fa rupture of fetal viability membranes – a condition in which water breaks too early – a pregnant patient in Texas urgently needed an abortion. She risked infection, sepsis, excessive bleeding and even death.
But her healthcare provider’s hands were tied by Senate Bill 8, a near-complete ban in effect since September 2021, preventing her from accessing that potentially life-saving care in her home state. Despite the risk associated with air travel, she boarded a plane to get the proceedings out of state. Her midwife warned that she could give birth in flight and give birth to a 19-week stillborn fetus. “If you’re having contractions on the plane, leave the placenta inside you,” the doctor warned.
Even before Roe v Wade was quashed last month, paving the way for a pre-Roe ban to take effect in Texas, another state abortion ban dramatically limited care after the detection of embryonic heart activity, usually around six weeks of gestation. .
Despite an exception for medical emergencies, the law put the lives of high-risk pregnant patients at risk, according to Texas researchers documenting its effects in a recent New England Journal of Medicine study. Some patients had to be “on the brink of death” to be legally terminated, the paper found, underlining how abortion bans have dangerous consequences for complicated pregnancies.
The law, SB 8, provides no exception for rape, incest or serious fetal abnormalities and has banned in-state care for the vast majority of abortion patients in Texas. Months after it was enacted, it was widely regarded as the strictest abortion ban in the US. With nearly half of US states having banned or about to ban abortion, Texas offers a disturbing harbinger of things to come.
“What we’ve seen in Texas could very well be a preview of what we’ll see elsewhere,” Dr. Whitney Arey, lead author of the paper and researcher with the Texas Policy Evaluation Project, a group that monitors the impact of state reproductive health policies. , told the Guardian. “These minor exceptions in abortion bans create a climate of fear for healthcare providers, which will be really dangerous for some of the most vulnerable patients and endanger many lives.”
In an effort to address the issue, the Department of Health and Human Services (HHS) issued guidelines Monday making it clear that emergency abortion should be available regardless of state restrictions.
But experts emphasize that the rule will only be symbolic without strong government enforcement and public awareness. The Texas law’s exception for “medical emergencies” isn’t well-defined, often leaving hospitals and clinicians on the cautious side, and it’s unclear whether the HHS rule will change that. The law allows anyone to sue a healthcare provider or anyone who “aids or encourages” illegal abortion for at least $10,000 in damages, which has a “chilling effect” on healthcare professionals.
“Even if the guidance is pretty clear, I think some physicians in these situations will still find it a very challenging decision,” said Mary Ziegler, a professor at the University of California, Davis who specializes in the legal history of reproductive health. † “They may continue to feel uncomfortable — especially given the harsh penalties in the state’s abortion laws, including life in prison.”
‘They wait until heart failure’
In Texas, patients with medically complex pregnancies or pre-existing medical conditions are being forced to delay abortion care until their situation becomes life-threatening or until fetal heart activity is no longer detectable, according to the study, which was conducted by abortion providers, researchers and maternal-fetal medicine. specialists, who interviewed 25 clinicians and 20 patients with high-risk pregnancies.
An obstetrician only recalled a single patient who was able to have an abortion at their hospital under the law’s exemption after her serious heart condition worsened to the point that she was admitted to intensive care. In “several cases,” treating physicians sent patients home, only to see them return only with signs of sepsis, the paper notes.
“Some physicians no longer offer termination if there is a risk of death for the pregnant patient,” said Dr. Lorie Harper, chief of maternal-fetal medicine at the University of Texas at Austin Dell Medical School. “They wait for heart failure, wait for bleeding, wait for a patient to be intubated, or [having organ failure]† Patients have to be a lot sicker before they get life-saving care – and not every patient who gets that seriously ill will recover.”
The researchers are concerned about an increase in maternal deaths as a result of denial of care to pregnant women. Texas already has a maternal death rate that is higher than the US average, with black women being disproportionately affected. Overall, the US has the highest maternal mortality rate of comparable developed countries and is the only industrialized country where such deaths are on the rise.
Fearing lawsuits and possible loss of medical license, some Texas clinicians believe they are not even allowed to inform patients about abortion in cases of increased maternal risks or poor fetal health, provide information about abortion clinics out of state or transfer patient records to those clinics.
The study tells the story of a 39-year-old woman who, after being given a fetal diagnosis of spina bifida and a chromosomal disorder, was “appalled” that her doctor wouldn’t even inform her about termination options. “If you’ve already received such news and can barely function, the thought of having to do your own research to determine where to get this medical care and arrange for getting out of the state feels extra overwhelming,” she said. them.
In an amicus brief to the Supreme Court, two dozen health organizations, including the American Medical Association and the American College of Obstetricians and Gynecologists, emphasize that abortion bans, with limited exceptions, force clinicians to make an “impossible choice” between living up to their ethical standards. obligations and following the law. “By forcing doctors to wait until a patient is close enough to death to risk their drug license in order to save her life by providing necessary abortion care, the state is indefensibly harming health. of patients at risk,” they write.
A pre-Roe 1925 abortion ban is now in effect in Texas after it was ratified by the state’s Supreme Court. It bans all abortions with rare exceptions for the life of the mother. Abortion providers are challenging that century-old ban in court, but they are also opposing a “trigger” law that will go into effect sometime this summer, which would have a similar impact.
Texas researchers hope their work is a cautionary tale for other states navigating the post-Roei landscape.
“It’s really frustrating not being able to provide patients with the full range of medical information and services,” Harper says. “I fear this could all get a lot worse under these trigger laws. I really fear for the lives of patients.”