Texas is 2012 Galway

The New England Journal of Medicine tells us that Texas is hell-bent on letting women die if their pregnancies go wrong. Two, three, many Savita Halappanavars.

Health systems and clinicians planning their responses3 can look to Texas, where we have already witnessed the impact of strict abortion bans on the provision of evidence-based, essential health care for pregnant people. Since September 1, 2021, Texas Senate Bill 8 (SB8) has prohibited abortions after the detection of embryonic cardiac activity, which occurs around 6 weeks after a person’s last menstrual period. After that point, SB8 allows abortions only in physician-documented medical emergencies. Anyone suspected of violating the law or aiding and abetting a prohibited abortion can face a civil lawsuit with monetary penalties of at least $10,000.

(Even here, where clarity is so urgent, even the NEJM censors the word “women,” as if this vicious, murderous policy were an injustice to everyone as opposed to very specifically women.)

We interviewed 25 clinicians from across Texas about how SB8 has affected their practice in general obstetrics and gynecology, maternal and fetal medicine (MFM), or genetic counseling. We concurrently interviewed 20 Texans who had medically complex pregnancies and sought care either in Texas or out of state after September 1, 2021. Although aimed at clinicians who provide abortion care, SB8 has had a chilling effect on a broad range of health care professionals, adversely affecting patient care and endangering people’s lives.

Clinicians we interviewed recounted a variety of circumstances in which a patient could have received hospital-based abortion care before SB8 but was now denied that care. Patients with a life-limiting fetal diagnosis, such as anencephaly or bilateral renal agenesis, are only being counseled to continue their pregnancy and offered neonatal comfort care options after delivery. All hospitals where our respondents practiced have prohibited multifetal reduction, even though in some cases (e.g., complications of monochorionic twins) failure to perform the procedure could result in the loss of both twins.

Patients with pregnancy complications or preexisting medical conditions that may be exacerbated by pregnancy are being forced to delay an abortion until their conditions become life-threatening and qualify as medical emergencies, or until fetal cardiac activity is no longer detectable. An MFM specialist reported that their hospital no longer offers treatment for ectopic pregnancies implanted in cesarean scars, despite strong recommendations from the Society for Maternal–Fetal Medicine that these life-threatening pregnancies be definitively managed with surgical or medical treatment.

That’s just plain terrifying. Ectopic pregnancies can explode and cause the woman to bleed to death before the medics can stop the bleed.

Some clinicians believe that patients with rupture of membranes before fetal viability are eligible for a medical exemption under SB8, while others believe these patients cannot receive an abortion so long as there is fetal cardiac activity. In multiple cases, the treating clinicians — believing, on the basis of their own or their hospital’s interpretation of the law, that they could not provide early intervention — sent patients home, only to see them return with signs of sepsis.

Like Savita Halappanavar.

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