Texas laws say treatments for miscarriages, ectopic pregnancies remain legal but leave lots of space for confusion

Treatments for miscarriages and ectopic pregnancies are still legal under the state’s abortion ban, according to state law and legal experts. But the statutes don’t account for complicated miscarriages, and confusion has led some providers to delay or deny care for patients in Texas.

Texas laws banning abortions make narrow exceptions only to save the life of a pregnant patient or prevent “substantial impairment of major bodily function.” And lawmakers in recent years have clarified state statutes to say treatments for miscarriages, known as “spontaneous abortions” in medicine, and ectopic pregnancies, in which a fertilized egg grows outside of the uterus and becomes unviable, do not count as abortions.

Texas laws say treatments for miscarriages, ectopic pregnancies remain legal but leave lots of space for confusion

Texas laws say treatments for miscarriages, ectopic pregnancies remain legal but leave lots of space for confusion” was first published by The Texas Tribune, a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.

Sign up for The Brief, our daily newsletter that keeps readers up to speed on the most essential Texas news.

Treatments for miscarriages and ectopic pregnancies are still legal under the state’s abortion ban, according to state law and legal experts. But the statutes don’t account for complicated miscarriages, and confusion has led some providers to delay or deny care for patients in Texas.

Texas laws banning abortions make narrow exceptions only to save the life of a pregnant patient or prevent “substantial impairment of major bodily function.” And lawmakers in recent years have clarified state statutes to say treatments for miscarriages, known as “spontaneous abortions” in medicine, and ectopic pregnancies, in which a fertilized egg grows outside of the uterus and becomes unviable, do not count as abortions.

But the lack of clarity accompanying the threat of jail time and six-figure fines for medical professionals has led some hospitals and doctors in the state to deny or delay care for pregnancy complications, according to multiple reports. Doctors and experts also worry that patients with pregnancy complications may be too afraid of being accused of inducing an abortion to seek care.

Delays in care — particularly for first-trimester conditions such as bleeding, hemorrhaging, septic miscarriages and ectopic pregnancies — can become lethal, said Dr. Natalie Crawford, an OB/GYN and cofounder of a fertility clinic.

“Those can be acute life-threatening emergencies,” she said.

That’s why Crawford said it’s important for patients to quickly seek medical care if they notice their pregnancy isn’t progressing normally or they are bleeding.

“If you’re having severe pain, if you’re getting a fever, you need to keep your medical team in the loop,” Crawford said. “We want to keep you safe.”

In cases in which a medical provider may be hesitant to conduct a needed treatment, it’ll be critical for patients to stay informed, seek help or get more than one medical opinion, said Joanna Grossman, a professor at Southern Methodist University’s Dedman School of Law.

“More than ever, I think people, patients really need to be extremely well-informed and really aggressive about advocating for their own health because the system right now is basically designed to fail,” she said.

But for patients facing a medical emergency, or low-income or uninsured Texans, seeking a second opinion may not be possible.

The American College of Obstetricians and Gynecologists has information on early pregnancy loss, finding an OB-GYN and having better conversations with your doctor.

Texas’ abortion laws penalize the person who performs an abortion and, under a state law from 1925, anyone who “furnishes the means” for an abortion. But the National Advocates for Pregnant Women provide free legal assistance to women who have been charged with a crime because of a pregnancy loss like a miscarriage. You can reach them at 212-255-9252.

Delays in care

Last week, the Texas Medical Association warned that several hospitals in the state have turned away or waited to treat patients with pregnancy complications — including a physician in Central Texas who was allegedly instructed by a hospital to not treat an ectopic pregnancy until a rupture occurred. Such a rupture can be life-threatening.

“To the extent anybody is delaying or denying care for ectopic pregnancy, they are simply misunderstanding the law,” Grossman said.

But things can be murkier when it comes to treating miscarriages, she said.

A miscarriage is generally defined as the loss of a fetus before the 20th week of pregnancy typically because of complications outside of a patient’s control. About 10% to 20% of confirmed pregnancies end in miscarriages, but estimates are as high as 30% to 50% for all pregnancies, including those in which a person may not know of the pregnancy.

There is no treatment to stop a miscarriage once it has started, and miscarriages can become life-threatening to the pregnant patient if complications are untreated.

But in cases of unviable pregnancies in which fetal cardiac activity can still be detected, treatment to remove the expected miscarriage could be considered illegal under Texas’ laws, Grossman said.

“What you’re really worried about is that period of time when what’s going to be a miscarriage, if you let it take a natural course, might cause severe suffering, and/or death to the mother, to the pregnant person,” she said. “If you do something to prevent that, you might be in fact performing an illegal abortion.”

That’s what recently caused Dr. Jessian Munoz, an OB-GYN in San Antonio, to wait a day to treat a patient who had started to miscarry and developed a womb infection, according to the Associated Press.

“We physically watched her get sicker and sicker and sicker,” he told the AP. The patient lost liters of blood and had to be put on a breathing machine because of the 24-hour delay in care.

Another patient in Dallas was denied a surgical procedure for a miscarriage, according to The New York Times, and a Texas woman told CNN she had to carry her dead fetus for two weeks until she could find an OB-GYN willing to remove it. A recent study also reported 28 women with dangerous pregnancies at two Texas hospitals faced delays for care because fetal cardiac activity was detected, according to the AP.

Given the state’s severe penalties, Grossman said medical professionals and their legal teams might err on the side of caution in regard to the law, even if it puts patients at risk.

“The way the system is going to work is that the patients are going to always pay the price,” Grossman said. “Because the providers have a choice whether to provide and the patients are the ones who need the care. But the incentives are all very strong for those providers to err on the side of not providing care.”

There have been no criminal charges against providers since the U.S. Supreme Court’s decision in late June to overturn the constitutional right to abortion access that was protected by Roe v. Wade, but anti-abortion groups and state lawmakers have threatened to ramp up the pressure against abortion providers and their allies.

The Biden administration last week told hospitals they must treat pregnant patients who need an abortion to stabilize a life-threatening condition. Texas Attorney General Ken Paxton quickly sued the Biden administration over the federal guidance.

Federal law typically trumps state laws, but it will now be up to courts to decide whether that will be the case in this instance.

In the meantime, Grossman said the delay and denial of care will likely become more common.

Denials at the pharmacy

Confusion around the laws has caused issues for patients outside of emergencies. Crawford, the OB/GYN and fertility clinic co-founder, said she’s seen instances of pharmacies not wanting to fill prescriptions for certain medications that are related to abortions but being used for other treatments.

This represents more confusion around state policy. While another law enacted last year forbids dispensing and shipping abortion-inducing medications like misoprostol, mifepristone and methotrexate past seven weeks of a pregnancy, it makes exceptions for when the drugs are used for “other medical reasons.”

Misoprostol is used to help prevent stomach ulcers, but it can induce abortions, particularly if taken along with mifepristone. For patients who are not pregnant, it can also open up the cervix and make surgeries safer, Crawford said.

Methotrexate, another abortion-inducing medication, is used to treat ectopic pregnancies as well as rheumatic illnesses, inflammatory bowel disease, psoriasis and cancer.

Dr. John Thoppil, president of the Texas Association of Obstetricians and Gynecologists, said doctors usually note a diagnosis when prescribing medicines, and prescription rejections don’t appear to be widespread. He said the association has been in communication with some pharmacy leaders to “help clarify proper interpretation of the rules.”

If patients run into trouble filling prescriptions, Thoppil and Crawford say they should try to find another pharmacy or talk to their health care provider.

“We haven’t seen a large issue, but there are certainly anecdotes,” Thoppil said. “Thankfully, I think there’s still plenty of pharmacies that understand the proper utilization of some of the medications we use for nonelective [pregnancy] terminations.”

Disclosure: Southern Methodist University, Texas Medical Association and New York Times have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.


When you join us at The Texas Tribune Festival Sept. 22-24 in downtown Austin, you’ll hear from changemakers who are driving innovation, lawmakers who are taking charge with new policies, industry leaders who are pushing Texas forward and so many others. See the growing speaker list and buy tickets.

This article originally appeared in The Texas Tribune at https://www.texastribune.org/2022/07/20/texas-abortion-law-miscarriages-ectopic-pregnancies/.

The Texas Tribune is a member-supported, nonpartisan newsroom informing and engaging Texans on state politics and policy. Learn more at texastribune.org.

We're ad free

That means that we rely on support from readers like you. Help us keep reporting on the most important New Mexico Stories by donating today.

Related

Emily’s List endorses seven candidates for Legislature

Emily’s List endorses seven candidates for Legislature

Emily’s List, a nonprofit that supports women candidates and reproductive rights, endorsed seven incumbents facing general election opponents in New Mexico legislative elections. All…
Equality New Mexico endorses 15 legislative candidates

Equality New Mexico endorses 15 legislative candidates

A New Mexico-based LGBTQ rights organization endorsed 15 candidates for state House and Senate seats for the 2024 elections.  Marshall Martinez, executive director of…
Lujan Grisham pocket vetoes two bills

Lujan Grisham pocket vetoes two bills

Gov. Michelle Lujan Grisham pocket vetoed two bills the legislature passed this legislative session: one changing the Cybersecurity Act and the other concerning law…
BLM announces final methane waste rule

BLM announces final methane waste rule

The federal Bureau of Land Management announced its final methane waste rule on Wednesday. These new regulations clamp down on the practice of venting…
What consumers, farmers should know about the flu impacting dairy cows

What consumers, farmers should know about the flu impacting dairy cows

Migrating birds appear to have caused a virus in dairy cattle that is causing reduced milk production. So far, the disease, which initially started…
Republicans seek to limit national monument designations

Republicans seek to limit national monument designations

Republican-backed legislation in the U.S. Congress would make it harder for the government to designate new national monuments. The proposed Congressional Oversight of the…
Amid new graduation requirements, what do high schoolers want to learn?

Amid new graduation requirements, what do high schoolers want to learn?

By Margaret O’Hara, The Santa Fe New Mexican The main things that bring Brayan Chavez to school every day: Seeing, talking to and engaging with…
Special ed teachers hope lawmakers OK pay raises, admin changes

Special ed teachers hope lawmakers OK pay raises, admin changes

By Margaret O’Hara, The Santa Fe New Mexican Brittany Behenna Griffith has a laundry list of adjectives to describe the ideal special education teacher:…
Lawmakers must find consensus on competing education spending plans

Lawmakers must find consensus on competing education spending plans

By Margaret O’Hara, The Santa Fe New Mexican A challenging task awaits New Mexico lawmakers in the next 30 days: Reconciling three very different…
Health workers fear it’s profits before protection as CDC revisits airborne transmission

Health workers fear it’s profits before protection as CDC revisits airborne transmission

Amy Maxmen, KFF Health News Four years after hospitals in New York City overflowed with covid-19 patients, emergency physician Sonya Stokes remains shaken by…
Lujan Grisham, Biden admin announce $10 million in federal funds for tribes, pueblos

Lujan Grisham, Biden admin announce $10 million in federal funds for tribes, pueblos

Gov. Michelle Lujan Grisham announced Friday $10 million in funding from the federal American Rescue Plan Act was awarded to six tribal nations and…
Proposal to curb executive powers moves to House Judiciary

Proposal to curb executive powers moves to House Judiciary

The House Government, Elections and Indian Affairs Committee discussed a potential constitutional amendment that seeks to limit the governor’s executive powers. The committee approved…
Senators introduce legislation to aid abortion providers

Senators introduce legislation to aid abortion providers

Sen. Martin Heinrih and other Senate colleagues introduced abortion rights legislation into the U.S. Senate on Thursday. The Abortion Care Capacity Enhancement and Support…
U.S. Supreme Court hears case to restrict access to medication abortion

U.S. Supreme Court hears case to restrict access to medication abortion

The U.S. Supreme Court heard the case about the regulations around mifepristone, one of a two-step regime for abortion medication, on Tuesday. FDA v.…
At stake in mifepristone case: Abortion, FDA’s authority, and return to 1873 obscenity law

At stake in mifepristone case: Abortion, FDA’s authority, and return to 1873 obscenity law

Lawyers from the conservative Christian group that won the case to overturn Roe v. Wade are returning to the U.S. Supreme Court on Tuesday in pursuit…
Senators introduce legislation to aid abortion providers

Senators introduce legislation to aid abortion providers

Sen. Martin Heinrih and other Senate colleagues introduced abortion rights legislation into the U.S. Senate on Thursday. The Abortion Care Capacity Enhancement and Support…
New Mexico Medicaid to cover cost of over-the-counter oral contraception

New Mexico Medicaid to cover cost of over-the-counter oral contraception

New Mexico Medicaid announced on Wednesday that it will cover the cost of Opill, the first oral contraception approved for over-the-counter use. It is…
U.S. Supreme Court hears case to restrict access to medication abortion

U.S. Supreme Court hears case to restrict access to medication abortion

The U.S. Supreme Court heard the case about the regulations around mifepristone, one of a two-step regime for abortion medication, on Tuesday. FDA v.…
San Juan County, Navajo Nation settle redistricting case

San Juan County, Navajo Nation settle redistricting case

The Navajo Nation and San Juan County reached an agreement Monday about commission districts after the tribe alleged that its members were not adequately…
MIT ranks NM elections most well-run in the U.S.

MIT ranks NM elections most well-run in the U.S.

New Mexico’s 2022 election was ranked most well-run in the country by Massachusetts Institute of Technology’s Election Data and Science Lab’s Elections Performance Index.…
Emily’s List endorses seven candidates for Legislature

Emily’s List endorses seven candidates for Legislature

Emily’s List, a nonprofit that supports women candidates and reproductive rights, endorsed seven incumbents facing general election opponents in New Mexico legislative elections. All…
Ex-GOP candidate allegedly hired people to kill witnesses in shootings of homes of Democratix politicians

Ex-GOP candidate allegedly hired people to kill witnesses in shootings of homes of Democratix politicians

Republican failed state house candidate Solomon Peña is facing more federal charges, this time on a murder-for-hire scheme.  Peña allegedly tried to hire two…
BLM announces final methane waste rule

BLM announces final methane waste rule

The federal Bureau of Land Management announced its final methane waste rule on Wednesday. These new regulations clamp down on the practice of venting…
U.S. Supreme Court hears case to restrict access to medication abortion

U.S. Supreme Court hears case to restrict access to medication abortion

The U.S. Supreme Court heard the case about the regulations around mifepristone, one of a two-step regime for abortion medication, on Tuesday. FDA v.…

GET INVOLVED

© 2023 New Mexico Political Report