It's been six months since the Texas law banning almost all abortions after about six weeks of pregnancy took effect. Doctors and patients feel frustrated as they navigate the new legal environment.



Doctors in Texas have been warning that the state's abortion law known as SB 8 would make it harder for them to treat medical crises and would endanger their patients. The law has been in effect for nearly six months now, and as NPR's Sarah McCammon reports, those predictions are coming true. And we should warn you - this story contains frank discussions about miscarriage and sexual assault.

SARAH MCCAMMON, BYLINE: Anna and Scott were planning their wedding in Central Texas for this coming May when Ana realized her period was almost two weeks late.

ANA: And I just remember laughing to myself because I was like, wow. For as responsible as I think I am all the time, like, I had no idea that I was pregnant and that late.

MCCAMMON: We're just using Ana and Scott's first names because of the sensitivity of this story. It was September, and SB 8 had just taken effect. It bans most abortions in Texas as soon as any cardiac activity can be detected - usually around six weeks of pregnancy or about two weeks after a missed period. That didn't give Ana and Scott much time, but they were open to having a baby, so they moved up their wedding plans to December. When that day arrived, Ana was 19 weeks pregnant, and she was in her wedding dress when she noticed something was wrong.

ANA: It felt like something was coming out of me, so I freaked out. Like, I literally wet my dress in the seat that I was in.

MCCAMMON: Ana'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 heartbreaking news.

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

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

ANA: You're at a high chance of going septic or bleeding out, and unfortunately, we recommend termination, but we cannot provide you one here in Texas because of this law.

MCCAMMON: In her situation, Ana's doctor says a patient would normally be offered a few options - wait and watch for signs of danger or terminate the pregnancy. She says termination would be safest and most likely to preserve Ana's future fertility. But under Texas law, abortions are only allowed at that stage for severe medical emergencies, defined as when a patient is, quote, "in danger of death or a serious risk of substantial impairment of a major bodily function." Ana's doctor asked us not to use her name because she worries about frivolous lawsuits in the current environment.

UNIDENTIFIED DOCTOR: If you were given this on a board exam, you would say, what would you tell this patient? And your answer would be expectant management or offer a termination. Those are essentially the two choices that is standard of care in the United States.

MCCAMMON: As long as fetal heart tones were detectable, doctors told Ana they couldn't offer her a termination unless her life was in imminent danger. It's impossible to know how many patients and doctors are facing similar conversations in Texas, but Ana's doctor says many of her colleagues are feeling frustration and disbelief as they navigate complex situations. The law contains no exception for pregnancies conceived through rape or incest, which can also create unexpected and wrenching decisions for patients and doctors. Doctor Andrea Palmer is an OB-GYN in Fort Worth. She 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.

ANDREA PALMER: She was not able to discern whether the baby was the product of consensual sex with her husband or the product of her sexual assault.

MCCAMMON: 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.

PALMER: The thought of carrying something in your body and of 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.

MCCAMMON: Palmer says her patient gave permission to share her story anonymously so people could hear how complicated and difficult these decisions can be.

JOHN SEAGO: Yeah, I mean, it's absolutely horrific.

MCCAMMON: John Seago is legislative director with Texas Right to Life, which helped push SB 8 through the state legislature last year. He says the law's supporters believe abortion is an act of injustice no matter what.

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

MCCAMMON: Seago says when it comes to medical emergencies, medical associations should do more to help doctors understand what's allowed under the law. But groups like the American College of Obstetricians and Gynecologists say the law is vaguely worded and leaves providers of vulnerable to being sued. In the ER, on their wedding night, Ana and Scott say their doctors could do little to help them.

ANA: And I remember being like, why can't you just do this? You know, they couldn't even say the word abortion. Like, I could see the fear in these doctors' eyes that they were just so scared to even talk about it. Like...

SCOTT: They were typing stuff out on their phones and showing it to us.

MCCAMMON: Ana's doctor wasn't working that night in the ER, but one of her partners filled her in the next morning. The doctor says she called Ana right away.

ANA: She asked, so the state of Texas just wants me to get sick enough that I have to be admitted to the hospital? And I said, yes, that's essentially what's happening.

MCCAMMON: They needed a plan to get Ana 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.

SCOTT: So there's two options. There's New Mexico, and there's Colorado. Would we rather have her go into labor on a plane or out by Midland?

ANA: Like, in a car.

SCOTT: In a car.

UNIDENTIFIED DOCTOR: And I said, absolutely not.

MCCAMMON: That's Ana's doctor again.

UNIDENTIFIED DOCTOR: Because West Texas is at least eight or nine hours of desert with hours with no cell phone reception or gas station in, you know, the middle of a medical crisis. So I requested she take a flight and make it a direct flight if possible.

MCCAMMON: But Ana says that plan came with its own set of risks.

ANA: Oh, God, when I talk about this, this is the hardest thing. I had to come up with the 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 - like, no one should ever have to do that.

MCCAMMON: But even through tears, Ana 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 across the region say they're struggling to accommodate the surge in demand from Texas patients, 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. Since her ordeal, Ana says she fears for the lives of other women.

ANA: I don't call any of these people pro-life because I've never felt like I didn't matter, that my life was expendable than I did in that moment. Somebody is going to die eventually.

MCCAMMON: Lawmakers in states including Oklahoma, Florida and Ohio are sponsoring bills modeled after the one in Texas. Meanwhile, some states like California and Vermont are taking steps to expand abortion access, hoping to increase their ability to take in patients like Ana from around the country. Sarah McCammon, NPR News, Central Texas.