Abortion Laws in Texas are Disrupting Maternal Care : Short Wave New abortion bans have made some doctors hesitant to provide care for pregnancy complications. That's led to life-threatening delays, and trapped families in a limbo of grief and helplessness.

Today, senior health editor Carrie Feibel shares the story of one woman in Texas, whose pregnancy became a medical crisis because of the state's abortion laws.

Read Carrie's full reporting: https://n.pr/3zpDXK0

Abortion Laws in Texas are Disrupting Maternal Care

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EMILY KWONG, HOST:

You're listening to SHORT WAVE from NPR. The repeal of Roe v. Wade does far more than ban or restrict abortions in many states in this country. It's having serious consequences on pregnancy care. And to talk about that with me today, I'm joined by Carrie Feibel, senior health editor on the science desk. Hey, Carrie.

CARRIE FEIBEL, BYLINE: Hi, Emily.

KWONG: So these abortion bans that have gone into effect in some states are so new and often so ill-defined that doctors and hospitals don't really know how they apply in moments when a pregnancy goes wrong.

FEIBEL: That's right. And in some states like Texas, this kind of impact has been going on since even before Roe was overturned because of abortion restrictions they already had. I was a health reporter in Texas for seven years before I came to NPR. And there's always been this problem - this entanglement of the abortion laws that are written by politicians and the lived realities of pregnant couples who need medical care.

KWONG: And the couple that you profiled for this story, Elizabeth and James Weller - they had their pregnancy seriously impacted by these laws. Why did you want to tell their story?

FEIBEL: Well, I really wanted to hear from a pregnant person who was going through this from beginning to end. You know, what was it like? What were the physical effects? But also, what are the emotional and the psychological effects of having a law sort of collide with your medical care?

KWONG: Today on the show, the story of a woman in Texas whose pregnancy took a sudden turn. And because of the state's abortion laws, her case became a medical crisis. You're listening to SHORT WAVE, the daily science podcast from NPR.

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KWONG: All right. Carrie, tell us about Elizabeth and James Weller, the couple you profile in this story. Where do they live?

FEIBEL: Yes. So the Wellers live in Houston. This was their first pregnancy. And about 17 weeks into it, they found out they were having a girl. And they also had an anatomy scan, and that showed that everything looked great.

ELIZABETH WELLER: There was nothing wrong with her - no development issues wrong.

FEIBEL: A week after that scan, Elizabeth went for a walk after breakfast. It was May 10, weeks before the Supreme Court would overturn Roe v. Wade. But in Texas, things had already changed. Most abortions after six weeks were banned. Elizabeth didn't think that could affect her. They were going for it. They were setting up the nursery. But when Elizabeth got back from her morning walk, she felt something shift inside.

WELLER: This burst of water just falls out of my body. And I screamed because that's when I knew something wrong was happening.

FEIBEL: James rushed home, and they drove to the ER at Houston Methodist Hospital in The Woodlands.

WELLER: (Crying) And I asked the technician - I was like, is she OK? She goes, well, it's kind of hard to tell 'cause there's very little amniotic fluid. At the time, I had no idea what that meant.

FEIBEL: It was premature rupture of membranes. Her waters had broken too soon. It happens in about 3% of pregnancies. If it's later in pregnancy, sometimes doctors can delay delivery, give the fetus more time to develop. But sometimes the baby is born far too early and dies or is born with serious disabilities. Elizabeth was admitted to the hospital, and later that night, her OB-GYN called to talk it through. She was 18, almost 19 weeks pregnant. There was still a fetal heartbeat, but it could stop at any moment. The watery cushion of amniotic fluid had disappeared. That also meant the lungs in the fetus would stop developing. Her doctor said one option was to try to stay pregnant, although this could be very risky and would likely not work.

WELLER: And she says, let's say if you get to the week of viability, which is around 24 weeks, I can't promise you that she will continue to live past that point. And because there's no amniotic fluid left, she's no longer going to be a developed baby.

FEIBEL: Elizabeth's doctor wouldn't do an interview for this story, but Dr. Alan Peaceman, a maternal fetal specialist at Northwestern University's Feinberg School of Medicine, says the chance of a fetus surviving in that state from 18 until 24 weeks is virtually zero.

ALAN PEACEMAN: It's almost inevitable that the pregnancy is going to be lost anyway. And many women would say, why do I have to continue to carry a pregnancy that is doomed? And that's a huge psychological burden.

FEIBEL: Prolonging the pregnancy also meant Elizabeth could develop a serious or even life-threatening infection in her uterus. So her other option was to end the pregnancy. Elizabeth was distraught and heartbroken. She could never have imagined making that decision. But now she felt continuing the pregnancy was wrong. It felt scary and also cruel.

WELLER: You have to ask yourself, would I put any living thing through the pain and the horrors of having to try to fight for their life the minute that they're born?

FEIBEL: James was in total agreement. But the next morning they learned it wasn't their decision to make. The Texas law was making it hard for her OB to arrange the procedure.

WELLER: I remember hearing her from my room speaking loudly about how nothing is being done here.

FEIBEL: Her doctor came back to her bedside. Elizabeth says she looked defeated.

WELLER: And she starts to cry, and she tells me, they're not going to touch you and that you can either stay here and wait to get sick where we can monitor you, or we discharge you and you monitor yourself, or you wait till your baby's heartbeat stops.

FEIBEL: The Texas abortion law meant they couldn't end the pregnancy as long as there was a fetal heartbeat. There was one exception - for a medical emergency. But wasn't this a medical emergency? Elizabeth was told, no, not yet. She had to wait for more signs of a growing infection in her uterus. Dr. Peaceman in Illinois says the hospital in Houston was dealing with a state law that doesn't define what qualifies as a medical emergency.

PEACEMAN: It's terrible, but the care providers are treading on eggshells. They don't want to get sucked into this, into a legal morass.

FEIBEL: 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.

WELLER: At first, I was really enraged at the hospital and administration.

FEIBEL: To Elizabeth, it already felt like a medical emergency. She had cramps. She was passing blood. But she was told those weren't the right symptoms. She needed a fever of 100.4 and chills. Her discharge had to be darker, and it had to smell bad. Then they could proceed and end the pregnancy.

WELLER: To them, my life was not in danger enough.

FEIBEL: Elizabeth says she realized later the hospital was just as trapped as she was.

WELLER: 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.

FEIBEL: Under Texas law, doctors can be sued by almost anyone for performing an illegal abortion. Elizabeth was discharged, but she was barely out the door when her phone rang.

WELLER: But as I'm leaving Methodist, I get a call from Methodist. And it's this woman who was saying, hi, Miss Weller. You're at the 19-week mark, so I'm here to call you to register for your delivery on October 5 so I can collect all your insurance information. How are you doing, and are you excited for the delivery? And I just cried and screamed in the parking lot. This poor woman had no idea what she was telling me (crying). And I told her, no, ma'am, I'm actually headed home right now because I have to await my dead baby's delivery. And she goes, I'm so sorry. I'm so sorry. I didn't know.

FEIBEL: Elizabeth went home to wait for one of two things to happen, both awful - for the fetal heartbeat to stop or to get sick enough to become a medical emergency. The next day, Thursday, she started throwing up, but when she called, they said vomiting wasn't one of the symptoms they were looking for. On Friday, she called back and begged to get in. Maybe the fetal heartbeat had finally stopped. They went to the office. The heartbeat was still there. Her OB had been calling other hospitals, but none of them would help. Right there in the office, James started looking for flights to states with less restrictive abortion laws.

WELLER: And he and I kept telling each other, what is the whole point of the Hippocratic Oath? To do no harm. And yet we are being pulled through this.

FEIBEL: They went back home. They started booking tickets. And then suddenly Elizabeth felt another gush of fluid leave her body. The color and odor were much worse. They called the doctor again. Now they were told to go to the ER and hurry. These symptoms showed the infection was getting worse. Elizabeth and James rushed back to Methodist. They were still checking into the ER when her OB called again. The ethics panel had reached a decision.

WELLER: They found a doctor from East Texas who spoke up and was so patient-forward, so patient-advocating that he said, this is ridiculous. Everybody there agreed and decided that what was happening was unethical, and they decided to induce you tonight.

FEIBEL: Elizabeth and James stood up and threw their arms around each other. They said, thank you, out loud over and over.

WELLER: We shouldn't have been celebrating, and yet we were because the alternative was hell.

FEIBEL: It was Friday night. They induced labor, and it was so painful that she needed an epidural. After midnight on Saturday, May 14, she gave birth. Their daughter was stillborn, as expected.

WELLER: They laid down this beautiful baby girl in my arms (crying). And she was so tiny, and she rested on my chest. I cried, and I told her, I'm so sorry I couldn't give you life. I'm so sorry.

FEIBEL: Elaine Cavazos is a perinatal psychotherapist in Austin. She says there's already so much silence and stigma around pregnancy loss. All too often, patients are told to get over it, move on, try again. Now, many patients will also be coping with a new kind of medical trauma.

ELAINE CAVAZOS: It's just really unimaginable to be in a position of having to think, how close to death am I before somebody is going to take action and help me?

FEIBEL: This frightening lack of control can make the grief over losing a pregnancy much, much worse.

CAVAZOS: She has had the very worst thing happen to her, and that will color any subsequent pregnancy. It will be hard.

FEIBEL: But Elizabeth Weller isn't ready. Watching Roe get overturned enraged her, and she fears not just another complication but getting trapped by the law again.

WELLER: This is the one situation in my entire life where I have felt absolutely hopeless and that I was drowning and no one was willing to save me. The state of Texas put me through that mental anguish because I couldn't get the help that I needed.

FEIBEL: As abortion rights topple in state after state, a terrible question remains. Even the strictest bans have an exception for the woman's life, but right now, almost no one knows exactly how close to the edge her life needs to be.

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KWONG: Carrie, I barely have words listening to what Elizabeth and her husband went through. How common is Elizabeth's experience? Do we even know?

FEIBEL: Well, I mean, this particular complication, premature rupture of membranes, we know that happens in about 3% of pregnancies. But the broader experience of not being able to proceed with their medical care and having a delay, I mean, we don't really know how often this is happening in places like Texas. And we don't know how common something like this could become as more states outlaw abortion. But there was one study that's tried to get at the actual impact of the Texas law. They studied two hospitals in Dallas, and they had 28 patients there who had similar situations to Elizabeth's, meaning very dangerous complications early in their pregnancies, but there was a delay in care because of the law. And in those cases, all but one lost the fetus or the baby died soon after being born. And for the patients themselves, almost half of them got an infection or had a hemorrhage. And, you know, doctors do know a lot about how to handle these problems, but what's really changed now is geography.

KWONG: I mean, that's one of the biggest realities of life post Roe v. Wade - is that what you can expect out of your pregnancy care really depends on the state you live in.

FEIBEL: Right. And not only that, I mean, how are the doctors interpreting the law in your state? How cautious are they being?

KWONG: And what's difficult, I imagine, is simply not knowing how it will play out if you're preparing to have a baby. I mean, I just can't imagine having to wait around and see when the hospital will think I'm sick enough to get medical help at any turn in my pregnancy, you know?

FEIBEL: Yeah. And that is, you know, the big reason why I wanted to tell Elizabeth's story. It's really significant. I mean, physically, she's OK, but it was really, really hard, as you heard. And we do talk more these days about things like postpartum depression, but people can get depressed or anxious during pregnancy, too, and that's often linked to changing hormone levels. So if you do have a miscarriage or lose the pregnancy, like Elizabeth did, I mean, hormones change then, too. And now there's this growing fear that if you add a medical trauma of having a delay because of an abortion law, on top of that, then that can raise the risk of depression, anxiety, even PTSD or even suicide.

KWONG: It's really hard to talk about, but given how common it is, it's kind of shocking we don't talk about it more. What do you make of the fact that stories like this are starting to emerge in light of these law changes?

FEIBEL: Yeah. I mean, we sort of have this belief in society that most pregnancies are fine, and if you get past the eight or 10 weeks, then, you know, babies will be healthy. And it's true that in the majority of pregnancies, things are OK. But, you know, there's so many pregnancies, and even if just a small percentage of them end up having complications, that's still a high number. And if your pregnancy was not OK, you know, often people can be really quick to say, well, you can always try again. You know, there's a happy ending in your future. And that can make people think I should stay quiet about this, about losing a pregnancy. So, you know, there's always been this silence and stigma around these stories, and now the fear is that these state laws could make pregnancy loss even more of a taboo subject.

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KWONG: Carrie, thank you so much for bringing this conversation to all of us. It's been really great to talk to you.

FEIBEL: You're welcome. Thanks for having me.

KWONG: This episode was produced by Rachel Carlson. It was edited by Rebecca Ramirez and also fact-checked by Rachel Carlson. I'm Emily Kwong. Thank you for listening to SHORT WAVE, the daily science podcast from NPR.

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