conflict between standard obstetric practice and the stringent new requirements of Texas law.
That was May 10, 2022. Elizabeth is 18 weeks pregnant. She ate a healthy breakfast, went for a walk, and came home.
In the nursery upstairs, they hid some baby clothes and new cans of paint. In the kitchen, images of recent scans and ultrasounds are affixed to the refrigerator.
Elizabeth stood up for lunch. That’s when she felt something “moving” in her womb, dropped low, and “the water just came out of my body. I screamed because then I knew it happened. What’s the matter.”
Her water has broken, throwing her into what she calls a “dystopian nightmare” of “physical, emotional and spiritual pain.” She blamed the ensuing medical trauma on Republican lawmakers who passed the state’s anti-abortion law; Texas Gov. Greg Abbott signed the deal; on inflammatory political rhetoric, Elizabeth said viewing abortion as ” One thing, a black and white issue, when abortion has all these gray areas.”
State abortion laws complicate other types of obstetric care
Elizabeth’s pregnancy crisis began and ended weeks before June 24, when the U.S. Supreme Court struck down the federal Dobbs v. Jackson Women’s Abortion in Health Organization ruling.
But Wellers and 28 million other Texans have been living under a de facto abortion ban for eight months since September 2021. By then, a new state law will ban all abortions after detection of fetal or fetal heart activity, usually around six weeks into a pregnancy. Since then, thousands of women have left Texas for abortions in other states.
Today, abortion is also illegal in Texas under a 1925 law announced by the state’s Attorney General Ken Paxton. Roe v. Wade effect after being overturned. Another ban, the so-called “trigger law” passed in Texas in 2021, is expected to go into effect within weeks.
The crisis Wellers is experiencing is emblematic of the huge and possibly unintended medical impact of criminalizing abortion in Republican-led states. The new abortion ban—or the old law revived in the postRoe world—is strictly written and untested in court. Many do not provide immunity for rape, incest, or fetal abnormalities.
But the most puzzling development concerns the existence of exemptions for the life or health of women or because of “medical emergencies”. These terms are ambiguous or undefined.
The results caused confusion and confusion for doctors and hospitals in multiple states, risk delays and complications for patients facing obstetric conditions such as ectopic pregnancy, incomplete miscarriage, placental problems and premature rupture of membranes .
“It’s horrible,” said Dr. Alan Piseman, professor of maternal-fetal medicine at Northwestern University Feinberg School of Medicine. “Care providers are stepping on eggshells. They don’t want to get bogged down in the law. So they don’t even know what the rules are.”
‘I need you to tell me the truth’
James rushed home from get off work and drove Elizabeth to the nearby Woodlands Hospital, part of the Houston Methodist hospital system. An ultrasound confirmed she had premature rupture of membranes, which affects about 3% of pregnancies.
A doctor sat down and told her: “There is very little amniotic fluid. This is not a good thing. All you can do now is hope and pray that everything is going well.”
Elizabeth recalls that staff remained ambiguous about what happened next. She was taken to hospital, and when her obstetrician called later that night, she pleaded for information.
“I told her, ‘Look, doctor, people around me are telling me to stay hopeful. They tell me to think about the positives. But I need you to tell me the truth, because I Don’t think all the positive things they tell me are true. I need you to give me the facts.'”
Facts are grim. At 18 weeks, the watery protective pad of amniotic fluid disappeared. The heartbeat is still there, but may stop at any time. Both the fetus and Elizabeth are now very vulnerable to a uterine infection called chorioamnionitis, among other risks.
Elizabeth said she was unable to suggest two OB-GYNs who spoke to reporters for this article. choose.
One is termination of pregnancy; this is called “termination for medical reasons”. Another option, called “anticipatory management,” would see Elizabeth stay in the hospital and try to maintain the pregnancy until 24 weeks, which is considered the start of viability for the fetus outside the womb.
Expected management results vary by water break time. Later in pregnancy, doctors can try to delay delivery to give the fetus more time to develop while avoiding infections or other maternal complications, such as bleeding.
But when the membranes rupture early in pregnancy, especially after the first few weeks of age 24, the chances of a fetus surviving drop dramatically. One reason is that amniotic fluid plays a key role in fetal lung development. According to Peaceman, for an 18-week-old fetus, the chances of surviving in that state are virtually non-existent: “It’s probably as close to zero as you get in a drug.”
A fetus that survives a premature birth may die shortly after birth. If they survive, they could suffer major problems with their lungs or stroke, blindness, cerebral palsy or other disabilities and illnesses.
For women, expectant management after premature rupture of membranes comes with its own health risks. One study showed that compared with women who terminated their pregnancy, they were 4 times more likely to develop an infection and 2.4 times more likely to have postpartum hemorrhage.
In some cases, the infection can become serious or life-threatening, leading to sepsis, hysterectomy, and even death. In 2012, a woman in Ireland died after her water broke at 17 weeks, and doctors refused to give her an abortion. The case sparked a movement that led to Ireland overturning its abortion ban in 2018.
A clinical battle begins behind the scenes
Although distraught at the news, Elizabeth forced Think for yourself.
After she and James talked, they agreed to terminate the pregnancy. Elizabeth’s health risks are simply too high.
For Elizabeth, termination of the pregnancy was also the most merciful option for her fetus. Even if the chances of surviving to 24 weeks are slim, the newborn will face severe physical challenges and aggressive medical intervention.
“You have to ask yourself, am I going to make any living creature go through pain? Scary to have to fight for their lives the moment they are born?”
The next day, Elizabeth’s obstetrics department went to the hospital to arrange an operation. She immediately hit a roadblock because of Texas law. A fight began, and Elizabeth realized it for the first time as her doctor paced the hall outside her room, calling her.
Done here. “
After one conversation, the doctor went back to her bedside.
“I could tell she was beaten because she’d been working hard all day for me Fight and defend me,” Elizabeth said. “She started crying and she told me: ‘They’re not going to touch you. ‘ “You can stay here and wait to get sick and we can monitor you, or we can discharge you and you monitor yourself. Or you wait until your baby’s heart stops.”
This is because of state law It is stipulated that termination of pregnancy is prohibited as long as there is fetal heart activity. The law that is still in effect does contain an exception – “medical emergencies”. But the statute does not define the term. No one really knows what the legislature means, and doctors are afraid to cross the line.
Waiting for fetal death or her own illness
For Elizabeth, things are clearly getting worse. She had cramps and was bleeding. Her discharge was yellow and smelled strange. But hospital staff told her that these were not the correct symptoms yet. Signs of a serious infection in her uterus included a fever of 100.4 degrees and chills. Her discharge must be deeper. And it has to smell bad, really bad. Enough to make her gag.
Houston Methodist declined to comment on the details of Elizabeth’s care, other than to say it complied with all state laws and that medical ethics committees sometimes review complex cases.
For Northwestern’s Peaceman, it sounds like hospital clinicians are using the most common clinical symptoms of chorioamnionitis as a guide. If Elizabeth showed enough of these, he said, they could record an invasive infection to terminate the pregnancy under the law’s “medical emergency” provision.
Elizabeth thought this was crazy.
“At first, I was very angry with the hospital and the administration,” she said. “My life wasn’t dangerous enough for them.”
The conundrum became painfully and painfully clear: Wait until the condition worsens, or until the fetal heart stops. Either way, all she saw was fear and sadness—prolonged, delayed, amplified.
“Having to have such a pregnancy with such a low chance of survival is torture,” Peaceman said. “Most women will find this very difficult and emotionally very challenging. That’s a big part of the problem when we as physicians try to ease the pain of our patients. Texas doesn’t allow them to.”
Later, Elizabeth said, she realized that her anger against the Methodists was wrong. “The Methodist Hospital refused to serve me not because they didn’t want to, but because the Texas law . Under state law, almost anyone can sue a doctor for an abortion.
The pain of waiting at home
Elizabeth chose to go home instead of waiting in the hospital to get sick.
But as soon as she went out, still in the parking lot, the phone rang. It was someone else from the Methodist Church, maybe a clerk, calling to check some paperwork.
“It was the woman who said, ‘Hey Miss Weller, you’re 19 weeks old. We usually have our moms register the labor at this point. So I’m here to call you Call to register your October 5th delivery so I can gather all your insurance information. How are you, are you excited about giving birth?'”
Elizabeth knew it was just a Terrible coincidence, a terrifying bureaucratic oversight, but it made her understand how powerless and alone she was, in the midst of a vast healthcare system of rules, laws, and income.
“I was just crying and screaming in the parking lot,” she recalls. “This poor woman had no idea what she was telling me. I told her, ‘No, ma’am. I’m actually going home now because I have to wait for the delivery of my dead baby. Then she said, ‘I’m sorry, I’m sorry, I didn’t know.'”
For Elizabeth, that tragic conversation was just “the beginning of hell” to continue over the next week.
The next day, a Thursday, she started vomiting.But when she called, they told her nausea and vomiting Not the symptom they were looking for.
When she woke up on Friday, she was still bleeding and discharge, still feeling nauseous and feeling strange things in her womb. She felt lost and bewildered. “I’m just lying in bed, you know, wondering: Am I pregnant, or not? That’s the stupid distinction you make in grief. You’re trying to understand exactly what’s going on. Because at this point, I In survival mode. I’m trying to understand. I’m trying to survive mentally.”
How the law causes medical trauma
Elizabeth’s experience It amounts to a medical trauma, says Elaine Cavazos, a psychotherapist specializing in the perinatal period and chief clinical officer of reproductive psychiatry and counseling in Austin, Texas, This trauma is superimposed on the grief of miscarriage.
“Having to think: How far am I from dying before someone takes action to help me?”
Miscarriage is a special loss that tends to Make other people — even health professionals — uncomfortable. Many times, patients are told to get over it, move on, and try again, Cavazos said. These dismissals only add to the sense of isolation, stigma, and shame.
Now Texas abortion laws have created additional constraints, Cavazos said.
In the event of a sudden obstetric emergency, termination may be the clinically least risky option. But now, says Cavazos, “your medical provider says it’s illegal and they can’t provide it — not only can they not provide it, but they can’t talk to you about it.”
“You might even Be afraid to reach out and ask for support – even mental health support,” she added. “Because the state has made it clear that if you talk about this, you can easily be prosecuted.”
An invisible panel weighs the case
As Friday dragged on, Elizabeth began to wonder if her heart had stopped. She called her doctor and begged to go in. At the office, her obstetrician turned down the volume of the ultrasound so they wouldn’t have to hear it.
“I said, ‘Well, is there? Is the heartbeat still there? She said, ‘Yes. And it’s strong.'”
“Heard The news is simply devastating,” Elizabeth said. “Not because I want my kids to die, but because I need this hell to end. And I know my kids are suffering, I know I’m suffering, I know my husband is suffering.”
Her doctor said she had been calling other hospitals but none of them helped. She said the Houston Methodist Church convened a physician ethics group, but her doctors didn’t seem optimistic.