Doctors report compromising care out of fear of Texas abortion law

The recovery area at Alamo Women’s Reproductive Services in San Antonio on June 14, 2022. (Credit: Kylie Cooper/The Texas Tribune)

Doctors worried about getting sued under Texas’ restrictive abortion law have delayed treating pregnancy complications until patients’ lives were in danger, according to a paper from the Texas Policy Evaluation Project.

The law, which empowers private citizens to file suit against anyone who “aids or abets” in an abortion after about six weeks of pregnancy, has caused confusion among providers and complicated treatment for patients facing pregnancy complications, the study found.

The impact of Texas’ law, which went into effect in September, is a harbinger of things to come as the nation braces for the U.S. Supreme Court to overturn Roe v. Wade. Texas, along with more than two dozen other states, is expected to ban all abortion, with only a narrow exception to save the life of the pregnant patient.

The Texas Policy Evaluation Project, a research institute at the University of Texas that focuses on “evidence-based, equitable reproductive and sexual health care,” has been studying the impacts of Texas’ abortion law and other policy changes.

The paper, which was authored by TxPEP researchers, maternal-fetal medicine specialists and abortion providers, highlights the experiences of 25 clinicians and 20 people who have experienced pregnancy complications.

Although Texas’ abortion law contains an exemption to save the life of the pregnant patient, doctors said it was unevenly and insufficiently applied.

“People have to be on death’s door to qualify for maternal exemptions” to Texas’ current law, one maternal-fetal medicine specialist told the paper’s authors.

Doctors reported that they have postponed abortion care until a patient’s health or pregnancy complication has deteriorated to the point that their life was in danger, including multiple cases where patients were sent home, only to return once they were in sepsis.

And even when patients were able to qualify for an abortion under the life-saving exemption, some doctors report being unable to get nurses or anesthesiologists to assist on these procedures for fear that they will be seen as “aiding and abetting” in an abortion, which is prohibited by the law.

In some cases, doctors said they have avoided standard abortion methods, like a dilation and evacuation, and instead used less common surgical methods or induction to avoid risking a lawsuit.

“Physicians have said that they don’t feel like they can offer the standard medical interventions that are the standard of care across the United States,” said Whitney Arey, the lead researcher on the paper. “That’s resulted in people using less common or outdated practices because it might not be construed as performing an abortion.”

All of the doctors interviewed said their hospitals have prohibited multifetal reduction, by which doctors preserve the health of the pregnancy by reducing the number of fetuses a patient is carrying.

Clinicians also reported confusion over whether they can even counsel patients on abortion as an option or direct them to out-of-state clinics.

A 39-year-old woman told TxPEP that her doctor would not discuss abortion options with her after she received a significant fetal diagnosis.

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

Another patient whose water broke at 19 weeks of pregnancy had to decide between waiting to see if she could access care in Texas or getting on a plane to get an abortion elsewhere. She ended up taking the risk of flying out of state while experiencing a significant health emergency.

Some of the doctors who spoke with TxPEP described the mental toll it takes on them to have to treat patients under these restrictions. Several said they were considering leaving the state but were weighing the impact on patients who will continue to need care for high-risk and medically complicated pregnancies.

Anti-abortion advocacy organizations have pushed back against the idea that these restrictions endanger maternal health. Texas Right to Life argued in a blog post that “misinformation” from the media and abortion advocates is the real problem.

“The misinformation surrounding what Texas law actually entails could cause physicians to hesitate before performing any sort of procedure that may even look like abortion even if it is clearly not an elective abortion,” the post said. “Unfortunately, this could cause women who need that critical medical attention to be turned away.”

But these doctors and the patients they treat say it’s the laws that are sowing confusion and fear — and having real-world impacts on health care.

“We know in the post-Roe landscape, physicians and institutions are going to have really diverse interpretations of narrow exemptions,” Arey said. “And this is going to compromise pregnant people’s ability to get evidence-based health care and support from the health care provider that they need.”

“We’re expecting to see more patients that will be forced to wait until they’re sick enough to receive care, or see patients traveling out of state,” she said.