AUSTIN, Texas — The room went cold during Samantha Casiano’s 20-week anatomy scan for her fifth pregnancy. The ultrasound tech, previously bubbly and talkative, went silent. Something was wrong, Casiano recounted in a Travis County court Wednesday.
Casiano, 29, thought she’d find out the gender of her baby that day. Instead, she learned her unborn daughter’s brain and skull were not forming properly and she would not survive.
Casiano carried her pregnancy to term because she didn’t qualify for an abortion under Texas’ abortion law and she was scared to travel to a state where abortion is legal. Her daughter, named Halo, died four hours after she was born.
“She had no mercy,” Casiano said. “There was no mercy there for her. And I couldn’t do anything.”
Halfway through testimony, Casiano became overwhelmed and vomited.
Three Texas women shared emotional recollections of abortions they say they were denied or forced to delay treatment because of a state ban on the procedure. It was the first in a two-day hearing of Zurawski vs. State of Texas, in which an abortion rights group is seeking to define the “life-threatening” exemption under state law as it applies to medically-complicated pregnancies.
The outcome of the hearing could have significant implications as the court decides if Texas will temporarily exempt women with complex pregnancies and obstetric complications from the abortion ban.
Simultaneously, the state has motioned for the case to be thrown out entirely.
The Zurawski case, filed by the Center for Reproductive Rights, is one of the first major lawsuits to challenge Texas’ abortion ban, which went into effect after the U.S. Supreme Court overturned federal abortion protections in June 2022.
The case is unique in both its narrow scope and the plaintiffs represented in the lawsuit, said health law expert Seema Mohapatra, a professor at Southern Methodist University Dedman School of Law.
“The whole case is unusual in terms of the fact that these are not people who were seeking to terminate their pregnancy,” Mohapatra said. “These were people that were seeking to have a healthy pregnancy who ended up having pregnancy complications.”
In opening arguments, the state’s lawyer Amy Pletscher said the plaintiffs lack standing because they aren’t currently facing the decision of whether to get an abortion.
“The plaintiffs’ past experiences are tragic. But they are just that — in the past,” Pletscher said. “Any future harm is purely hypothetical.”
In the plaintiff’s opening statement, Center for Reproductive Rights attorney Molly Duane said Texans should be able to consider the impacts of state abortion laws even if they are not currently seeking an abortion.
“Does the state think that the only person who would have standing to challenge an abortion law is a woman who comes to court with amniotic fluid or blood dripping down her leg?” Duane said.
The state also argued that the plaintiffs’ blame is misplaced. Their stories are a result of their medical provider failing them, Pletscher said, not abortion bans.
What comes next
The hearing on the plaintiffs’ requested temporary injunction and the state’s motion to dismiss the case will pick up Thursday at 9 a.m. The plaintiffs will call three people to testify while the defense will call one.
It is unlikely that decisions for either motion will be given at the end of the day tomorrow.
Under a temporary injunction, the abortion ban could no longer be enforced on pregnant Texans with medically-complicated pregnancies. If the judge does not grant the injunction, the ban will continue while the case is litigated, which could take months or years.
If the case is dismissed altogether, the plaintiffs would likely appeal the decision to a higher court.
Wednesday’s testimonies
There are 15 plaintiffs in the Zurawski case: 13 women who were denied abortions and two doctors who say the vague language of the abortion bans leaves them at risk of prison, large fines and losing their licenses.
Three of the four plaintiffs who spoke were women who detailed their abortion experience. The defense did not call anyone to testify Wednesday.
Casiano said she began to have physical reactions to her grief after her daughter’s diagnosis. She would sometimes get sick talking about Halo, especially after she died.
“There are certain things that make my body remember,” Casiano said.
The time that followed Halo’s death were a constant reminder that she did not have the baby that her body carried and birthed. Casiano noted the differences between how she was treated by medical practitioners in past pregnancies and how she was treated while delivering Halo.
Casiano said she went on antidepressants. She fundraised for her daughter’s funeral. She so feared getting pregnant again that she wanted to get her fallopian tubes removed.
Another plaintiff shared similar fears. Ashley Brandt, who lives in Dallas, was 12 weeks into her pregnancy with twins when she found out one of the babies had a fatal birth defect.
A maternal-fetal medicine specialist confirmed that Brandt’s options were to continue the pregnancy, which could put her other twin at risk, or go out-of-state for a “selective fetal reduction,” which is considered an abortion.
Brandt, 31, went to Colorado for the procedure with the hope of saving her healthy twin. She delivered her daughter, Marley, 8 months ago.
Marley made Brandt and her husband parents of two children. The couple said they long planned to have three kids, but changed their minds. Brandt’s husband got a vasectomy.
“I don’t feel safe to have children in Texas anymore,” she said.
The lead plaintiff in the case, Amanda Zurawski, still wants to have a baby.
When pregnant last August, she learned her cervix dilated prematurely. Her daughter, Willow, would not survive.
Because Zurawski’s condition was not considered to be life-threatening, doctors sent her home. She was told to stay close to a hospital because she was at risk for infection.
Three days later, she returned to the hospital in septic shock.
Doctors induced labor and Zurawski delivered Willow. The baby’s heart had stopped beating. Just after the birth, Zurawski’s vitals crashed and she was transferred to the Intensive Care Unit. One of her fallopian tubes is now permanently closed.
Her life was so endangered, she said, that family members flew from across the country in case they had to say goodbye.
Zurawski, 36, has since had surgeries and IVF treatments, hoping for another child. But she worries that with the trauma her body endured she won’t be able to become pregnant again.
She said she’s enduring the pain of sharing her story to spread awareness because experiences like hers are happening to pregnant people all over the country.
“Reliving the worst thing you’ve ever gone through over and over and over again in grueling detail is not just difficult, it’s excruciating,” Zurawski said.
The state’s attorneys asked all three women during cross examinations whether they were directly instructed not to get abortions by now-suspended Attorney General Ken Paxton, any state representatives or any Texas Medical Board members. All three women said they were not directly contacted by any of those parties.
Dr. Damal Karsan, a Houston obstetrician and gynecologist who is a plaintiff in the suit, also took the stand Wednesday. She described cases of women she could not offer abortions because they were not sick enough to qualify under state law.
“Life-threatening physical condition” is not a defined medical term, Karsan said. If patients aren’t on “death’s doorstep,” it’s difficult to know if she can legally treat them.
“It’s all gray. Every case is nuanced and complex,” she said. “It’s a continuum. I don’t know where you can draw a line.”
