A mom’s nightmare: Intense morning sickness in a Dallas woman’s pregnancy revealed to her fetus is trisomy 18
She wrote about it in her journal on August 20, 2022, when she was 50 years old. Over a full day later it is now the afternoon. I can’t even keep down crackers, water, tea.”
She was worried about dehydration, so she went to an E.R. near her home in Dallas. She received a bag of IV fluid and medication for the nausea and was told she had hyperemesis gravidarum – severe morning sickness. The doctor did an exam. She says that they found out about the twins after that.
“I was just completely shocked because we have no history of twins on either side of our family,” she says. Miller, 35, and her husband, Jason, already have a 1-year-old son. But it explained her intense morning sickness; that’s a typical side effect in twin pregnancies.
At first, she felt overwhelmed, thinking through all they would need to do to get ready for twins: a bigger car, another crib, more baby gear. “But within a few days we were getting excited – I always wanted three [kids] so it’s kind of like I got a two-for-one special,” she laughs.
This past fall, when Lauren Miller of Dallas was 13-weeks pregnant with twins, she got horrible news. One of the twins had trisomy 18, a genetic abnormality that causes about 90% of fetuses to die before birth. The other twin was healthy.
A few hours later, a genetic counselor called her. “It just gets worse,” she wrote after that conversation. Every day that Baby B gets older, I and my twin are at greater risk of having a premature birth, or even a heart attack. She was cautious about what she said and she can’t say much.
All that the genetic counselor told her was that, when she practiced in New York, doctors would do a “single fetal reduction,” Miller recalls, though she didn’t explain what that procedure was, only that “you can’t do that in Texas now.”
Miller felt like she knew why the genetic counselor was vague. Selective reduction is an abortion procedure for pregnancies with multiple fetuses. Doctors can selectively terminate one fetus, while another or multiple other fetuses continue to develop. Multiple pregnancies are inherently risky, and selective reduction can increase the chance of a live birth or births.
There are three laws that ban abortion in the state. As far as 1856, there was one predating the decision to allow abortion. The maximum penalty for performing an abortion in a state is life in prison, if the Supreme Court overturns the case. Then there’s SB-8, that allows people to bring civil charges for “aiding or abetting” a Texas abortion.
Getting a GYN’s diagnosis before delivering Baby B: “It’s a mystery, but it’s real,” she recounts
She wrote in her journal: “So now we have to scramble – I don’t even know what we’re doing, but we have to make plans. I am blind and confused and scared and I don’t like all of this.
The following day, Miller was able to get in to see another OB-GYN who specializes in high risk pregnancies for a test to confirm the trisomy 18 diagnosis.
There, she had another medical procedure. The scans of Baby B were “heartbreaking”, she says. There were more concerning signs: an incomplete abdominal wall, indications of heart abnormalities, and the cystic hygromas had grown larger. The doctor had trouble getting the tissue sample for the diagnostic test. After multiple attempts, Miller recalls, he threw his gloves in the trash.
After she returned home, Miller says, her fear of about the abortion laws in Texas lingered. At her next prenatal appointment, as she got her ultrasound and it was clear that Baby B’s heart had stopped, she wondered — could the ultrasound tech report her?
Plans were put together quickly. A friend connected her with a doctor in Colorado. She made an appointment for the following week, in early October. She and Jason arranged to have their son stay with family, booked a flight and a hotel, and got ready.
She said it was so weird that it was like a secret mission. It was so completely out of the ordinary. I’m from Texas – I’m an 8th generation Texan – and to be feeling like I need to escape the state was just a bizarre sensation.”
Lauren Miller’s Last Explanation for an Abortion Loss: Embarrassment, Emotions, and Friendships
Miller remembered that they used to take one last photo of the twins as a farewell to him. It was a single needle. They injected it into Baby B.
The whole thing took a few minutes. There’s no removal process in a case like hers, where one twin is healthy – both fetuses stay in her uterus for the rest of her pregnancy. One grows, and one doesn’t.
“As soon as they left, I was sobbing,” she says. “It was just so many emotions. This was very much a wanted pregnancy. That was the first time that we were confronted with the full consequences of the loss.
She found herself in a relationship with abortion after returning to Dallas. If the technician knew that she traveled out of state to get an abortion, could she be reported? “You don’t know where anybody stands, so it feels like we’re all kind of talking in code,” Miller says.
It’s been nearly five months since Lauren Miller traveled from Texas to Colorado for her abortion. She’s been taking care of her one year old and getting ready for the new baby, in between which she’s been processing all of it.
“The amount of stress we’ve had to go through has been so overwhelming, that I’ve been so angry,” she says. Additional costs were also added. She estimates it cost more than $3,000 for her to travel to Colorado for the abortion – she’s acutely aware that most people can’t drop that much money on short notice.
Do doctors have the right to speak freely? An advocate for abortion bans in the u.s., according to Webber and Sepper
Diane Webber edited the audio and digital versions of this story. As a visual designer and developer, she worked with a lot of different people. Elena Burnett was the audio producer.
Elizabeth Sepper is the professor of law at University of Texas at Austin and she explained that the first amendment protects free speech. “Physicians have independent speech rights, to speak to their patients openly,” she says. “Physicians should not be scared to say the ‘a-word.’”
Lauren Miller’s OB- GYN asked NPR not to use her name because she is not authorized by her employer to speak with the media.
Sepper argues many doctors and hospital systems are overreading the Texas abortion bans, and should consider the ethical and professional obligations to give patients complete information about their diagnoses and options. “Providing information, even providing referrals, is not within the terms of SB8 or the criminal bans,” she says. She says doctors are afraid of being sued and won’t talk about abortion.
There is an exception in Texas law that allows abortion when a woman’s life or a “major bodily function” is in imminent danger. But it’s not uncommon for there to be pregnancy complications — like Lauren Miller’s — where many doctors would consider it to be the standard of care to offer abortion as an option. It’s the kind of circumstances in which physicians don’t feel they can be completely honest about their patient’s choices without facing a lawsuit.
Even though the doctor is careful not to write things down, she is still vulnerable because of the frank discussions with her patients about abortion out-of-state. “I am putting myself out there,” she says. “If a patient’s grandmother and or partner or sister finds out that I’ve talked to them about an abortion, and that’s something that really, really upsets them, all they have to do is find a lawyer and all of a sudden I’m ‘aiding and abetting’ someone into an abortion.”
It’s not clear whether doctors can openly counsel their patients without violating the law. “The law’s vague – it’s really poorly written, probably on purpose,” says Palmer, adding, “Nobody wants to be defendant number one on this.”
Source: https://www.npr.org/sections/health-shots/2023/03/01/1158364163/3-abortion-bans-in-texas-leave-doctors-talking-in-code-to-pregnant-patients
Telling Texas Pregnant Physicians About Abortion Laws, and Telling People Not to Go Out-of-State
“Those restrictive laws are increasing complex abortion care because people come later, and abortions later in gestation are more complicated,” Espey explains. One of the drivers of those delays is people having no idea that there are options out-of-state, she adds.
She recalls one Texas patient whose fetus had acrania, where the fetus has no skull. It’s a very serious condition for the fetus. The doctor didn’t tell her to go out-of-state. “She was an immigrant. It took her six weeks to figure out how she could get the money to go to New Mexico for an abortion.
The patient was bleeding so much that he needed a hysterectomy. “This is a patient who — if she had been able to have that pregnancy termination at 11 or 12 weeks — very likely would not have lost her uterus the way she did when she was 16 to 17 weeks,” says Espey.
One strange aspect of all this, Espey notes, is that pregnant women in Texas still have access to many genetic testing options, available as early as 10 weeks of pregnancy, and very little ability to act on that information.
Palmer, the doctor in Fort Worth, agrees. “We are asking questions that we can only provide limited resources for the answer,” she says. “And it is really frustrating as a physician to not be able to provide full care for patients.”
In order to inquire about Texas’s abortion laws, NPR asked five Republican lawmakers, but they didn’t reply. The attorney general’s office did not respond to NPR’s request about how the state plans to enforce Texas’s abortion laws.
Source: https://www.npr.org/sections/health-shots/2023/03/01/1158364163/3-abortion-bans-in-texas-leave-doctors-talking-in-code-to-pregnant-patients
Is abortion still illegal in the state? A comment on “Texas left doctors talking in code to pregnant patients” by C.E. Steinhauser
Steinhauser says that he doesn’t hear much about it in the capital. “I think that you’re probably not going to see a lot of change in the session this year. “
Although Texas Republicans did well in the last election, they did not want to bring up abortion again since the state’s restrictions on abortion took effect. He says that the Republican legislators realized they weren’t punished for passing the bills at the ballot box. Is there an incentive to do anything different?
O’Donnell of Texas Alliance for Life, one of the the groups in the state that lobbies for abortion restrictions Her group is not advocating for more restrictions at the moment. The medical emergency exception currently in the law is “adequate” since it maintains pro-life gains, she says. She pointed out that the goal of her group is to make abortion not only illegal in the state, but unthinkable.
Source: https://www.npr.org/sections/health-shots/2023/03/01/1158364163/3-abortion-bans-in-texas-leave-doctors-talking-in-code-to-pregnant-patients
Where are we going? The Mom of an 82-year-old and the father of a two-born baby: Where do we go? What can we do?
She says that they would have been able to give the information freely. What do we actually need would not become a whole process of just trying to get information. Where are we going?
She’s been processing her experience, in between caring for her 1-year-old and preparing for the arrival of her baby at the end of March. She says she’s civically engaged. “If something happens, I have to stay informed, I have to call a member of Congress, and I have to send a letter to the council.”