After Texas adopted the most restrictive abortion law in the nation, Dr. Palmer gave bad news to a Fort Worth patient.
There was a rare neural tube defect in the fetus. The brain wouldn't develop, and the baby would die shortly after birth. The doctor warned that carrying the pregnant woman to term would be emotionally exhausting and would raise the risk of blood clot and severe bleeding.
The new law in Texas did not allow an abortion because the patient was past six weeks and there was no risk of permanent disability.
Dr. Palmer said that she looked at her patients like a time bomb.
In this case, the woman had the means to travel, and she obtained an abortion in another state, an option not available to many low-income and working class women.
The new measure in Texas was supposed to impose strict limits on abortion. It is also affecting women who have no desire for abortion. Doctors are unable to discuss the procedure with patients until the patient's condition gets worse and her life is at risk.
Only when a woman is facing a life-threatening or disabling medical emergency can she have an abortion. The law does not allow for exceptions for pregnancies in which the fetus has no chance of survival.
Private citizens with no connection to the patient, doctor or health center are deputized to file lawsuits against anyone who performs an abortion once cardiac activity can be detected in the embryo. It can happen as early as two weeks after a missed period, when most women don't know they are pregnant.
If a person wins a lawsuit, they will get $10,000 and legal fees.
The Supreme Court is expected to rule soon on whether abortion providers and the Biden administration can challenge the law. The justices turned down the request to block the law.
Many physicians say they can't intervene in complex pregnancies that can spin out of control and pose no immediate threat to the patient. For fear that their advice could be seen as aiding an abortion, some patients hesitate to counsel them about the option of abortion.
The law's supporters say they want to save the life of every embryo.
Joe Pojman, executive director of the Texas Alliance for Life, said that they don't advocate taking a life of an unborn child unless it's necessary to protect a woman's life.
In cases of rape or incest, we don't advocate for taking the life of an unborn child for the crime of the father.
The law's supporters say that it provides enough wiggle room for physicians to act if a mother's life or bodily functions are compromised.
A girl as young as 9 or 10 can have a baby without health risks, according to Dr. Skop, who is an OB-GYN with the American Association of Pro-life Obstetricians and Gynecologists.
She can give birth to a baby if she is developed enough to be menstruating and pregnant.
The American Association of Pro-life Obstetricians and Gynecologists' Dr. Skop testified during a House Oversight Committee hearing.
Studies show that pregnant teenagers are more likely to develop a dangerous condition called pre-eclampsia, and they are also more likely to have small babies and stillbirths. Young rape victims are more likely to have small babies that score poorly on tests of heart rate and muscle tone after birth, and they are more likely to have them later in life.
The new law allows doctors to act when necessary and to justify their treatments in court if they are sued.
She said that it was disingenuous to say that the law prevented obstetricians from following the medical standard of care.
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, according to many physicians.
The chair of the board of trustees of the Texas Medical Association said that it was one of the most egregious invasions of the physician-patient relationship he had ever seen.
The law doesn't allow for an exception for pregnant women who learn that the fetus has chromosomal anomalies that will cause the baby to die soon after birth. The six-week limit for such testing is not always met, according to a genetic counselor in Dallas.
Ms. Uhles said that she has a code of ethics to uphold and that she talks to her patients about all their options. One of those options may be abortion.
She said that the hospital where she works pays her to have conversations with patients, but there is not necessarily any guarantee that they will back her up in a lawsuit.
The Texas law puts people like Uhles in a bind, she said.
The Texas law, which is also called Senate Bill 8, allows for an exception for abortion in a medical emergency if the woman is in danger of death.
There is professional judgement involved in making these determinations, and some physicians in Texas fear they will be second-guessed in a courtroom. Dr. Robert Carpenter Jr. said that one person's emergency may not be another person's emergency.
ectopic pregnancies that implant outside the uterus are not considered abortions under state law. Some health conditions can jeopardize a woman's health in the long term, but not be an immediate threat to her life.
Dr. John Thoppil doesn't perform abortions, but he does deliver babies. The new Texas law has affected his ability to practice.
The new law went into effect in September, and one patient who used an interrogating device for birth control became pregnant, according to Dr. John Thoppil, president of the Texas Association of Obstetricians and Gynecologists.
She didn't realize she was pregnant until after the six-week mark. The device was impossible to remove because of the pregnancy.
His patient faces a pregnant woman with a lot of medical problems. The new law made it impossible for Dr. Thoppil to counsel her on abortion.
He said that talking about options would be considered aiding and abetting someone getting an abortion.
Some people who support the law say that it doesn't prohibit a doctor from referring a woman to an abortion provider outside of Texas. Travel can be expensive for pregnant women if they are unwell, and the language is ambiguous.
Pregnancies can be difficult due to a number of medical conditions. Women with certain congenital heart conditions are advised by the American College of Cardiology and the American Heart Association not to get pregnant.
Women should be given the option of abortion if they become pregnant. The Texas law makes it difficult for doctors to treat such patients.
He said that he could be sued if he gave the patient the standard of care. I could be sued if I don't give my patient the standard of care.
In rare cases, an infection can cause the amniotic sac to break before the fetus is viable. The law may prevent physicians from taking action even if the baby is dead.
Doctors prefer to offer an abortion because the woman's condition can quickly get worse. Dr. Carpenter said he has seen cases where a woman went from normal to shock in less than an hour. If you don't respond quickly enough, your patient will die.
The death of a pregnant woman in Poland has led to protests over the country's abortion laws. Her doctors did not start treating her until the fetus stopped breathing because they were afraid of violating the abortion ban.
The new law leaves unclear whether a physician can act when a woman has a stillbirth and is bleeding heavily, but the fetus has not passed.
A more common scenario raises difficult questions, said Dr. Ghazaleh Moayedi, an gynecologist in Texas. She said that sometimes a woman has a miscarriage and is bleeding heavily, but the fetus has not passed and can still be detected.
The only way to stop the heavy bleeding is to end the pregnancy, according to Dr. Moayedi. Time is the most important thing. She said that every OB-GYN cared for someone who died from a hemorrhage. How long do I have to wait if someone is bleeding?
If the mother's life is saved, she could need an emergency hysterectomy, which would leave her infertile, according to Dr. Moayedi.
When a woman is carrying twins or multiples, abortion of one of the fetus can be done to make the other live. Not doing so can cause the death of all of the fetuses. There is a new state law that forbids reductions that are not voluntary.
In some cases, a pregnant woman's medical needs may conflict with her fetus.
The Texas legislature passed a new law just a few months before Dr. Robert Gunby was caring for a pregnant woman who was losing weight. She was diagnosed with a cancer of the immune system.
The oncologist wanted the woman to start treatment immediately, but it would have been harmful to the fetus.
Dr. Gunby said that she first said that she wanted the baby so badly. It was the only choice they had to save the young woman. As soon as an abortion was performed, the treatment began.
Dr. Palmer said that one of her patients was trying to get pregnant after the new law went into effect, and she had sex with her partner.
She went out to celebrate a friend's birthday and was raped on her way home. She found out she was pregnant after taking a pregnancy test. She didn't know who the father was.
The earliest time that a genetic test could be done would be at seven weeks, according to Dr. Palmer. She knew she wouldn't be able to travel out of state for an abortion later on.
Dr. Palmer was unsure if counseling the patient about her options, including an abortion outside Texas, would have been considered aiding and abetting.
She said that the law is murky, but that it is the bottom line. I am going to tell my patients what they need to know.