In Texas, where a strict abortion ban recently met the daily realities of needing medical care in cases of pregnancy complications. This perfect storm has resulted in horrific outcomes for women suffering miscarriages. In August 2022, when the state criminalized abortion in all cases, it placed innumerable women’s lives at risk. Sarah De Pablos Velez, one of those women, experienced deadly consequences as a result. During a miscarriage she had last year, she was sent home from an emergency room as she began to bleed profusely. To save her life, she required three blood transfusions. This story once again illustrates the disastrous effect of the state’s bill on women’s health.
The Texas abortion ban has led to a whopping 54% increase in blood transfusions for first-trimester miscarriages. This increase has mostly been seen in emergency room visits. Now healthcare professionals are sounding the alarm on this frightening trend. They’re lamenting its potential impact on the new realities of medical care in the state. The dangerous reality women face was underscored by the tragic death of Porsha Ngumezi in June 2023. These hazards are exacerbated by the legal barriers described above.
Hope has been stripped from the healthcare provider decision-making process by fear and uncertainty that has reigned since the ban was enacted. Fearing blame, practitioners foster a culture of caution. They practice under laws that threaten up to 15 years in prison to anyone who performs abortions except under narrowly carved circumstances. The confluence of events has created significant ethical challenges for physicians who are forced to navigate the legal consequences with the immediate concerns of their patients.
Surge in Blood Transfusions
It is hard to overstate how unique Texas hospital discharge record data is for delineating the surge in blood transfusions linked to early pregnancy loss. Indeed, reports of blood transfusions during emergency visits for first-trimester miscarriages increased dramatically after the abortion ban went into effect.
Sarah De Pablos Velez’s lived experience is an archetypical case in point of this national pattern. After being released from the hospital without the dilation and curettage (D&C) surgery she needed, she made the choice to seek further treatment. Ultimately, she ended up needing two blood transfusions.
“What happened to me was just so wrong,” – Sarah De Pablos Velez
This burgeoning reliance on medical interventions fosters important questions about the quality of care that women in highly distressing circumstances are afforded. Dr. Jodi Abbott, who has seen many similar cases, noted the horrific similarity between De Pablos Velez’s case and that of Ngumezi, who unfortunately did not make it through her miscarriage.
“Basically received the same care Porsha Ngumezi did, only Porsha died and she survived,” – Dr. Jodi Abbott
Dr. Sarah Prager raised the alarm about the very real dangers of delaying critical healthcare. She emphasized that a lack of access to blood transfusions would result in thousands of preventable deaths.
Fear Among Healthcare Providers
The climate inside health care institutions, too, has changed since the passage of Texas’ abortion ban. For Dr. Gabrielle Taper, a uni res at a Catholic city ERT, as she might have sung her classmates were incredibly scared. They were afraid they would be subjected to legal prosecution while simply trying to provide critical care.
“People are already in distress, and you are giving them confusion, a false sense of hope,” – Dr. Gabrielle Taper
In this environment, healthcare providers are becoming more wary. They’re concerned that if they offer the procedures that would best help their patients, it will expose them to legal liability. We’re all rethinking how to manage the patients who have miscarriages. Penalizing them with the threat of up to 99 years in prison has caused them to reconsider their practices.
Dr. Taper said it was infuriating for him to have to send these patients home when he knew they would begin developing life-threatening complications. She talked about the emotional burden this causes for medical professionals who want to get their patients the care they need quickly and effectively.
“Having to send a patient home knowing they may bleed so much they would need a blood transfusion — when I know there are procedures I could do or medicine I could offer — is just excruciating,” – Dr. Gabrielle Taper
In light of these challenges, some hospitals have begun implementing policies that clarify when abortions can be performed in life-threatening emergencies, even if not imminent. A majority of healthcare providers are still worried about how to follow these confusing prescriptions.
Legislative Changes and Patient Care
With this move, the Texas Legislature finally responded to escalating fears for patient safety and reproductive healthcare quality in the abortion-free state. Earlier this year, under the leadership of Republican state Rep. According to a news report, the legislation now permits doctors to provide life-saving abortions—including in life-threatening emergencies. This is true, even if the emergency is not yet upon us.
Healthcare providers like Dr. Anitra Beasley understand that the recent legislative change has not removed the confusion on these laws. There is still a lot of uncertainty that remains. This uncertainty has caused panic among practitioners about whether they can or cannot intervene in emergent circumstances.
“Doctors need to be providing care to pregnant women — that needs to be a baseline,” – Sarah De Pablos Velez
Providing concise, evidence-based information and effective care management alternatives continue to be important for patients undergoing miscarriages. Dr. Courtney A. Schreiber underscored the need for medical teams to thoroughly inform patients so they can make informed decisions. This means full conversations about medications and D&C procedures for symptom management such as bleeding.
De Pablos Velez’s hospital chart indicated that “all management options have been discussed with the patient and her husband.” She and her husband maintain that they were never offered the choice of a D&C. This intervention would have dramatically improved her otherwise life-threatening situation.
The rapidly changing healthcare environment in Texas has created an increasingly difficult landscape for patients and providers to navigate. As lawmakers seek to clarify policies surrounding reproductive health care, it remains essential to ensure that women receive timely medical attention during critical periods.
