Texas’ abortion ban has OB-GYNs working in an environment of ‘extreme fear’

Fearful, frustrated, and angry – that’s how five doctors who provide reproductive health care in Texas feel. 

They told Courier Texas that they are trying to provide the best and safest care to their pregnant patients while abiding by the state’s extreme abortion ban; following the Supreme Court’s decision to overturn Roe v. Wade in 2022, Texas’ trigger law began prohibiting most abortions. The law threatens doctors who perform abortions with fees, medical license loss, and jail. 

These doctors can also be scrutinized by any member of the public who can make a verifiable claim that a doctor performed an illegal abortion under the Texas Heartbeat Act. The law outlaws abortion after a fetal heartbeat is detected, which usually happens at around six weeks gestation. Doctors can be sued civilly for violating this law.  

Despite these threatened punishments, every doctor who spoke with Courier Texas said that they are committed to staying in Texas for now even as they watch multiple colleagues retire or leave to practice in other states without abortion bans.

Abortion bans are killing women

Since these bans were implemented, several women — Porsha Negumezi, Josseli Barnica and Nevaeh Crain — have died due to miscarriage complications in the state.

”These abortion bans are truly killing people and have caused so much fear and hesitation in physicians, that women’s lives are being lost,” Dallas OBYN Dr. Austin Dennard said.

“I feel in my heart that these laws [have] greatly influenced any kind of decision-making and thinking around these cases,” Dr. Todd Ivey, a Houston based OB-GYN said. “It’s absolutely gut-wrenching.”

Yet the vast majority of the over 6 million Texas women and teen girls of reproductive age may not be aware that the state’s abortion bans mean they could be in danger if they become pregnant in the state.

The data itself serves as a warning. From 2019 to 2022, the rate of maternal mortality cases in Texas rose by 56%. Nationwide in that time frame, the figure was just 11%, according to the Gender Equity Policy Institute. 

Doctors are working in “an environment of extreme fear,” Dr. Ivey said. “You’ve [the Republican-controlled state legislature] created a climate where physicians feel like they cannot practice medicine safely.” 

The unintended consequences of these bans, according to the doctors who spoke with Courier Texas, are that doctors can’t intervene promptly to treat potentially deadly pregnancy complications as they would have done before the bans were put in place. Take the treatment of “incomplete miscarriages” for example. This is when the remains of a fetus haven’t totally passed on their own. In these cases, doctors are tasked with evacuating the rest of the remains, or the “products of conception” in order to stave off infection and bleeding. 

Dr. Ivey said that he’s been in several situations where he wanted to proceed with treatment for a pregnant patient experiencing a complication only to be instructed to stand down by hospital administrators based on legal advice.

“People will step in and say, ‘No, you can’t do that,’” he said. 

He said only when a situation reaches a certain, dire point will treatment be allowed.

“The sad part for me is that the patient is being taken out of this, so all of the decisions are being made by politicians and physicians and hospital administrators and attorneys,” Dr. Ivey said. “The patient really hasn’t been considered very much in this.”

One pregnant miscarrying woman he treated, who realized that her health was endangered, begged Dr. Ivey to end her pregnancy. Because her fetus still had a heartbeat, he said, he was forced to tell her he couldn’t perform the needed treatment. Only when her water broke and she developed an infection in her uterus was he allowed to save her.

According to Dr. Ivey, a Republican lawmaker in the state actually told him that the stories of women dying, losing their fertility, or nearly dying because of doctors’ fears of violating the abortion ban “aren’t real.”

“We don’t have to make up stories,” Dr. Ivey said. “This is what we face all the time.”

Dr. Dennard also pushed back at anti-abortion activists and Republican state legislators who insist that Texas doctors are responsible for women’s deaths because they are misinterpreting the abortion bans’ language. 

“They want to just point the fingers at doctors,” she said. ”We’re doing the best we can with our backs against the wall, being forced to make these difficult decisions in such critical circumstances with everything on the line.”

Dr. Ivey agreed. 

“They say, ‘You can use your reasonable medical judgement to make a decision [about a pregnant woman’s care] but then if we don’t recognize your judgment as reasonable medical judgement, we’re going to come after you,’” he said. “How is a provider supposed to feel comfortable in those situations?”

Working in a climate of fear

Texas Attorney General Ken Paxton has been aggressive about enforcing the state’s abortion bans and has threatened doctors and hospitals with prosecution if they provided Texas mom Kate Cox with an abortion. 

In 2023, Cox learned her fetus had a fatal condition and was denied care in her home state because of the ban in place, forcing her to flee to another state for emergency abortion care.

Paxton was specifically mentioned as a source of fear among the doctors and their colleagues who are still ending women’s pregnancies when legally allowed. 

But Dr. Nancy Binford, an Austin-based OB-YN, who stopped doing deliveries after the state’s initial 2021 ‘heartbeat’ ban went into effect, said that Paxton is “completely unwilling to say that this [obstetrics] is an area that he doesn’t understand.” 

“He’s completely ignorant about how fast things can turn,” she said. “He doesn’t realize what it can be like with the volume of bleeding that you can see.” 

Dr. Binford said the Heartbeat Act was “the last straw” for her. 

“I couldn’t practice the full scope of my work as an OB-GYN…I felt too ineffective and that anxiety led me to make the decision to quit [performing deliveries],” she said.

OB-GYNS leaving the state

Quitting Texas is exactly what many of the state’s OB-GYNs are already doing. Every doctor interviewed knew colleagues who had left the state or are in the process of leaving.

“Fear is a topic of discussion every time we get together…that’s really no way to practice,” Dr. Emily Briggs, a family doctor who practices obstetrics, said. “Those of us who have stayed behind are here because we care so deeply about our patients…but there will come a point where it’s akin to being in an abusive relationship. If you can get out, you should get out.”

Dr. Nicole Moretti, an Austin OB-GYN, has three colleagues who have fled to non-abortion ban states in the past year.

”They just felt they couldn’t work under these conditions anymore,” she said. 

What makes the situation even worse for Texas women — who need all kinds of reproductive health care including annual screenings for breast and cervical cancer — is that as experienced OB-GYNs are packing up, far fewer medical students say they plan to stay in the state when they finish their training.

“When I talk to medical students and residents, they voice their concerns about staying,” Dr. Ivey said. 

According to a study published in October by Manatt Health, a health care consulting firm, 29% of current resident physicians are planning to leave Texas when their programs end and that abortion laws are playing an outsized role in their decision-making. 

That same study found that 23% of Texas’ “experienced” OB-GYNs have already left or are planning to leave, and that 13% plan to retire early, and 7% are quitting obstetrics or leaving medicine altogether. That’s almost half of the state’s OB-GYNs. 

“We have people literally choosing not to learn how to practice medicine in Texas, which means they’re not going to start their practice once they get out of residency in Texas,” Dr. Briggs said.

This story was originally published by Courier Texas.