“At Death’s Door” | Study Shows How Abortion Bans Endanger High-Risk Patients

A new study in the New England Journal of Medicine details the harsh realities of living with a high-risk pregnancy in the state of Texas, which passed a statewide abortion ban in September of last year. The law, known as SB 8, drastically limited access to reproductive care after the detection of embryonic cardiac activity, which usually occurs around six weeks after pregnancy. 

The law offers no exception for rape, incest, or severe fetal abnormality. The Texas law is considered the strictest abortion ban in the country, but now that Roe v. Wade has been overturned, legal experts say it could be a harbinger of what’s to come.

The study shows the law endangers the lives of high-risk pregnancy patients. Researchers noted that the law forces pregnant women experiencing severe complications to wait to have an abortion until the embryonic heartbeat can no longer be detected. Some patients needed to be “at death’s door” to receive pregnancy termination, the study found.

The paper highlighted one Texas woman with pregnancy complications. She was experiencing a rupture of membranes before fetal viability, which is when the water breaks too soon. She desperately needed to terminate the pregnancy for medical reasons, but SB 8 barred her healthcare provider from performing an abortion that could’ve potentially saved her life. Researchers noted that by continuing to carry the pregnancy, the woman risked infection, sepsis, excessive bleeding, and even death.

She then got on a plane to travel to another state where abortion is still legal even though her obstetrician warned her that she could go into labor during the flight and give birth to a stillborn 19-week-old fetus.

“If you labor on the plane, leave the placenta inside of you,” the doctor told her prior to the trip.

Medical experts warn that other states could pass abortion bans like the one in Texas, which would put more pregnant women at risk.

“What we have seen in Texas could very well be a preview of what we will see elsewhere,” said Dr. Whitney Arey, lead author of the paper and researcher with the Texas Policy Evaluation Project, a group that tracks the impact of state reproductive health policies. “These narrow exceptions in abortion bans create a climate of fear for providers, which will be really dangerous for some of the most vulnerable patients and put many lives at risk.”

The Department of Health and Human Services issued a statement on Monday that said abortion must be made available in medical emergencies, regardless of state restrictions.

But experts warn these competing messages can leave patients and providers confused. For example, the Texas law makes exceptions for “medical emergencies”, but they aren’t well defined. Hospitals and clinicians must decide how to navigate these laws, but many simply err on the side of caution, especially if providing an abortion could lead to jail time or prosecution.

“Even if the guidance is pretty clear, I think some doctors in these situations will still find it a really challenging decision to make,” said Mary Ziegler, a professor at the University of California, Davis who specializes in the legal history of reproductive health. “They may continue to be uncomfortable – especially considering some of the harsh penalties in state abortion laws, including life in prison.”

The study was conducted by abortion providers, researchers, and maternal-fetal medicine specialists. Overall, the group interviewed 25 clinicians and 20 patients with high-risk pregnancies.

One OB-GYN said they only saw one patient who was able to obtain an abortion at their hospital under the law’s exemption, after her severe cardiac condition had worsened to the point that she was admitted to the intensive care unit. In “multiple cases”, treating physicians sent patients home, only to see them return with signs of sepsis, the paper notes.

“Some doctors are no longer offering termination when there is risk of death for the pregnant patient,” said Dr. Lorie Harper, chief of maternal-fetal medicine at the University of Texas at Austin Dell Medical School. “They are waiting until heart failure, waiting until hemorrhaging, waiting until a patient needs to be intubated, or is [having organ failure]. Patients have to be a lot sicker before they receive life-saving care – and not every patient who becomes that critically ill will recover.”

The researchers fear these kinds of bans could lead to an increase in maternal mortality as more high-risk pregnant women are denied care. Texas already has one of the highest maternal death rates in the country, and black and latinx women are more likely to be affected than white women.

Some clinicians say they are hesitant to even give their patients information about abortions.

Another woman in the study said she was “shocked” after her doctor told her he couldn’t even tell her about options for terminating the pregnancy. She had just received a fetal diagnosis of spina bifida and chromosomal disorder and suddenly found herself completely on her own.

“When you already have received news like that and can barely function, the thought of then having to do your own investigating to determine where to get this medical care and to arrange going out of state feels additionally overwhelming,” she told the researchers.

“It is really frustrating to not be able to offer patients the full range of healthcare information and services,” Harper added. “I fear that this all could get much worse under these trigger laws. I really fear for patients’ lives.”