Doctors' worst fears about the Texas abortion law are coming true

In the days after the new Texas abortion law known as S.B. 8 took effect last September, Anna was planning her wedding to her fiancé, Scott. They'd set a date for this coming May — until Anna realized her period was almost two weeks late.

"I just remember laughing to myself because I was like, wow, for as responsible as I think I am all the time, I had no idea that I was pregnant — and that late," says Anna. NPR is only using her first name because of the sensitivity of her story.

Doctors in Texas have been warning that S.B. 8 would make it harder for them to treat medical crises and would endanger their patients. Six months in, many say those predictions are coming true.

"I don't want to be talking about this at all," says Anna, who lives in central Texas. "But it's important to share this story. Because somebody is going to die eventually."

The law bans most abortions as soon as any cardiac activity can be detected, usually around six weeks of pregnancy, or about two weeks after a missed period. Most women don't know they're pregnant at that point.

For Anna, there would have been little to no time to get an abortion in Texas by the time she discovered her pregnancy. She and Scott were open to having a baby, even if a bit sooner than they might have planned, so they moved up their wedding plans to December.

When their wedding day arrived, Anna was 19 weeks pregnant. And she was in her wedding dress, getting makeup done with her bridesmaids, when she noticed something was wrong.

"It felt like something was coming out of me. So I freaked out. I literally wet my dress in the seat that I was in," she says.

Anna had to race against time

Anna's water had broken too early for the baby to survive. She and Scott spent the night of their wedding in the ER, trying to take in the heartbreaking news.

"Basically the doctor looked at me and was like, well, the baby's underdeveloped," says Anna. "Even with the best NICU care in the world, they're not going to survive."

And as painful as it was to hear that, the doctors told Anna there was another urgent concern.

"'You're at a high chance of going septic or bleeding out,'" she says the doctors told her — a risk of infection or hemorrhage, which could become deadly. "'And unfortunately we recommend termination, but we cannot provide you one here in Texas because of this law.'"

In Anna's situation, a patient would normally be offered two options: wait and watch for signs of danger; or terminate the pregnancy, which is usually the safest option and most guaranteed to preserve future fertility.

But under Texas law, abortions are only allowed at that stage for severe medical emergencies, defined as when a patient is "in danger of death or a serious risk of substantial impairment of a major bodily function."

And because fetal heart tones were detectable, doctors told Anna they couldn't offer her that option.

Patients face a heartbreaking choice

It's impossible to know how many patients and doctors are having similar conversations in Texas. Many are feeling frustration and disbelief as they navigate in the new legal environment.

Also creating complications is that the law contains no exception for pregnancies conceived through rape or incest, creating wrenching situations for patients whose lives have already been rattled by trauma.

Dr. Andrea Palmer, an OB-GYN in Fort Worth, recently took care of a woman who discovered she was pregnant after being drugged and raped at a party. Before the assault, she and her husband had been trying for a baby.

"She found out she was pregnant and was not able to discern whether the baby was the product of consensual sex with her husband or the product of her sexual assault," says Palmer.

Genetic testing could have answered that question, but not in time to legally get an abortion close to home. Palmer says her patient couldn't afford to travel out of state and didn't want to risk waiting and finding out the worst. So she got an early abortion in Texas while it was still legal.

"The thought of carrying something in your body and raising a baby that could have been by a man who was sadistic and sick and awful enough to drug and rape a complete stranger? I just cannot imagine that somebody who claims to have love in their heart would ever wish that particular bit of hell on another human being," says Palmer.

Her patient gave permission to share her story anonymously, so people could hear how complicated and difficult these decisions can be.

Anti-abortion-rights advocates say it's mainly a problem of understanding the law

"Yeah, I mean it's, it's absolutely horrific," says John Seago. He's the legislative director with Texas Right to Life, which helped push S.B. 8 through the state legislature last year. He says even though he feels for Anna and for Palmer's patient, the law's supporters believe that abortion is an "act of injustice," no matter what.

"Even in the worst circumstances, another act of violence on an innocent victim is not the best solution that we have," he says.

Seago says when it comes to medical emergencies, medical associations should do more to help doctors understand what's allowed under the law.

"It seems politically advantageous for some of these groups that oppose the bill, and oppose all pro-life legislation, to just say this is unreasonable," he says.

Groups including the American College of Obstetricians and Gynecologists have opposed S.B. 8. They say the law is vaguely worded, leaves providers vulnerable to being sued and puts patients at risk.

Dr. John Thoppil, president of the Texas Association of Obstetricians and Gynecologists, says medical groups have provided as much guidance as they can.

"I think the interpretation of the bill, through multiple layers, has been fantastically communicated, but that doesn't make the bill any better," he says. "This might help you say, 'I might win the lawsuit,' but it doesn't prevent the lawsuit."

Doctors are operating in a climate of fear

Molly Duane, an attorney with the Center for Reproductive Rights, which is challenging the law, says providers also are "extremely and understandably fearful" of providing abortions even in medical emergencies because of the law's design, which allows individuals to enforce it through civil suits.

"A physician who made that determination in the moment would be doing so knowing that if someone second-guessed their judgment, [anyone] could file a lawsuit saying that you violated S.B. 8.," she says.

In the emergency room on their wedding night, Anna and Scott say the doctors appeared nervous and concerned, but could do little to help them.

"I remember being like, what, why can't you just do this?" says Anna. "They couldn't even say the word 'abortion.' I could see the fear in these doctors' eyes that they were just so scared to even talk about it."

"They were typing stuff out on their phones and showing it to us," adds Scott, saying that the doctors were afraid to even be overheard helping them plan an abortion.

The next day, Anna's OB-GYN needed a plan to get Anna to a place where she could get the procedure as quickly as possible. They ruled out some nearby states, including Oklahoma and Arkansas, with mandatory waiting periods as long as three days.

"So there's two options," says Scott. "There's New Mexico and there's Colorado. Would we rather have her go into labor on a plane or like, out by Midland in a car?"

"And I said absolutely not," says Anna's doctor, who spoke with NPR on the condition of anonymity over fears of facing lawsuits. "Because west Texas is at least 8 or 9 hours of desert. Sometimes you have hours with no cell phone reception, no gas station ... in the middle of a medical crisis. So I requested she at least take a flight. And make it a direct flight if possible."

But Anna says that plan came with its own set of risks. There's a lump in her throat as she talks about what could have happened on the plane.

"I had to come up with a game plan with my OB in case I went into labor on the flight. And I made sure that I bought us front row seats so I could be close to the bathroom in case it happened. And I'm like, no one should ever have to do that."

But even through tears, Anna says she knows she was lucky to have several thousand dollars in savings to cover the cost — and to get an appointment in Colorado at all.

Clinics in nearby states are stretched thin

Clinics across the region say they're struggling to accommodate the surge in demand from patients from Texas, the nation's second most populous state. And they're fearful that many more states could implement similar laws if the U.S. Supreme Court overturns decades of precedent guaranteeing abortion rights.

"Texas is a very large state. So you have numerous people trying to get care elsewhere," says Kari White, a sociologist at the University of Texas at Austin. She's been researching patients who've left Texas for abortions since S.B. 8 took effect.

"There are not very many clinics in the states that surround Texas," she says. "And they're already serving the patients that live in that state, as well as sometimes in neighboring states."

White says the supply and demand problem is only likely to get worse. A major abortion case currently before the U.S. Supreme Court could overturn the Roe v. Wade decision that legalized abortion in 1973, opening the door to many more restrictions around the country. The Mississippi law at the center of the current case would ban most abortions after 15 weeks — four weeks earlier than when Anna was searching for an appointment in a neighboring state.

"People may not be able to go to Oklahoma or Louisiana four months from now, because care may not be available in those states either," White says.

Lawmakers in states such as Oklahoma, Florida and Ohio are sponsoring bills modeled after the one in Texas. Meanwhile, states including California and Vermont are taking steps to expand abortion access, hoping to increase their ability to take in patients like Anna from around the country.

Since her ordeal, Anna says she fears for the lives of other women.

"I've never in my life felt like I didn't matter, that my life was expendable," she says, but "I did in that moment."

She's especially worried about families without the resources to travel long distances for potentially life-saving treatment.

"I have a savings account and a job that I could have made this happen for myself," she says. "There's plenty of other people on this planet with uteruses who could not have done that. And what would they have done? Would they have just died? I think about that all the time."

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