Did an Abortion Ban Cost a Young Texas Woman Her Life?

By 2022, two hospital employees told me, the number of women giving birth in the Luling E.R. was surging. They recalled seeing only five or six births in the previous decade. Now it felt like “uncontrolled chaos,” one of them said. Babies were being delivered in the waiting room, or crowning on a stretcher in the hallway, the four beds being occupied.

The two employees were accustomed to seeing early miscarriages or the swift delivery of someone’s fourth child. But lately women were coming in with more varied and complex conditions, and at times the E.R. felt like a neonatal intensive-care unit—but one lacking the equipment to properly handle sick babies. The hospital’s single baby-warming crib was discovered, during a birth, to be missing a wheel; a nurse had to prop it up with her feet to prevent the newborn from falling out while the doctor received obstetrics counsel over the phone from a specialist in Austin.

“Anything that fails in society, anything that’s broken, ends up being the emergency room’s problem,” one of the employees told me. Both of them suspected that the surge was being driven by diminished access to abortions, following the enactment, in 2021, of a state law known as S.B. 8, which banned the procedure after the sixth week of pregnancy in nearly all cases. A Johns Hopkins Bloomberg School of Public Health study recently showed that, in a nine-month period following the passage of S.B. 8, nearly ten thousand additional babies were born in Texas.

What conservative lawmakers hailed as the saving of infant lives, medical professionals I interviewed in rural Texas saw as a beleaguering challenge. According to state data, even before S.B. 8 half the counties in Texas were unequipped to treat pregnant women, lacking a single specialist in women’s health, such as an ob-gyn or a certified midwife. Multiple doctors told me that the overturning of Roe v. Wade, in June of 2022, exacerbated the crisis, as practitioners retired early or moved to states where they’d have more liberty to make medical judgments. So who, exactly, was supposed to handle the extra deliveries in women’s-health deserts such as Caldwell County? What would become of women in remote locales who experienced a hemorrhage or a ruptured fallopian tube?

Although it was illegal for the E.R. to turn away patients who needed urgent care, hospital workers in Luling couldn’t hide their reservations. “This is not the place you want to be,” one of them told pregnant patients. “It could end up tragic.” There wouldn’t be an anesthesiologist on hand to numb the pain with an epidural, much less an expert in maternal-fetal medicine. Not every patient was in a position to travel elsewhere, however. If a pregnant woman visited the Luling E.R. three times in a row, staff came to assume that she’d end up delivering there, whether they were prepared or not.

Yeni was among the uninsured, and when her teeth hurt or drug-store creams weren’t curing a rash, she turned to the Luling E.R. Over time, the staff came to know her and her ailments. In her mid-twenties, she learned that she had hypertension, or high blood pressure, and diabetes. Both conditions ran in her family; Yeni began storing her insulin next to her mother’s in the fridge.

After Covid-19 peaked in Luling, Yeni fell ill, and she was hospitalized with pulmonary edema, a condition, in which the lungs fill with fluid, that strains the heart and can be fatal. Another long-term complication was her weight, which rarely dipped below two hundred and sixty pounds. For all these reasons, when Yeni became pregnant she was a high-risk patient.

Seven weeks into her pregnancy, in late January, 2022, Yeni messaged Andrew: “Slight breathing problems.” A few days later, she woke up bleeding. Her first instinct was to call her mother. ‘Does it hurt?,’ Leticia asked. It didn’t, but Yeni was too scared to trust her mother’s theory that miscarriages were accompanied by pain. She raced to the E.R., where her case was termed a “threatened miscarriage.” An ultrasound showed normal fetal growth; her blood pressure, however, had spiked to a worrisome 185/98.

“It would be worth ten times that with legs.”

Cartoon by Mike Twohy

Although some women with the same conditions as Yeni—hypertension, diabetes, a history of pulmonary edema, severe obesity—end up safely delivering healthy babies, others become so unwell that a difficult question arises: Is this a pregnancy that the patient can safely continue? Some studies show that cardiovascular diseases account for more than a third of pregnancy-related deaths in the U.S. “When a pregnant patient comes to you with a history of pulmonary edema, the question is: What is the cause, and can it be managed or reversed?,” Uri Elkayam, the director of the maternal-cardiology program at the University of Southern California, told me. “Pregnancy increases blood volume, and with limited cardiac reserves the pressure from the heart may be reflected into the lungs, causing pulmonary edema and heart failure.” His rule of thumb is that, if a patient is fairly sick early on, “one needs to assume that as pregnancy progresses things only will get worse.” In those cases, he said, termination lowers the risk of death.

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