Would-be parents postpone pregnancies over abortion ban issues

After enduring two nonviable pregnancies, Sarah Fischer had learned how to read an ultrasound technician’s face, and she knew she was about to receive yet another devastating diagnosis.

Nearly every year for the last four years, Fischer, 40, and her husband have lost a pregnancy.


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In 2019, her fetus developed outside her uterus. In 2020, a fetal heartbeat that had once given her hope faded, and she eventually needed a surgical procedure to remove the fetus. And at the start of this year, a simple look from her technician told her all she needed to know.

The Hill Country couple desperately want a child, but the vague wording of the emergency exception in the state’s abortion ban that’s causing some doctors to delay care for miscarriages has her so worried that they’ve postponed trying again.

A new study found that pregnant patients at two Dallas hospitals
faced almost double the risk of serious health complications
after the state’s abortion restrictions took effect and caused doctors to hold off on care until their lives were in immediate danger.

“I am literally frozen in fear about it,” Fischer said. “For the foreseeable future, we are not in a place where it feels smart — or safe — to try to get pregnant.”


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The state’s near-total abortion ban, which was triggered into law after the Supreme Court this summer removed federal protections on the procedure, contains an exception — not for rape, incest or fetal abnormalities — but for medical emergencies that threaten to take the mother’s life or to impair a “major bodily function.” On paper, the law also allows doctors to remove a fetus during a miscarriage or an ectopic pregnancy.

But multiple news reports and studies have shown that doctors are struggling to decide when a situation can be legally justified as

an emergency.

That’s because many complications may begin with no immediate risk to the mother but could quickly take a turn for the worst. The state’s ban makes it a felony to provide an abortion, punishable by up to life in prison, and carries civil penalties of at least $100,000 per illegal abortion.

About 8 percent of all pregnancies involve complications that, if left untreated, may harm the mother or the baby,
according to Johns Hopkins Medicine
.

Anti-abortion groups have defended the laws as written, saying they provide enough information to guide emergency decisions in the delivery room.

“If it’s a true health emergency that warrants a medical emergency exception, I believe any physician would be able to clearly ascertain what would fall under that exception,” Amy O’Donnell, spokeswoman for the Texas Alliance for Life,
told Hearst Newspapers this spring
.

Meanwhile, the Texas Medical Association has asked the state’s medical board to step in and clarify the law to “prevent any wrongful intrusion into the practice of medicine,”
according to a report by the Dallas Morning News
.

Last month,
Baylor College of Medicine released a position paper
saying Texas’ abortion laws need further clarity for the same reason.


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Dr. Patrick Ramsey, professor and chief of maternal-fetal medicine at UT Health San Antonio, said he has heard from many patients, especially those older than 35 who are statistically at higher risk of complications or who have had miscarriages, who worry that it may not be safe

for them to get pregnant in Texas anymore.

Ramsey said Texas’ law “muzzles” doctors in terms of what they can say to patients about abortion, even when it’s the appropriate medical intervention according to their training. For that reason, he’s had to come up with workarounds in discussing options, such as letting patients know that doctors in other states may have a “second opinion.”

“I tell them ‘If you choose to go that route, we’re here to support you, and we’ll get second opinions or other opinions if needed to help you through it,’” Ramsey said. “I think you have to justify that their concerns are valid, and it is a reality today.”

Among known pregnancies, up to 1 in 4 will end in a miscarriage, according to the National Library of Medicine. Studies show that fewer than 5 percent of patients will experience two consecutive miscarriages and that only 1 percent experience three or more.

While that may seem low, Ramsey said it’s important to remember that Texas has about 400,000 births annually, accounting for 10 percent of all births in the United States. It’s early and the data is still coming in, but he said he predicts that without a change in the law or some other new guidance, pregnant Texans’ health will suffer.

“We will probably see some potential harm to women over the next several months to years,” he said, “from either lack of access to critical medical care to prevent complications or to women going to nonmedical facilities to receive treatment or going out of state behind the scenes and coming back with complications.”

All of this weighs heavy on Fischer and her husband, who have family, friends and a ranch full of animals in Texas that depend on them, making a move to another state unfeasible.

“People don’t realize how much this impacts women and people like me who are trying to have a family,” Fischer said. “We’d love to have a baby. We’d make amazing parents. … My concern is, I get pregnant again and have another problem like any of the ones I had before, and no one is willing to touch me because of the law.”

‘Off the table now’

Fischer said that since

her last miscarriage, she hasn’t been able to muster the strength to make a follow-up appointment to discuss future pregnancies with her doctor.

The last miscarriage left the deepest physical and emotional scars, she said. Her doctors had told her to wait for a natural miscarriage at home, and she spent an agonizing five days waiting, fretting and searching for discarded tissue every time she went to the bathroom.

“I just laid around the house sobbing, wondering if I needed to go to the hospital after all,” Fischer said.

Eventually, she was prescribed two rounds of medication to terminate the pregnancy.

It’s scary enough to get pregnant again, knowing she could have to go through that all over again. But on top of that, now she says she has to worry about whether doctors this time will be able to help her as swiftly as before.

“I don’t know if I can mentally do it,” Fischer said. “We’re at a point where we might not get to be parents. And you know, we’ve talked about adoption, things like that, but … it’s just really sad.”

“There are so many layers of emotional pain involved with losing a pregnancy,” she added. “To have people, primarily men, that have never met me, will never meet me, decide that it’s going to be that much harder for me or even put my life at risk, I don’t know if I have a word for it.”

While she laments that a medical issue has become political, she said she hopes her story and others like it galvanize Texans to vote against politicians who support the state’s abortion ban.

Elizabeth Markowitz, 28, a communications associate who lives in a suburb of Dallas, finds herself in the same situation, having had three miscarriages. She and her husband and their 1-year-old son moved to Texas from Alaska a few months ago, and the move has completely upended their family planning.

“We weren’t positive about how soon we were going to have a second child. We were probably thinking in the next five years,” Markowitz said. “I would say it’s definitely off the table now for as long as we’re in Texas.”

Markowitz already had some reservations about a future pregnancy in Texas after the Supreme Court decision this summer. But as more reporting has come out showing the scenarios that can ensue when doctors or medical groups fear legal liability more than a poor health outcome for their patient, she felt confident it was the right decision.

“I don’t think it’s paranoia; I don’t think it’s hysteria,” she said. “I think the proof is already there — and I suspect that it’s just going to continue to grow — that women just aren’t going to be able to get the same high-quality care, now that doctors are working under the fear of prosecution.”

The memory of her last and most difficult miscarriage — twins she lost at about 11 weeks pregnant — is one that has stuck with her as she made the decision. She had planned to have surgery for their removal, but she ended up naturally miscarrying at home a day before the operation.

“It was probably the most traumatic night of my life,” she said. “It was basically like mini-labor, just pushing them out of your body. I remember lying on my bathroom floor and screaming so loud, I was worried the neighbors were going to hear.”

“It was absolutely the most pain I have ever been through,” she added. “Hands down the most painful experience of my life, physically and mentally.”

She recalls being given pre-authorization paperwork for her scheduled-but-missed operation to remove her nonviable twins and feeling surprised that it used the word “abortion.”

“I think we need to be talking about a very broad coalition of women and girls who need abortions,” she said. “All kinds of people need abortion. … Even in a perfect world, you’re married, you want a baby, you still need abortion to be on the table because you just never know.”