When a pregnant woman arrived in crisis at a small hospital in Texas last month, she was being counseled by a doctor who specializes in high risk pregnancies.
Without the protection of the amniotic sac, the fetus wouldn't be viable outside the womb, and the woman would be at risk of death from an infectious disease. In states where abortion is legal, there would be an option to end a pregnant woman's pregnancies.
Texas has an exception for when a woman's life is in danger. The patient's life was not in immediate danger at the moment. She was sent back to the hospital to be checked out for signs of labor or an illness.
The woman traveled hundreds of miles to New Mexico to get an abortion because she was worried.
She decided to take matters into her own hands. She said that her patient made a decision.
Each of the 13 states with bans on abortions allows for exemptions to save the life of the mother or to address a serious risk of impairment of a major bodily function.
Doctors in several states said that making that determination has become fraught with uncertainty and legal risk, with many saying that they have already been forced to significantly alter the care they provide to women with high-risk pregnancies.
The Texas attorney general sued the Biden administration over federal guidelines that required doctors to perform an abortion even in states with abortion bans.
Hospitals are struggling with where to draw the line. A panel of doctors and lawyers decide when a pregnant woman can be premature. Other people have required multiple doctors to sign off on the decision to have an abortion.
Doctors said the result has delayed treatment.
Dr. Alireza A. Shamshirsaz used to practice in Houston but left last month. It's a dangerous way to practice. Some of them will die, that's for sure.
The impact on women who want to have children is due to the fact that they have to deal with birth defects. In cases where there is a risk of harm to the mother, doctors offer the option to end the pregnancies.
The effect was most visible in Texas, which passed a law prohibiting most abortions after six weeks of pregnancy.
A new study of two hospitals in Dallas County found that pregnant women who were not allowed to end their pregnancies because of the Texas law ended up with serious health problems.
More than half of the women who met the criteria for the study experienced significant medical problems, including infections and hemorrhaging, in the face of state mandated limits on treatment. A woman needed a surgical procedure. The study found that the rate of maternal health problems was much higher in states where patients were offered the option of ending their pregnancies.
Dr. Judy Levison, who was not involved in the study, said that the study almost doubled the rate of maternal morbidity. One of the pregnancies ended with the death of the fetus. Why did the women have to go through that?
The Dallas Morning News reported that the Texas Medical Association sent a letter to state regulators asking them to step in after doctors complained that hospitals were preventing them from providing abortions when medically necessary.
There was an exception for medical emergencies that required immediate abortions to avoid death or injury when the abortion ban went into effect. Hospitals across the state are looking at the word "immediate" to see if it means an imminent danger of death or a threat to a woman's health.
In Texas, some hospitals have considered internal review panels to approve medically necessary abortions. Multiple doctors are required by others.
The law doesn't require two doctors, according to Dr. David Eisenberg. It's best to have more than one physician document the nature of the medical emergency and the need for abortion care.
Doctors said care can vary from town to town.
The uncertainty of the legal landscape has made statewide medical associations wary of giving direction on what treatments the "life of the mother" exceptions give.
The Missouri Hospital Association is not used to being on the sideline. The meaning of the exception will be decided by litigation.
Hospitals would need to make decisions based on their own pain thresholds. Knowing that lawsuits or prosecutions could come later is important for physicians. In Texas, doctors accused of violating abortion laws face fines and unlimited civil lawsuits; when the law goes into effect, it could lead to felony charges.
According to the Houston surgeon, no one wants to speak up because they can be fired.
He talked about a colleague who had patients with twins. She gave birth to one stillborn and asked to have the other aborted because of the risk of infections. The abortion was denied because the fetus had a heartbeat.
He stated that the patient was sent home against her will.
The woman came back to the hospital feeling unwell. She had to be admitted to the intensive care unit for life threatening conditions after her pregnancy was terminated.
He said that they needed to wait until the mom came with the symptoms.
The health and life of the mother are at risk. The researchers found that the risk of death is higher for pregnant women. As medicine advanced and as social mores changed around the acceptance of abortion, determining whether a woman's life is at risk has always been a gray area.
According to a University of Oklahoma historian, by 1900 every state had banned abortions throughout all stages of pregnancies, with the exception of when the life of the mother was at risk. The 1925 law in Texas has recently been revived thanks to the overturn of the abortion law.
During that time, the decisions about abortions were left to the doctor.
If you had access to a sympathetic family doctor, there was a degree of flexibility over what constituted a threat to the mother.
Elizabeth Nash is a state policy analyst at the Guttmacher Institute, which supports abortion rights. State legislatures have passed hundreds of abortion restrictions over the last decade, but they have rarely been challenged in court.
The new abortion restrictions have made it difficult for women and their doctors to navigate.
After the restrictive abortion law went into effect in Texas, a critical care nurse became pregnant. She had a happy occasion, but then her water broke. She was frightened and went to the emergency room. Her baby was going to die. She knew that her own condition was in danger. She was told that she couldn't do anything about the fetus.
She said that the doctors wouldn't help her until she was sick. I was completely shocked. I didn't know what to think. No one comes into an E.R. and we wait to find out how sick they are.
They went to Colorado for an abortion. She had a high temperature on the day of the procedure. She said she was getting sick that day.
In 15 percent of pregnancies, a procedure is needed to remove the fetus. In 5 to 8 percent of pregnancies, pre-eclampsia can occur and can be fatal. There is a 2 percent chance that a pregnant woman will have an ectopic baby, which means that the fertilized egg will be outside of the uterus and cause the baby to be dead.
No one is sure how serious those conditions must be before they can justify an abortion.
The chair of the Texas district of the American College of Obstetricians and Gynecologists said it was all chances. How high a percentage does it need to be before everyone agrees that this woman is in danger?
The Oklahoma abortion ban went into effect in May and Dr. Christina Bourne received a call from a patient who had an ectopic pregnancy.
There are two abortion clinics in Oklahoma City and one in Kansas where abortion is still legal. She said that the woman came in after consultation with the clinics lawyers. She was already suffering from abdominal pain and bleeding when she was taken to a hospital for treatment.
The people we are seeing are sicker than they used to be. The effects of a failed system are visible to us. The failed systems coalesce in pregnancy.
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