‘Collateral damage’: Texas doctors say why abortion ban is killing pregnant women

The Texas abortion ban’s harsh penalties are “terrifying” doctors, preventing them from quickly treating miscarriages and wannabe moms are paying with their lives.

Photo by Max Böhme on Unsplash

Readers - this piece is the first in a series of three stories I’ve written about the dire situation for women in Texas, who risk their lives with every pregnancy they have today. If Trump effectively ends abortion, women in all states could pay the ultimate price. Here, Texas OBYNs explain why a common pregnancy complication is killing healthy women.

“It’s like a knife straight to your stomach,” Dr. Todd Ivey, a Houston-based OB-GYN at an academic hospital, admitted after learning that a third young woman had died in the state during a miscarriage.

“It’s just like, we’ve got to stop this. We’ve got to do something to stop this. Pregnancy is high-risk enough without putting all these complications on top of it.”

The “complications” that Ivey is warning Texas women about are the state’s two abortion bans, which outlaw the procedure in Texas from the moment of conception.

The laws impose such harsh penalties on doctors that they are “terrified that they’re going to be criminalized,” said Dr. Austin Dennard, a Dallas-based OB-GYN.

And why wouldn’t they be terrified when they face a sentence of up to 99 years in jail if they perform an abortion that’s considered illegal? They’ll also be stripped of their medical licence, have to pay a $100,000 fine, and can also be sued civilly by anyone who wants to claim a bounty of $10,000 if they can prove a doctor provided an abortion.

“It’s hardly surprising that pregnant women have become the ‘collateral damage’ of Republican lawmakers’ mission to outlaw abortion no matter what the circumstances,” said Austin Kaplan, the Austin-based civil rights attorney who represented Texas mom Kate Cox.

Cox, 31, and a mom of two, unsuccessfully petitioned the Texas Supreme Court to allow her to get a legal abortion after she learned that her baby had a fatal anomaly and that continuing the pregnancy would endanger her future fertility and possibly her life.

Now, it’s been documented by ProPublica that since the first ban, known as Senate Bill 8, which went into effect on Sept 1, 2021, three young, healthy women pregnant with wanted babies have died in the state from miscarriage complications.

Nevaeh Crain, just 18, lost her life following a sepsis infection during a miscarriage less than 24 hours after her first visit to a hospital ER in Southeast Texas.

Just a day earlier, she was opening gifts at her baby shower and thrilled to be six months pregnant with a baby daughter that she planned to name Lillian.

But after she started vomiting and running a fever, she was sent home from two hospitals with mistaken diagnosis before finally being admitted after a futile third visit on Oct 29, 2023.

Her mother was forced to desperately scream for someone to “do something” at the hospital to save her dying daughter’s life, but it was too late.

Josseli Barnica, a 28-year-old mom of a one-year-old daughter died of sepsis in a Houston hospital after doctors delayed what used to be standard miscarriage treatment for 40 hours, while she lay with her uterus open and exposed to bacteria.

Only when her 17-week fetus no longer had a heartbeat did doctors finally intervene to help complete her miscarriage. By then, it was too late and Barnica died of sepsis.

Porsha Negumezi, 35 and a mother of two sons, passed away during a miscarriage in a Houston hospital only 10 hours after arriving, hemorrhaging blood clots the size of grapefruits.

She bled so heavily that she required two transfusions and began experiencing chest pain. A coroner later ruled that she died of hemorrhage.

I interviewed five doctors who provide reproductive health care in Texas about why they believe Negumezi, Crain and Barnica, all healthy young women, died and asked them for advice about how other pregnant Texans can do their best to survive a miscarriage in the state.

Doctors: 3 miscarrying women in Texas died unnecessarily

The deaths of the women were tragically “unnecessary” according to Dennard.

“It feels like we’re in the ‘olden days,’” added Austin-based OB-GYN Dr. Nicole Moretti. “It’s a bizarre contrast … to know what you need to do in a scenario … knowing you can provide that treatment, you can physically perform the management that someone needs but then simultaneously feel like you are limited or could face repercussions. It’s maddening. It’s ludicrous.”

While none of the doctors interviewed had treated any of the women, nor had access to their medical records, they all have years of experience caring for women experiencing pregnancy complications in Texas.

And all agreed with Dennard that none of these women should have died or would have died before Texas lawmakers banned abortion.

“Women are literally losing their lives because management (of their care) is being delayed because of these bans,” said Dr. Emily Briggs, a family physician who provides obstetric care in Central Texas.

Moretti called it “crazy” that doctors are “delaying treatment to speak to a medical legal team” to find out if and when they can proceed with life saving treatment.

Texas’ abortion law bans abortions except if a woman has a life-threatening condition and is at risk of death or of “substantial impairment of a major bodily function.”

A Texas physician must also try to save the life of the fetus unless this would increase the risk of the patient’s death or impairment.

“If for whatever reason (a woman’s) body has decided that it’s time to push this pregnancy out… and there is still a heartbeat, we cannot as physicians in Texas move forward with assisting the mom with helping her uterus clamp down and cut off those blood vessels, so (instead) she keeps bleeding and bleeding and bleeding,” Briggs explained.

“A miscarriage is unintended,” Dennard pointed out. “The Texas legislature … because they don’t know anything about medicine, it didn’t realize that women have miscarriages and sometimes you need to do a D&C (dilation and curettage) procedure which I guess is being conflated with abortion.”

Even if miscarrying women in Texas don’t have a fetus with a heartbeat, there is “still a lot of confusion around this,” Ivey said.

“I don’t think our standard (of treating miscarriages) has changed. But how they’ve been handled has changed because of our restrictive abortion laws,” Ivey said. “There is a climate of fear in our state among physicians, among hospitals, among other health care providers.”

Specifically, according to all the doctors, there is now a reluctance among Texas doctors to provide a heavily bleeding and miscarrying woman with a dilation and curettage or dilation and evacuation, which are both used effectively to empty a miscarrying woman’s uterus of all the pregnancy remains. However, they do end a pregnancy, just as an abortion does.

“These aren’t even new cutting edge procedures, but they are lifesaving,” said Morretti, who pointed out that these procedures have been used as standard care in Texas and around the world for decades in order to help women complete difficult miscarriages.

Yet Negumezi, Crain and Barnica never received either procedure. Instead they suffered painful cramping, and in some cases ran fevers and bled out as their uteruses unsuccessfully tried to push their fetuses, which had no chance of survival, out of their bodies.

Negumezi was in dire need of a D&C to stop her life threatening blood loss, according to Dr. Nancy Binford, an Austin-based OB-GYN.

Gasping for breath, calling out for help

When the OB-GYN finally examined Negumezi seven hours after she arrived at Houston Methodist Sugar Land Hospital, he prescribed the drug misoprostol, which can be used to help complete miscarriages in certain circumstances.

But that could have made her condition worse, according to Binford.

“It would have made her uterus just do more of the contracting,” she said.

Binford said that because Negumezi was hemorrhaging and medical providers had already transfused her twice, she qualified as a “rush back” to the operating room.

“I’ve done a 100 rush backs in my 24 years (of practice) for an urgent issue like this to have a D&C,” she said.

But that’s not what happened to Negumezi, and even when she began having chest pains, no more tests were ordered. She began gasping for breath a couple of hours later and died as her husband frantically called out to hospital staff for help

“What happens when they’re bleeding out at a certain point, they’ve lost too much blood to support their cardiac activity,” Dennard concurred. “You lose so much blood your body is no longer able to create the clotting factors that are needed to support the blood that you have circulating in your body.”

The circumstances of the deaths of these three women have to be a warning to pregnant Texas women and their loved ones.

Young women who are having complications miscarrying can appear healthy before getting “sick very quickly,” Ivey explained.

How women can protect themselves from dying

“If you are experiencing serious symptoms while miscarrying, you have to move very quickly to prevent (your) organs from failing,” Ivey said.

And while only three Texas women have been documented to have died from miscarriages since the state’s abortion ban has been in place, the number of Texas women who died from pregnancy or labor complications soared 56% from 2019 to 2022, according to a study by the Gender Equity Policy Institute.

Kaplan said he advises pregnant mothers in Texas to pack a “to go bag” so that “if you need to get out of this state to get the care you need, you’ll be ready to go. Always be thinking — if something were to go wrong, where am I headed outside of Texas.”

But what can a pregnant woman who can’t quickly leave Texas do if local hospitals or urgent care centers don’t appear to be taking the risk to their lives seriously?

“Go to the biggest city near you and go to the downtown-ist hospital and don’t care what it looks like,” Binford said. ”They have the most volumes of deliveries and with volume come pregnancy complications and that means experience in handling them.”

Binford also advised that hospitals affiliated with medical schools will have established ethics committees that will include a lawyer and that committee members will be reachable quickly if a doctor is unsure about whether they can go ahead with a procedure to remove a fetus from a woman’s body.

Texas health lawyer Leah Stewart, who advises doctors and hospitals about the abortion laws, agreed that if a woman thinks she is having a severe miscarriage or another dangerous complication like an ectopic pregnancy or if her water breaks long before viability, then she should go to a large urban hospital.

They see “every single thing that goes wrong … and are better equipped to connect the right provider and give the woman standard care.”

And if you aren’t getting the attention you need quickly, she added, “You have to keep ramping up your fit throwing.”

“You don’t think it’s going to happen to you,” said Ryan Hamilton, a Dallas-area father whose wife nearly died when she miscarried with what would have been their second child at 13 weeks pregnant.

After multiple visits to medical centers over three days and three rounds of treatment with misoprostol, Hamilton’s wife passed out unconscious on the bathroom floor in a pool of blood.

She only survived because Hamilton raced her to a hospital ER for treatment.

“”Women are dying… under the circumstances we went through.. If I wouldn’t have been home to find my wife, she would have been one of those women… I could have lost her….it’s like, ‘oh my God, I really could have.’ That’s reality and that’s hard,” Hamilton added.